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Tweet MS, Pellikka PA, Gulati R, Gochanour BR, Barrett-O'Keefe Z, Raphael CE, Best PJM, Hayes SN. Coronary Artery Tortuosity and Spontaneous Coronary Artery Dissection: Association With Echocardiography and Global Longitudinal Strain, Fibromuscular Dysplasia, and Outcomes. J Am Soc Echocardiogr 2024; 37:518-529. [PMID: 38467311 DOI: 10.1016/j.echo.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The etiology and significance of coronary artery tortuosity (TCA) among patients with spontaneous coronary artery dissection (SCAD) are unknown. The aim of this prospective imaging cohort study was to report echocardiographic findings and evaluate whether TCA correlates with cardiac anatomy and function among patients with SCAD. Comorbidities including fibromuscular dysplasia (FMD) and outcomes were also assessed. METHODS TCA was determined on coronary angiography performed during the diagnosis of SCAD, and cardiac structure and function were evaluated using prospective comprehensive echocardiography. RESULTS Among 116 patients with SCAD, the mean age at echocardiography was 50.8 ± 8.8 years, a median of 10.9 months after SCAD. Sixty-two patients (53.4%) had FMD, 41 (35.3%) had histories of hypertension, and 17 (14.8%) were hypertensive during echocardiography. Most patients (n = 78 [69%]) had normal left ventricular geometry with normal median ejection fraction (61%; interquartile range, 56% to 64%) and normal global longitudinal strain (-22.2%; interquartile range, -24.0% to -19.9%). Fifteen patients (13.4%) had diastolic dysfunction that was associated with hypertension at the time of echocardiography. Patients with TCA (n = 96 [82.8%]) were older (mean age, 52.1 ± 8.0 vs 44.7 ± 9.9 years; P < .001) with a higher prevalence of FMD (59.4% vs 25%, P = .007) but a similar prevalence of hypertension (35% vs 35%, P > .99) compared with patients without TCA. Across the age range (31.5 to 66.9 years), each decade of age was associated with an approximately 0.89-unit increase in coronary tortuosity score (P < .0001). Echocardiographic parameters were not significantly different between the two groups. Median follow-up duration was 4.4 years (95% CI, 3.8 to 5.2 years). The Kaplan-Meier 3-year SCAD recurrence rate was 9.4% (95% CI, 3.7% to 14.8%). There were no deaths. CONCLUSIONS The majority of patients with SCAD had normal or near normal echocardiographic results, including global longitudinal strain, with no differences according to TCA. However, patients with SCAD with TCA were older, with a higher prevalence of FMD.
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Affiliation(s)
- Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Benjamin R Gochanour
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Zachary Barrett-O'Keefe
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Patricia J M Best
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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Kanaji Y, Ahmad A, Sara JDS, Ozcan I, Akhiyat N, Prasad A, Raphael CE, Kakuta T, Lerman LO, Lerman A. Coronary Vasomotor Dysfunction Is Associated With Cardiovascular Events in Patients With Nonobstructive Coronary Artery Disease. JACC Cardiovasc Interv 2024; 17:474-487. [PMID: 38418053 DOI: 10.1016/j.jcin.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Coronary vasomotor dysfunction (CVDys) can be comprehensively classified on the basis of anatomy and functional mechanisms. OBJECTIVES The aim of this study was to evaluate the association between different CVDys phenotypes and outcomes in patients with angina and nonobstructive coronary artery disease (ANOCA). METHODS Patients with ANOCA who underwent coronary reactivity testing using an intracoronary Doppler guidewire to assess microvascular and epicardial coronary endothelium-dependent and endothelium-independent function were enrolled. Endothelium-dependent microvascular and epicardial coronary dysfunction were defined as a <50% change in coronary blood flow in response to intracoronary acetylcholine (Ach) infusion and a <-20% change in coronary artery diameter in response to Ach. Endothelium-independent microvascular and epicardial coronary dysfunction were defined as coronary flow reserve < 2.5 during adenosine-induced hyperemia and change in cross-sectional area in response to intracoronary nitroglycerin administration < 20%. Major adverse cardiac and cerebrovascular events (cardiovascular death, nonfatal MI, heart failure, stroke, and late revascularization) served as clinical outcomes. RESULTS Among the 1,196 patients with ANOCA, the prevalence of CVDys was 24.5% and 51.8% among those with endothelium-independent and endothelium-dependent microvascular dysfunction, respectively, and 47.4% and 25.4% among those with endothelium-independent and endothelium-dependent epicardial coronary dysfunction, respectively. During 6.3 years (Q1-Q3: 2.5-12.9 years) of follow-up, patients with endothelium-dependent microvascular dysfunction, endothelium-dependent epicardial coronary dysfunction, or endothelium-independent microvascular dysfunction showed significantly higher event rates compared with those without (19.5% vs 12.0% [P < 0.001], 19.7% vs 14.6% [P = 0.038] and 22.2% vs 13.8% [P = 0.001], respectively). Coronary flow reserve (HR: 0.757; 95% CI: 0.604-0.957) and percentage change in coronary blood flow in response to Ach infusion (HR: 0.998; 95% CI: 0.996-0.999) remained significant predictors of major adverse cardiac and cerebrovascular event after adjustment for conventional risk factors. CONCLUSIONS CVDys phenotype is differentially associated with worse outcomes, and endothelium-dependent and endothelium-independent microvascular function provide independent prognostic information in patients with ANOCA.
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Affiliation(s)
- Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ilke Ozcan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nadia Akhiyat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Breen TJ, Raphael CE, Ingraham B, Lane C, Huxley S, Roger VL, Jaffe A, Lewis B, Sandoval YB, Prasad A, Rihal CS, Gulati R, Singh M. Incidence and outcomes of high bleeding risk patients with type 1 and type 2 myocardial infarction in a community-based cohort: Application of the Academic Research Consortium High Bleeding Risk Criteria. Int J Cardiol 2024; 396:131565. [PMID: 37913957 PMCID: PMC10841724 DOI: 10.1016/j.ijcard.2023.131565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/29/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND AIMS The incidence and outcomes of high bleeding risk (HBR) patients in a community cohort according to the Academic Research Consortium (ARC) criteria is not known. We hypothesized that HBR is common and associated with worse outcomes for all-comers with myocardial infarction. METHODS We prospectively collected all patients with cardiac troponin T > 99th percentile upper limit of normal (≥0.01 ng/mL) in Olmsted County between 2003 and 2012. Events were retrospectively classified as type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI), or myocardial injury. Patients were further classified as HBR based on the "ARC-HBR definition." Outcomes included all-cause mortality, cardiovascular mortality, recurrent MI, stroke, and major bleeding. RESULTS 2419 patients were included in the final study; 1365 were classified as T1MI and 1054 as T2MI. Patients were followed for a median of 5.5 years. ARC-HBR was more common in T2MI than T1MI (73% vs 46%, p < 0.001). Among patients with T1MI, HBR was associated with higher all-cause mortality (HR 3.7, 95% CI 3.2-4.5, p < 0.001), cardiovascular mortality (4.7, 3.6-6.3, p < 0.001), recurrent MI (2.1, 1.6-2.7, p < 0.001), stroke (4.9, 2.9-8.4, p < 0.001), and major bleeding (6.5, 3.7-11.4, p < 0.001). For T2MI, HBR was similarly associated with higher all-cause mortality (HR 2.1, 95% CI 1.8-2.5, p < 0.001), cardiovascular mortality (2.7, 1.8-4.0, p < 0.001), recurrent MI (1.7, 1.1-2.6, p = 0.02) and major bleeding (HR 15.6, 3.8-63.8, p < 0.001). CONCLUSION HBR is common among unselected patients with T1MI and T2MI and is associated with increased overall and cardiovascular mortality, recurrent cardiovascular events, and major bleeding on long-term follow up.
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Affiliation(s)
- Thomas J Breen
- Department of Cardiovascular Medicine, Yale University, 20 York Street, New Haven, CT 06510, United States of America.
| | - Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Brenden Ingraham
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Conor Lane
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Sam Huxley
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Veronique L Roger
- Division of Intramural Research, National Heart Lung and Blood Institute, Bethesda, MD 20814, United States of America
| | - Allan Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Bradley Lewis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Yader B Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
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4
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Yaker ZS, Lincoff AM, Cho L, Ellis SG, Ziada KM, Zieminski JJ, Gulati R, Gersh BJ, Holmes D, Raphael CE. Coronary spasm and vasomotor dysfunction as a cause of MINOCA. EUROINTERVENTION 2024; 20:e123-e134. [PMID: 38224252 PMCID: PMC10786177 DOI: 10.4244/eij-d-23-00448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/15/2023] [Indexed: 01/16/2024]
Abstract
Increasing evidence has shown that coronary spasm and vasomotor dysfunction may be the underlying cause in more than half of myocardial infarctions with non-obstructive coronary arteries (MINOCA) as well as an important cause of chronic chest pain in the outpatient setting. We review the contemporary understanding of coronary spasm and related vasomotor dysfunction of the coronary arteries, the pathophysiology and prognosis, and current and emerging approaches to diagnosis and evidence-based treatment.
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Affiliation(s)
- Zachary S Yaker
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Leslie Cho
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - David Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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5
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Curran L, de Marvao A, Inglese P, McGurk KA, Schiratti PR, Clement A, Zheng SL, Li S, Pua CJ, Shah M, Jafari M, Theotokis P, Buchan RJ, Jurgens SJ, Raphael CE, Baksi AJ, Pantazis A, Halliday BP, Pennell DJ, Bai W, Chin CW, Tadros R, Bezzina CR, Watkins H, Cook SA, Prasad SK, Ware JS, O’Regan DP. Genotype-Phenotype Taxonomy of Hypertrophic Cardiomyopathy. Circ Genom Precis Med 2023; 16:e004200. [PMID: 38014537 PMCID: PMC10729901 DOI: 10.1161/circgen.123.004200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is an important cause of sudden cardiac death associated with heterogeneous phenotypes, but there is no systematic framework for classifying morphology or assessing associated risks. Here, we quantitatively survey genotype-phenotype associations in HCM to derive a data-driven taxonomy of disease expression. METHODS We enrolled 436 patients with HCM (median age, 60 years; 28.8% women) with clinical, genetic, and imaging data. An independent cohort of 60 patients with HCM from Singapore (median age, 59 years; 11% women) and a reference population from the UK Biobank (n=16 691; mean age, 55 years; 52.5% women) were also recruited. We used machine learning to analyze the 3-dimensional structure of the left ventricle from cardiac magnetic resonance imaging and build a tree-based classification of HCM phenotypes. Genotype and mortality risk distributions were projected on the tree. RESULTS Carriers of pathogenic or likely pathogenic variants for HCM had lower left ventricular mass, but greater basal septal hypertrophy, with reduced life span (mean follow-up, 9.9 years) compared with genotype negative individuals (hazard ratio, 2.66 [95% CI, 1.42-4.96]; P<0.002). Four main phenotypic branches were identified using unsupervised learning of 3-dimensional shape: (1) nonsarcomeric hypertrophy with coexisting hypertension; (2) diffuse and basal asymmetrical hypertrophy associated with outflow tract obstruction; (3) isolated basal hypertrophy; and (4) milder nonobstructive hypertrophy enriched for familial sarcomeric HCM (odds ratio for pathogenic or likely pathogenic variants, 2.18 [95% CI, 1.93-2.28]; P=0.0001). Polygenic risk for HCM was also associated with different patterns and degrees of disease expression. The model was generalizable to an independent cohort (trustworthiness, M1: 0.86-0.88). CONCLUSIONS We report a data-driven taxonomy of HCM for identifying groups of patients with similar morphology while preserving a continuum of disease severity, genetic risk, and outcomes. This approach will be of value in understanding the causes and consequences of disease diversity.
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Affiliation(s)
- Lara Curran
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
| | - Antonio de Marvao
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
- Department of Women and Children’s Health (A.d.M.)
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular & Metabolic Medicine and Sciences, King’s College London, United Kingdom (A.d.M.)
| | - Paolo Inglese
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Kathryn A. McGurk
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Pierre-Raphaël Schiratti
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Adam Clement
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Sean L. Zheng
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Surui Li
- Biomedical Image Analysis Group, Department of Computing (S.L., W.B.)
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Chee Jian Pua
- National Heart Research Institute Singapore, Singapore, PRC (C.J.P., C.W.L.C., S.A.C.)
| | - Mit Shah
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Mina Jafari
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Biomedical Image Analysis Group, Department of Computing (S.L., W.B.)
- Department of Brain Sciences, Imperial College London, London, United Kingdom (W.B.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
- Department of Women and Children’s Health (A.d.M.)
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular & Metabolic Medicine and Sciences, King’s College London, United Kingdom (A.d.M.)
- National Heart Research Institute Singapore, Singapore, PRC (C.J.P., C.W.L.C., S.A.C.)
- Department of Cardiology, National Heart Center Singapore, Singapore, PRC (C.W.L.C.)
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore (C.W.L.C.)
- Mayo Clinic Rochester, MN (C.E.R.)
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (S.J.J., C.R.B.)
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.J.J.)
- Cardiovascular Genetics Centre, Montreal Heart Institute (R.T.)
- Faculty of Medicine, Université de Montréal, QC, Canada (R.T.)
- Radcliffe Department of Medicine, University of Oxford, United Kingdom (H.W.)
| | - Pantazis Theotokis
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Rachel J. Buchan
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Sean J. Jurgens
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (S.J.J., C.R.B.)
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.J.J.)
| | - Claire E. Raphael
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Mayo Clinic Rochester, MN (C.E.R.)
| | - Arun John Baksi
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
| | - Antonis Pantazis
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
| | - Brian P. Halliday
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
| | - Dudley J. Pennell
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
| | - Wenjia Bai
- Biomedical Image Analysis Group, Department of Computing (S.L., W.B.)
- Department of Brain Sciences, Imperial College London, London, United Kingdom (W.B.)
| | - Calvin W.L. Chin
- National Heart Research Institute Singapore, Singapore, PRC (C.J.P., C.W.L.C., S.A.C.)
- Department of Cardiology, National Heart Center Singapore, Singapore, PRC (C.W.L.C.)
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore (C.W.L.C.)
| | - Rafik Tadros
- Cardiovascular Genetics Centre, Montreal Heart Institute (R.T.)
- Faculty of Medicine, Université de Montréal, QC, Canada (R.T.)
| | - Connie R. Bezzina
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (S.J.J., C.R.B.)
| | - Hugh Watkins
- Radcliffe Department of Medicine, University of Oxford, United Kingdom (H.W.)
| | - Stuart A. Cook
- Department of Women and Children’s Health (A.d.M.)
- National Heart Research Institute Singapore, Singapore, PRC (C.J.P., C.W.L.C., S.A.C.)
| | - Sanjay K. Prasad
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
| | - James S. Ware
- National Heart and Lung Institute (L.C., K.A.M., S.L.Z., P.T., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust (L.C., R.J.B., C.E.R., A.J.B., A.P., B.P.H., D.J.P., S.K.P., J.S.W.)
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
| | - Declan P. O’Regan
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, United Kingdom (A.d.M., P.I., K.A.M., P.-R.S., A.C., S.L.Z., S.L., M.S., M.J., P.T., R.J.B., S.A.C., J.S.W., D.P.O.)
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6
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Kumar A, Ogunnowo GO, Khot UN, Raphael CE, Ghobrial J, Rampersad P, Puri R, Khatri JJ, Reed GW, Krishnaswamy A, Cho L, Lincoff AM, Ziada KM, Kapadia SR, Ellis SG. Interaction Between Race and Income on Cardiac Outcomes After Percutaneous Coronary Intervention. J Am Heart Assoc 2022; 11:e026676. [DOI: 10.1161/jaha.122.026676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background
Compared with White Americans, Black Americans have a greater prevalence of cardiac events following percutaneous coronary intervention. We evaluated the association between race and neighborhood income on post–percutaneous coronary intervention cardiac events and assessed whether income modifies the effect of race on this relationship.
Methods and Results
Consecutive patients (n=23 822) treated with percutaneous coronary intervention from January 1, 2000, to December 31, 2016, were included. All‐cause mortality and major adverse cardiac event were assessed at 3 years. Extended 10‐year follow‐up was performed for those residing locally (n=1285). Neighborhood income was derived using median adjusted annual gross household income reported within the patient's zip code. We compared differences in treatment and outcomes, adjusting for race, income, and their interaction. In total, 3173 (13.3%) patients self‐identified as Black Americans, and 20 649 (86.7%) self‐identified as White Americans. Black Americans had a worse baseline cardiac risk profile and lower neighborhood income compared with White Americans. Although risk profile improved with increasing income in White Americans, no difference was observed across incomes among Black Americans. Despite similar long‐term outpatient cardiology follow‐up and medication prescription, risk profiles among Black Americans remained worse. At 3 years, unadjusted all‐cause mortality (18.0% versus 15.2%;
P
<0.001) and major adverse cardiac event (37.3% versus 34.6%;
P
<0.001) were greater among Black Americans and with lower income (both
P
<0.001); race, income, and their interaction were not significant predictors in multivariable models. At 10‐year follow‐up, increasing income was associated with improved outcomes only in White Americans but not Black Americans. In multivariable models for major adverse cardiac event, income (hazard ratio [HR], 0.97 [95% CI, 0.96–0.98];
P
=0.005), Black race (HR, 1.77 [95% CI, 1.58–1.96];
P
=0.006), and their interaction (HR, 0.98 [95% CI, 0.97–0.99];
P
=0.003) were significant predictors. Similar findings were observed for cardiac death.
Conclusions
Early 3‐year post–percutaneous coronary intervention outcomes were driven by worse risk factor profiles in both Black Americans and those with lower neighborhood income. However, late 10‐year outcomes showed an independent effect of race and income, with improving outcomes with greater income limited to White Americans. These findings illustrate the importance of developing novel care strategies that address both risk factor modification and social determinants of health to mitigate disparities in cardiac outcomes.
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Affiliation(s)
- Anirudh Kumar
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | | | - Umesh N. Khot
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Claire E. Raphael
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Joanna Ghobrial
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | | | - Rishi Puri
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | | | - Grant W. Reed
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Amar Krishnaswamy
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Leslie Cho
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | | | - Khaled M. Ziada
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Samir R. Kapadia
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Stephen G. Ellis
- Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
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7
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Raphael CE, O'Kane PD, Johnson TW, Prasad A, Gulati R, Sandoval Y, Di Mario C, Holmes DR. Evolution of the Crush Technique for Bifurcation Stenting. JACC Cardiovasc Interv 2021; 14:2315-2326. [PMID: 34736729 DOI: 10.1016/j.jcin.2021.08.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 01/01/2023]
Abstract
Bifurcation lesions are frequently encountered, associated with greater procedural complexity and consequently are at higher risk for restenosis and stent thrombosis. Early trials in bifurcation percutaneous coronary intervention favored a provisional stenting approach, but contemporary randomized trials have highlighted potentially superior outcomes using a double-kiss crush technique in unprotected distal left main stem bifurcation lesions. Although the evidence is greatest for double-kiss crush, many operators favor a mini-crush or nano-crush single-kiss approach. In this review, the authors describe the iterations of the crush technique and the evidence for each and review general principles for bifurcation percutaneous coronary intervention.
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Affiliation(s)
- Claire E Raphael
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter D O'Kane
- Department of Cardiology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Thomas W Johnson
- Department of Cardiology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlo Di Mario
- Department of Cardiology, University Hospital Careggi, Florence, Italy
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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8
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Raphael CE, Roger VL, Sandoval Y, Johnson M, Jaffe A, Lerman A, Rihal CS, Bell MR, Singh M, Gulati R. Causes of Death After Type 2 Myocardial Infarction and Myocardial Injury. J Am Coll Cardiol 2021; 78:415-416. [PMID: 34294275 PMCID: PMC10440997 DOI: 10.1016/j.jacc.2021.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/25/2022]
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9
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Raphael CE, Mitchell F, Kanaganayagam GS, Liew AC, Di Pietro E, Vieira MS, Kanapeckaite L, Newsome S, Gregson J, Owen R, Hsu LY, Vassiliou V, Cooper R, Mrcp AA, Ismail TF, Wong B, Sun K, Gatehouse P, Firmin D, Cook S, Frenneaux M, Arai A, O'Hanlon R, Pennell DJ, Prasad SK. Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy: the role of myocardial replacement fibrosis and the microcirculation. J Cardiovasc Magn Reson 2021; 23:26. [PMID: 33685501 PMCID: PMC7941878 DOI: 10.1186/s12968-021-00720-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/10/2020] [Accepted: 01/31/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational cohort study. METHODS Serial patients with HCM underwent CMR, including adenosine first-pass perfusion, left atrial (LA) and left ventricular (LV) volumes indexed to body surface area (i) and late gadolinium enhancement (%LGE- as a % of total myocardial mass). We used a composite endpoint of HF death, cardiac transplantation, and progression to NYHA class III/IV. RESULTS A total of 543 patients with HCM underwent CMR, of whom 94 met the composite endpoint at baseline. The remaining 449 patients were followed for a median of 5.6 years. Thirty nine patients (8.7%) reached the composite endpoint of HF death (n = 7), cardiac transplantation (n = 2) and progression to NYHA class III/IV (n = 20). The annual incidence of HF was 2.0 per 100 person-years, 95% CI (1.6-2.6). Age, previous non-sustained ventricular tachycardia, LV end-systolic volume indexed to body surface area (LVESVI), LA volume index ; LV ejection fraction, %LGE and presence of mitral regurgitation were significant univariable predictors of HF, with LVESVI (Hazard ratio (HR) 1.44, 95% confidence interval (95% CI) 1.16-1.78, p = 0.001), %LGE per 10% (HR 1.44, 95%CI 1.14-1.82, p = 0.002) age (HR 1.37, 95% CI 1.06-1.77, p = 0.02) and mitral regurgitation (HR 2.6, p = 0.02) remaining independently predictive on multivariable analysis. The presence or extent of inducible perfusion defect assessed using a visual score did not predict outcome (p = 0.16, p = 0.27 respectively). DISCUSSION The annual incidence of HF in a contemporary ambulatory HCM population undergoing CMR is low. Myocardial fibrosis and LVESVI are strongly predictive of future HF, however CMR visual assessment of myocardial perfusion was not.
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Affiliation(s)
- Claire E Raphael
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
- Department of CMR, Royal Brompton Hospital, Sydney Street, Sydney, SW3 6NP, UK.
| | - Frances Mitchell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | | | - Alphonsus C Liew
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Elisa Di Pietro
- Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Miguel Silva Vieira
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Lina Kanapeckaite
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Simon Newsome
- London School of Hygiene & Tropical Medicine, London, UK
| | - John Gregson
- London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Owen
- London School of Hygiene & Tropical Medicine, London, UK
| | - Li-Yueh Hsu
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Vassilis Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Robert Cooper
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Aamir Ali Mrcp
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Tevfik F Ismail
- King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Brandon Wong
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Kristi Sun
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Peter Gatehouse
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - David Firmin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Stuart Cook
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
- National Heart Center, Singapore, Singapore
| | | | - Andrew Arai
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Dudley J Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Sanjay K Prasad
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
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10
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Raphael CE, O'Kane PD. Contemporary approaches to bifurcation stenting. JRSM Cardiovasc Dis 2021; 10:2048004021992190. [PMID: 33717470 PMCID: PMC7917419 DOI: 10.1177/2048004021992190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
Bifurcation lesions are common and associated with higher risks of major cardiac events and restenosis after percutaneous coronary intervention (PCI). Treatment requires understanding of lesion characteristics, stent design and therapeutic options. We review the evidence for provisional vs 2-stent techniques. We conclude that provisional stenting is suitable for most bifurcation lesions. We detail situations where a 2-stent technique should be considered and the steps for performing each of the 2-step techniques. We review the importance of lesion preparation, intracoronary imaging, proximal optimization (POT) and kissing balloon inflation.
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11
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Kronzer VL, Tarabochia AD, Lobo Romero AS, Tan NY, O'Byrne TJ, Crowson CS, Turley TN, Myasoedova E, Davis JM, Raphael CE, Gulati R, Hayes SN, Tweet MS. Lack of Association of Spontaneous Coronary Artery Dissection With Autoimmune Disease. J Am Coll Cardiol 2021; 76:2226-2234. [PMID: 33153582 DOI: 10.1016/j.jacc.2020.09.533] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Case reports and referral-based studies suggest spontaneous coronary artery dissection (SCAD) is associated with autoimmune diseases and causes 2% to 4% of acute coronary syndromes. OBJECTIVES This study determined the association of SCAD with autoimmune diseases, together with incidence and recurrence, in a population-based study. METHODS This case-control study took place from 1995 to 2018 within the Rochester Epidemiology Project. The study identified cases with SCAD from diagnosis codes and verified them using coronary angiography images, matching each case to 3 control subjects on age, sex, county, and years of medical history. Autoimmune disease history came from a validated, code-based definition. A multivariable logistic regression model calculated the odds ratio (OR) for SCAD among patients with a history of autoimmune disease, adjusting for race and body mass index. RESULTS The study identified 114 cases with SCAD (mean age 51 years and 90% women) and 342 matched control subjects. Autoimmune disease occurred in 13 (11%) cases with SCAD and 40 (12%) control subjects (p = 0.93). Even after adjustment, autoimmune diseases were not associated with SCAD (OR: 0.81; 95% confidence interval [CI]: 0.40 to 1.66). SCAD incidence between 2010 and 2018 (2.7 per 100,000; 95% CI: 1.7 to 3.7) was 10-fold higher than the incidence between 1995 and 2009 (0.3 per 100,000; 95% CI: 0.0 to 0.6). SCAD recurrence was 10% (95% CI: 3% to 16%) at 5 years. CONCLUSIONS These findings suggested SCAD pathogenesis is noninflammatory and screening for autoimmune diseases based on SCAD alone is not warranted. The code-based incidence of SCAD has increased over time, highlighting the importance of considering SCAD among patients with acute coronary syndromes.
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Affiliation(s)
- Vanessa L Kronzer
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Tamiel N Turley
- Molecular Pharmacology and Experimental Therapeutics Track, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota; Cardiovascular Genetics Research Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - John M Davis
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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12
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Raphael CE, Liew AC, Mitchell F, Kanaganayagam GS, Di Pietro E, Newsome S, Owen R, Gregson J, Cooper R, Amin FR, Gatehouse P, Vassiliou V, Ernst S, O'Hanlon R, Frenneaux M, Pennell DJ, Prasad SK. Predictors and Mechanisms of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2020; 136:140-148. [PMID: 32950468 DOI: 10.1016/j.amjcard.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HC) is associated with significant symptomatic deterioration, heart failure, and thromboembolic disease. There is a need for better mechanistic insight and improved identification of at risk patients. We used cardiovascular magnetic resonance (CMR) to assess predictors of AF in HC, in particular the role of myocardial fibrosis. Consecutive patients with HC referred for CMR 2003 to 2013 were prospectively enrolled. CMR parameters including left ventricular volumes, presence and percentage of late gadolinium enhancement in the left ventricle (%LGE) and left atrial volume index (LAVi) were measured. Overall, 377 patients were recruited (age 62 ± 14 years, 73% men). Sixty-two patients (16%) developed new-onset AF during a median follow up of 4.5 (interquartile range 2.9 to 6.0) years. Multivariable analysis revealed %LGE (hazard ratio [HR] 1.3 per 10% (confidence interval: 1.0 to 1.5; p = 0.02), LAVi (HR 1.4 per 10 mL/m2[1.2 to 1.5; p < 0.001]), age at HC diagnosis, nonsustained ventricular tachycardia and diabetes to be independent predictors of AF. We constructed a simple risk prediction score for future AF based on the multivariable model with a Harrell's C-statistic of 0.73. In conclusion, the extent of ventricular fibrosis and LA volume independently predicted AF in patients with HC. This finding suggests a mechanistic relation between fibrosis and future AF in HC. CMR with quantification of fibrosis has incremental value over LV and LA measurements in risk stratification for AF. A risk prediction score may be used to identify patients at high risk of future AF who may benefit from more intensive rhythm monitoring and a lower threshold for oral anticoagulation.
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Affiliation(s)
- Claire E Raphael
- IHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Alphonsus C Liew
- IHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Frances Mitchell
- IHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | | | - Elisa Di Pietro
- IHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Simon Newsome
- Department of Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Owen
- Department of Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - John Gregson
- Department of Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Cooper
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Fouad R Amin
- Department of Cardiology, Frimley Park Hospital, Camberley, UK
| | - Peter Gatehouse
- IHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | | | - Sabine Ernst
- IHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Rory O'Hanlon
- IHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | | | - Dudley J Pennell
- IHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Sanjay K Prasad
- IHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
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13
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Vallabhajosyula S, Kanwar S, Aung H, Cheungpasitporn W, Raphael CE, Gulati R, Singh M. Temporal Trends and Outcomes of Left Ventricular Aneurysm After Acute Myocardial Infarction. Am J Cardiol 2020; 133:32-38. [PMID: 32807388 DOI: 10.1016/j.amjcard.2020.07.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 01/20/2023]
Abstract
There are limited data on the prevalence and an outcome of left ventricular (LV) aneurysms following acute myocardial infarction (AMI). Using the National Inpatient Sample during 2000 to 2017, a retrospective cohort of AMI admissions was evaluated for LV aneurysms. Complications included ventricular arrhythmias, mechanical, cardiac arrest, pump failure, LV thrombus, and stroke. Outcomes of interest included in-hospital mortality, temporal trends, complications, hospitalization costs, and length of stay. A total 11,622,528 AMI admissions, with 17,626 (0.2%) having LV aneurysms were included. The LV aneurysm cohort was more often female, with higher comorbidity, and admitted to large urban hospitals (all p < 0.001). In 2017, compared with 2000, there was a slight increase in LV aneurysms prevalence in those with (adjusted odds ratio [aOR] 1.57 [95% confidence interval {CI} 1.41 to 1.76]) and without (aOR 1.13 [95% CI 1.00 to .127]) ST-segment-elevation AMI (p < 0.001 for trend). LV aneurysms were more commonly noted with anterior ST-segment-elevation AMI (31%) compared with inferior (12.3%) and other (7.9%). Ventricular arrhythmias (17.6% vs 8.0%), mechanical complications (2.6% vs 0.2%), cardiac arrest (7.1% vs 5.0%), pump failure (26.3% vs 16.1%), cardiogenic shock (10.0% vs 4.8%) were more common in the LV aneurysm cohort (all p < 0.001). Those with LV aneurysms had comparable in-hospital mortality compared with those without (7.4% vs 6.2%; aOR 1.02 [95% CI 0.90 to 1.14]; p = 0.43). The LV aneurysm cohort had longer length of hospital stay, higher hospitalization costs, and fewer discharges to home. In conclusion, LV aneurysms were associated with higher morbidity, more frequent complications, and greater in-hospital resource utilization, without any differences in in-hospital mortality in AMI.
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14
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Raphael CE, Roger VL, Sandoval Y, Singh M, Bell M, Lerman A, Rihal CS, Gersh BJ, Lewis B, Lennon RJ, Jaffe AS, Gulati R. Incidence, Trends, and Outcomes of Type 2 Myocardial Infarction in a Community Cohort. Circulation 2020; 141:454-463. [PMID: 31902228 DOI: 10.1161/circulationaha.119.043100] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Type 2 myocardial infarction (T2MI) occurs because of an acute imbalance in myocardial oxygen supply and demand in the absence of atherothrombosis. Despite being frequently encountered in clinical practice, the population-based incidence and trends remain unknown, and the long-term outcomes are incompletely characterized. METHODS We prospectively recruited residents of Olmsted County, Minnesota, who experienced an event associated with a cardiac troponin T >99th percentile of a normal reference population (≥0.01 ng/mL) between January 1, 2003, and December 31, 2012. Events were retrospectively classified into type 1 myocardial infarction (T1MI, atherothombotic event), T2MI, or myocardial injury (troponin rise not meeting criteria for myocardial infarction [MI]) using the universal definition. Outcomes were long-term all-cause and cardiovascular mortality and recurrent MI. T2MI was further subclassified by the inciting event for supply/demand mismatch. RESULTS A total of 5460 patients had at least one cardiac troponin T ≥0.01 ng/mL; 1365 of these patients were classified as index T1MI (age, 68.5±14.8 years; 63% male) and 1054 were classified as T2MI (age, 73.7±15.8 years; 46% male). The annual incidence of T1MI decreased markedly from 202 to 84 per 100 000 persons between 2003 and 2012 (P<0.001), whereas the incidence of T2MI declined from 130 to 78 per 100 000 persons (P=0.02). In comparison with patients with T1MI, patients with T2MI had higher long-term all-cause mortality after adjustment for age and sex, driven by early and noncardiovascular death. Rates of cardiovascular death were similar after either type of MI (hazard ratio, 0.8 [95% CI, 0.7-1.0], P=0.11). Subclassification of T2MI by cause demonstrated a more favorable prognosis when the principal provoking mechanism was arrhythmia, in comparison with postoperative status, hypotension, anemia, and hypoxia. After index T2MI, the most common MI during follow-up was a recurrent T2MI, whereas the occurrence of a new T1MI was relatively rare (estimated rates at 5 years, 9.7% and 1.7%). CONCLUSIONS There has been an evolution in the type of MI occurring in the community over a decade, with the incidence of T2MI now being similar to T1MI. Mortality after T2MI is higher and driven by early and noncardiovascular death. The provoking mechanism of supply/demand mismatch affects long-term survival. These findings underscore the healthcare burden of T2MI and provide benchmarks for clinical trial design.
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Affiliation(s)
- Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Malcolm Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Bradley Lewis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Kok SN, Hayes SN, Cutrer FM, Raphael CE, Gulati R, Best PJM, Tweet MS. Prevalence and Clinical Factors of Migraine in Patients With Spontaneous Coronary Artery Dissection. J Am Heart Assoc 2019; 7:e010140. [PMID: 30561271 PMCID: PMC6405609 DOI: 10.1161/jaha.118.010140] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome predominantly in women without usual cardiovascular risk factors. Many have a history of migraine headaches, but this association is poorly understood. This study aimed to determine migraine prevalence among SCAD patients and assess differences in clinical factors based on migraine history. Methods and Results A cohort study was conducted using the Mayo Clinic SCAD "Virtual" Multi-Center Registry composed of patients with SCAD as confirmed on coronary angiography. Participant-provided data and records were reviewed for migraine history, risk factors, SCAD details, therapies, and outcomes. Among 585 patients (96% women), 236 had migraine history; the lifetime and 1-year prevalence of migraine were 40% and 26%, respectively. Migraine was more common in SCAD women than comparable literature-reported female populations (42% versus 24%, P<0.0001; 42% versus 33%, P<0.0001). Among all SCAD patients, those with migraine history were more likely to be female (99.6% versus 94%; P=0.0002); have SCAD at a younger age (45.2±9.0 years versus 47.6±9.9 years; P=0.0027); have depression (27% versus 17%; P=0.025); have recurrent post-SCAD chest pain at 1 month (50% versus 39%; P=0.035); and, among those assessed, have aneurysms, pseudoaneurysms, or dissections (28% versus 18%; P=0.018). There was no difference in recurrent SCAD at 5 years for those with versus without migraine (15% versus 19%; P=0.39). Conclusions Many SCAD patients have a history of migraine. SCAD patients with migraine are younger at the time of SCAD; have more aneurysms, pseudoaneurysms, and dissections among those imaged; and more often report a history of depression and post-SCAD chest pain. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01429727, NCT01427179.
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Affiliation(s)
- Susan N Kok
- 1 Division of General Internal Medicine Department of Medicine Mayo Clinic College of Medicine and Science Rochester MN
| | - Sharonne N Hayes
- 2 Department of Cardiovascular Diseases Mayo Clinic College of Medicine and Science Rochester MN
| | - F Michael Cutrer
- 3 Department of Neurology Mayo Clinic College of Medicine and Science Rochester MN
| | - Claire E Raphael
- 4 Dorset Heart Center Royal Bournemouth Hospital Bournemouth United Kingdom
| | - Rajiv Gulati
- 2 Department of Cardiovascular Diseases Mayo Clinic College of Medicine and Science Rochester MN
| | - Patricia J M Best
- 2 Department of Cardiovascular Diseases Mayo Clinic College of Medicine and Science Rochester MN
| | - Marysia S Tweet
- 2 Department of Cardiovascular Diseases Mayo Clinic College of Medicine and Science Rochester MN
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Raphael CE, Singh M, Bell M, Crusan D, Lennon RJ, Lerman A, Prasad A, Rihal CS, Gersh BJ, Gulati R. Sex Differences in Long-Term Cause-Specific Mortality After Percutaneous Coronary Intervention: Temporal Trends and Mechanisms. Circ Cardiovasc Interv 2019. [PMID: 29540493 DOI: 10.1161/circinterventions.117.006062] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women have higher rates of all-cause mortality after percutaneous coronary intervention. Whether this is because of greater age and comorbidity burden or a sex-specific factor remains unclear. METHODS AND RESULTS We retrospectively assessed cause-specific long-term mortality after index percutaneous coronary intervention over 3 time periods (1991-1997, 1998-2005, and 2006-2012). Cause of death was determined using telephone interviews, medical records, and death certificates. We performed competing risks analyses of cause-specific mortality. A total of 6847 women and 16 280 men survived index percutaneous coronary intervention hospitalization 1991 to 2012. Women were older (mean±SD: 69.4±12 versus 64.8±11.7 years; P<0.001) with more comorbidities (mean±SD: Charlson index 2.1±2.1 versus 1.9±2.1; P<0.001). Across the 3 time periods, both sexes exhibited a decline in cardiac deaths at 5 years (26% relative decrease in women, 17% in men, trend P<0.001 for each). Although women had higher all-cause mortality compared with men in all eras, the excess mortality was because of noncardiac deaths. In the contemporary era, only a minority of deaths were cardiac (33.8% in women, 38.0% in men). After adjustment, there was no evidence for a sex-specific excess of risk for cardiac or noncardiac mortality. The commonest causes of death were chronic diseases and heart failure in women (5-year cumulative mortality, 5.4% and 3.9%) but cancer and myocardial infarction/sudden death in men (5.4% and 4.3%). CONCLUSIONS The higher mortality after percutaneous coronary intervention in women is because of death from noncardiac causes. This is accounted for by baseline age and comorbidities rather than an additional sex-specific factor. These findings have implications for sex-specific clinical care and trial design.
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Affiliation(s)
- Claire E Raphael
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Mandeep Singh
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Malcolm Bell
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Daniel Crusan
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Amir Lerman
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Abhiram Prasad
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Charanjit S Rihal
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Bernard J Gersh
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN.
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Raphael CE, Frenneaux M. Wave intensity and cognitive decline: where the heart leads the mind follows. Eur Heart J 2019; 40:2310-2312. [PMID: 31102522 DOI: 10.1093/eurheartj/ehz307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
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Vassiliou VS, Perperoglou A, Raphael CE, Joshi S, Malley T, Everett R, Halliday B, Pennell DJ, Dweck MR, Prasad SK. Midwall Fibrosis and 5-Year Outcome in Moderate and Severe Aortic Stenosis. J Am Coll Cardiol 2019; 69:1755-1756. [PMID: 28359524 DOI: 10.1016/j.jacc.2017.01.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/09/2017] [Accepted: 01/18/2017] [Indexed: 12/11/2022]
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Raphael CE, Malouf JF, Maor E, Panaich SS, Pollak PM, Reeder GS, Rihal CS, Eleid MF. A hybrid technique for treatment of commissural primary mitral regurgitation. Catheter Cardiovasc Interv 2019; 93:692-698. [PMID: 30244543 DOI: 10.1002/ccd.27904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/09/2018] [Accepted: 08/29/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND MitraClip is an effective transcatheter therapy for mitral regurgitation (MR). However, MitraClip is challenging in commissural MR and the optimal therapeutic approach is unclear. METHODS We describe a case series of six consecutive patients with severe commissural primary mitral regurgitation who underwent MitraClip insertion followed by an Amplatzer Vascular Plug (AVP) II occluder between the commissure and the MitraClip. RESULTS The procedure was successful in all patients. MR was reduced from severe to mild/trivial in 50% and moderate in 50% of cases. On 30-day follow-up, NYHA class had improved from III (6 patients) to I (2 patients), II (2 patients), and III (2 patients). The mean transmitral gradient was 2.5 ± 1.8 mmHg at baseline and 4.8 ± 2.6 mmHg following the procedure. One patient developed hemolysis immediately post procedure. The other five patients remained well during a median follow-up of 20 months (range 5-50 months) with no reported device dislodgement. CONCLUSIONS Elective treatment of severe commissural MR with a laterally or medially placed MitraClip coupled with an AVP II occluder between the clip and the commissure is feasible and safe. This approach may provide a useful management alternative in selected patients.
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Affiliation(s)
- Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph F Malouf
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elad Maor
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sidakpal S Panaich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Peter M Pollak
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Panaich SS, Maor E, Reddy G, Raphael CE, Cabalka A, Hagler DJ, Reeder GS, Rihal CS, Eleid MF. Effect of percutaneous paravalvular leak closure on hemolysis. Catheter Cardiovasc Interv 2018; 93:713-719. [DOI: 10.1002/ccd.27917] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/13/2018] [Accepted: 09/09/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | - Elad Maor
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Gautam Reddy
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Claire E. Raphael
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Allison Cabalka
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Donald J. Hagler
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Guy S. Reeder
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | | | - Mackram F. Eleid
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
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21
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Raphael CE, Maor E, Panaich SS, Reeder G, Rihal CS, Eleid MF. The Use of Intraprocedural Reinfusion During MitraClip Implantation to Reduce Blood Loss and Transfusion Requirements. J Invasive Cardiol 2018; 30:E1-E3. [PMID: 29289949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND MitraClip implantation has been shown to reduce mitral regurgitation and is an effective treatment option for patients at high risk for conventional surgery. Blood loss is common during the procedure. We assessed the utility of intraprocedural reinfusion of blood aspirated during MitraClip implantation. METHODS We compared hemoglobin before and after MitraClip implantation and transfusion requirements in patients who did (n = 83) and did not receive reinfusion (n = 31) during their procedure. For patients who received reinfusion, blood removed during device manipulation was carefully injected back into the patient through the 24 Fr delivery sheath, followed by a saline flush. RESULTS As expected, patients who received reinfusion had a smaller reduction in hemoglobin post procedure compared to those who did not (0.96 ± 1.0 g/dL vs 1.55 ± 0.94 g/dL; P<.01). There was a trend to lower requirements for blood transfusion in the reinfusion groups (0.39 ± 0.96 units/patient vs 0.15 ± 0.53 units/patient; P<.10). At 30-day follow-up, there was no difference in mortality, stroke, endocarditis, or thromboembolic events between groups. CONCLUSION Reinfusion of aspirated blood during MitraClip was associated with reduced blood loss and a trend to reduced requirement for blood transfusion post procedure. Reinfusion during the procedure appeared safe, with no complications.
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Affiliation(s)
| | | | | | | | | | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA.
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Raphael CE, Heit JA, Reeder GS, Bois MC, Maleszewski JJ, Tilbury RT, Holmes DR. Coronary Embolus. JACC Cardiovasc Interv 2018; 11:172-180. [DOI: 10.1016/j.jcin.2017.08.057] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
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23
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Cooper RM, Raphael CE, Liebregts M, Anavekar NS, Veselka J. New Developments in Hypertrophic Cardiomyopathy. Can J Cardiol 2017; 33:1254-1265. [DOI: 10.1016/j.cjca.2017.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 01/22/2023] Open
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24
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Raphael CE, Alkhouli M, Maor E, Panaich SS, Alli O, Coylewright M, Reeder GS, Sandhu G, Holmes DR, Nishimura R, Malouf J, Cabalka A, Eleid MF, Rihal CS. Building Blocks of Structural Intervention. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005686. [DOI: 10.1161/circinterventions.117.005686] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Claire E. Raphael
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Mohamad Alkhouli
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Elad Maor
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Sidakpal S. Panaich
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Oluseun Alli
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Megan Coylewright
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Guy S. Reeder
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Gurpreet Sandhu
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - David R. Holmes
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Rick Nishimura
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Joseph Malouf
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Allison Cabalka
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Mackram F. Eleid
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Charanjit S. Rihal
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
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Maor E, Raphael CE, Panaich SS, Alkhouli M, Cabalka A, Hagler DJ, Pollak PM, Reeder GS, Eleid MF, Rihal CS. Left atrial pressure and predictors of survival after percutaneous mitral paravalvular leak closure. Catheter Cardiovasc Interv 2017; 90:861-869. [DOI: 10.1002/ccd.27179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/08/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Elad Maor
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Claire E. Raphael
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | | | - Mohamad Alkhouli
- Division of Cardiology; West Virginia University Heart & Vascular Institute; Morgantown West Virginia
| | - Allison Cabalka
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Donald J. Hagler
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Peter M. Pollak
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Guy S. Reeder
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
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Vassiliou VS, Flynn PD, Raphael CE, Newsome S, Khan T, Ali A, Halliday B, Studer Bruengger A, Malley T, Sharma P, Selvendran S, Aggarwal N, Sri A, Berry H, Donovan J, Lam W, Auger D, Cook SA, Pennell DJ, Prasad SK. Lipoprotein(a) in patients with aortic stenosis: Insights from cardiovascular magnetic resonance. PLoS One 2017; 12:e0181077. [PMID: 28704465 PMCID: PMC5509300 DOI: 10.1371/journal.pone.0181077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/26/2017] [Indexed: 12/21/2022] Open
Abstract
Background Aortic stenosis is the most common age-related valvular pathology. Patients with aortic stenosis and myocardial fibrosis have worse outcome but the underlying mechanism is unclear. Lipoprotein(a) is associated with adverse cardiovascular risk and is elevated in patients with aortic stenosis. Although mechanistic pathways could link Lipoprotein(a) with myocardial fibrosis, whether the two are related has not been previously explored. In this study, we investigated whether elevated Lipoprotein(a) was associated with the presence of myocardial replacement fibrosis. Methods A total of 110 patients with mild, moderate and severe aortic stenosis were assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance to identify fibrosis. Mann Whitney U tests were used to assess for evidence of an association between Lp(a) and the presence or absence of myocardial fibrosis and aortic stenosis severity and compared to controls. Univariable and multivariable linear regression analysis were undertaken to identify possible predictors of Lp(a). Results Thirty-six patients (32.7%) had no LGE enhancement, 38 (34.6%) had midwall enhancement suggestive of midwall fibrosis and 36 (32.7%) patients had subendocardial myocardial fibrosis, typical of infarction. The aortic stenosis patients had higher Lp(a) values than controls, however, there was no significant difference between the Lp(a) level in mild, moderate or severe aortic stenosis. No association was observed between midwall or infarction pattern fibrosis and Lipoprotein(a), in the mild/moderate stenosis (p = 0.91) or severe stenosis patients (p = 0.42). Conclusion There is no evidence to suggest that higher Lipoprotein(a) leads to increased myocardial midwall or infarction pattern fibrosis in patients with aortic stenosis.
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Affiliation(s)
- Vassilios S. Vassiliou
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- Norwich Medical School, University of East Anglia, Bob Champion Research & Education Building, Norwich, United Kingdom
- * E-mail: (BH); (VSV)
| | - Paul D. Flynn
- The Lipid Clinic, Addenbrooke’s Hospital, Cambridge University Foundation NHS Trust, UK and University of Cambridge, Cambridge, United Kingdom
| | - Claire E. Raphael
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Simon Newsome
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- Department of Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tina Khan
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Aamir Ali
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Brian Halliday
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- * E-mail: (BH); (VSV)
| | - Annina Studer Bruengger
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- Clinic of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Tamir Malley
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Pranev Sharma
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Subothini Selvendran
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Nikhil Aggarwal
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Anita Sri
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Helen Berry
- Department of Biochemistry, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Jackie Donovan
- Department of Biochemistry, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Willis Lam
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Dominique Auger
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Stuart A. Cook
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- Duke National University Hospital, Singapore, Singapore
- Cardiovascular Magnetic Resonance Imaging and Genetics, MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Dudley J. Pennell
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Sanjay K. Prasad
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
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Maor E, Raphael CE, Panaich SS, Reeder GS, Nishimura RA, Nkomo VT, Rihal CS, Eleid MF. Acute Changes in Left Atrial Pressure After MitraClip Are Associated With Improvement in 6-Minute Walk Distance. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004856. [DOI: 10.1161/circinterventions.116.004856] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
Background—
Data on the clinical use of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. This study evaluated the association between intraprocedural changes in LA pressure after MitraClip and improvement in exercise capacity as documented by 6-minute walk test (6MWT).
Methods and Results—
Study population included 50 patients who underwent MitraClip at the Mayo Clinic (Rochester, MN), between June 2014 and July 2016 and completed both baseline and 30-day follow-up 6MWT. Primary outcome for the current analysis was defined as 6MWT improvement above the median. Mean age of the study population was 79±10 years, and 34 (68%) were men. Baseline preprocedural 6MWT distance was 308 m (interquartile range [IQR], 234–394 m). Acute, intraprocedural change in LA pressure after MitraClip was 3 mm Hg (IQR, 1–6 mm Hg), and change in V wave was 11 mm Hg (IQR, 6–19 mm Hg). Median 6MWT improvement was 25 m (IQR, 19–47 m). Univariate analysis showed that patients with ≤ mild postprocedural mitral regurgitation were 4-fold more likely to experience an improvement in 6MWT (
P
=0.02). Multivariate model demonstrated that each 5 mm Hg decrease in V wave was associated with 49% increased likelihood for improvement in 6-minute walk (
P
=0.04). Similar model with V-wave change as a dichotomous variable showed that patients with a V-wave decrease of ≥11 mm Hg were 3.8× more likely to improve their 6MWT (
P
=0.05).
Conclusions—
Acute changes in LA pressure after MitraClip procedure are associated with clinical improvement as measured by 6MWT. Continuous LA pressure monitoring may be a useful tool for procedural guidance during transcatheter mitral repair.
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Affiliation(s)
- Elad Maor
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Claire E. Raphael
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Guy S. Reeder
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rick A. Nishimura
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Vuyisile T. Nkomo
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Charanjit S. Rihal
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Mackram F. Eleid
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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28
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Liew AC, Raphael CE, Mohiaddin R. A 38-year-old man with progressive dyspnoea and ventricular tachycardia. Heart 2016; 103:839. [PMID: 27993910 DOI: 10.1136/heartjnl-2016-310597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 11/03/2022] Open
Abstract
CLINICAL INTRODUCTION A previously healthy 38-year-old man presented with a 3-month history of progressive dyspnoea and ventricular tachycardia (VT). He suffered a viral illness 4 months earlier. There was no family history of cardiac disease or sudden cardiac death (SCD). ECG showed left bundle branch block (LBBB). Echocardiography revealed a dilated left ventricle with severely impaired systolic function. Coronary angiogram showed angiographically normal coronary arteries. He was diagnosed as having dilated cardiomyopathy and was referred for further assessment with cardiovascular magnetic resonance (CMR) (figure 1) and subsequently CT thorax. QUESTION What is the most likely diagnosis? Dilated cardiomyopathy secondary to HIVGranulomatosis with polyangiitis (GPA)SarcoidosisTuberculosisUnderlying malignancy with lung and cardiac metastases.
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Raphael CE, Keegan J, Parker KH, Simpson R, Collinson J, Vassiliou V, Wage R, Drivas P, Strain S, Cooper R, de Silva R, Stables RH, Di Mario C, Frenneaux M, Pennell DJ, Davies JE, Hughes AD, Firmin D, Prasad SK. Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis. J Cardiovasc Magn Reson 2016; 18:93. [PMID: 27964736 PMCID: PMC5154155 DOI: 10.1186/s12968-016-0312-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/03/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Wave intensity analysis (WIA) of the coronary arteries allows description of the predominant mechanisms influencing coronary flow over the cardiac cycle. The data are traditionally derived from pressure and velocity changes measured invasively in the coronary artery. Cardiovascular magnetic resonance (CMR) allows measurement of coronary velocities using phase velocity mapping and derivation of central aortic pressure from aortic distension. We assessed the feasibility of WIA of the coronary arteries using CMR and compared this to invasive data. METHODS CMR scans were undertaken in a serial cohort of patients who had undergone invasive WIA. Velocity maps were acquired in the proximal left anterior descending and proximal right coronary artery using a retrospectively-gated breath-hold spiral phase velocity mapping sequence with high temporal resolution (19 ms). A breath-hold segmented gradient echo sequence was used to acquire through-plane cross sectional area changes in the proximal ascending aorta which were used as a surrogate of an aortic pressure waveform after calibration with brachial blood pressure measured with a sphygmomanometer. CMR-derived aortic pressures and CMR-measured velocities were used to derive wave intensity. The CMR-derived wave intensities were compared to invasive data in 12 coronary arteries (8 left, 4 right). Waves were presented as absolute values and as a % of total wave intensity. Intra-study reproducibility of invasive and non-invasive WIA was assessed using Bland-Altman analysis and the intraclass correlation coefficient (ICC). RESULTS The combination of the CMR-derived pressure and velocity data produced the expected pattern of forward and backward compression and expansion waves. The intra-study reproducibility of the CMR derived wave intensities as a % of the total wave intensity (mean ± standard deviation of differences) was 0.0 ± 6.8%, ICC = 0.91. Intra-study reproducibility for the corresponding invasive data was 0.0 ± 4.4%, ICC = 0.96. The invasive and CMR studies showed reasonable correlation (r = 0.73) with a mean difference of 0.0 ± 11.5%. CONCLUSION This proof of concept study demonstrated that CMR may be used to perform coronary WIA non-invasively with reasonable reproducibility compared to invasive WIA. The technique potentially allows WIA to be performed in a wider range of patients and pathologies than those who can be studied invasively.
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Affiliation(s)
- Claire E. Raphael
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Cardiovascular Magnetic Resonance, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
| | - Jennifer Keegan
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Kim H. Parker
- Department of Bioengineering, Imperial College, London, UK
| | - Robin Simpson
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Julian Collinson
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Vass Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Ricardo Wage
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Peter Drivas
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Stephen Strain
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Robert Cooper
- Liverpool Heart and Chest Hospital, Imperial College Medical School, Liverpool, UK
| | - Ranil de Silva
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Rod H. Stables
- Liverpool Heart and Chest Hospital, Imperial College Medical School, Liverpool, UK
| | - Carlo Di Mario
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | - Dudley J. Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Justin E. Davies
- International Center for Circulatory Health, Imperial College, London, UK
| | - Alun D. Hughes
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - David Firmin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Sanjay K. Prasad
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Vassiliou V, Anita S, Malley T, Raphael CE, Tayal U, Ali A, Sehmi J, Bilal H, Mathew GL, Smith GC, Symmonds K, Greiser A, Spottiswoode BS, Alpendurada F, Auger D, Pennell DJ, Gatehouse P, Prasad S. Systolic T1 mapping for estimation of myocardial diffuse fibrosis. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032320 DOI: 10.1186/1532-429x-18-s1-q52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Vassiliou V, Wassilew K, Asimakopoulos G, Souza AD, Quarto C, Heng EL, Raphael CE, Spottiswoode BS, Greiser A, Nyktari E, Alpendurada F, Firmin D, Jabbour A, Pepper J, Pennell DJ, Gatehouse P, Prasad S. Histological validation of a new CMR T1-mapping-based protocol to improve accuracy for fibrosis assessment in patients with aortic stenosis. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032424 DOI: 10.1186/1532-429x-18-s1-q56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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32
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Vassiliou VS, Heng EL, Gatehouse PD, Donovan J, Raphael CE, Giri S, Babu-Narayan SV, Gatzoulis MA, Pennell DJ, Prasad SK, Firmin DN. Magnetic resonance imaging phantoms for quality-control of myocardial T1 and ECV mapping: specific formulation, long-term stability and variation with heart rate and temperature. J Cardiovasc Magn Reson 2016; 18:62. [PMID: 27659737 PMCID: PMC5034463 DOI: 10.1186/s12968-016-0275-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/23/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) phantoms are routinely used for quality assurance in MRI centres; however their long term stability for verification of myocardial T1/ extracellular volume fraction (ECV) mapping has never been investigated. METHODS Nickel-chloride agarose gel phantoms were formulated in a reproducible laboratory procedure to mimic blood and myocardial T1 and T2 values, native and late after Gadolinium administration as used in T1/ECV mapping. The phantoms were imaged weekly with an 11 heart beat MOLLI sequence for T1 and long TR spin-echo sequences for T2, in a carefully controlled reproducible manner for 12 months. RESULTS There were only small relative changes seen in all the native and post gadolinium T1 values (up to 9.0 % maximal relative change in T1 values) or phantom ECV (up to 8.3 % maximal relative change of ECV, up to 2.2 % maximal absolute change in ECV) during this period. All native and post gadolinium T2 values remained stable over time with <2 % change. Temperature sensitivity testing showed MOLLI T1 values in the long T1 phantoms increasing by 23.9 ms per degree increase and short T1 phantoms increasing by 0.3 ms per degree increase. There was a small absolute increase in ECV of 0.069 % (~0.22 % relative increase in ECV) per degree increase. Variation in heart rate testing showed a 0.13 % absolute increase in ECV (~0.45 % relative increase in ECV) per 10 heart rate increase. CONCLUSIONS These are the first phantoms reported in the literature modeling T1 and T2 values for blood and myocardium specifically for the T1mapping/ECV mapping application, with stability tested rigorously over a 12 month period. This work has significant implications for the utility of such phantoms in improving the accuracy of serial scans for myocardial tissue characterisation by T1 mapping methods and in multicentre work.
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Affiliation(s)
- Vassilios S. Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Ee Ling Heng
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Peter D. Gatehouse
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Jacqueline Donovan
- Department of Biochemistry, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
| | - Claire E. Raphael
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | | | - Sonya V. Babu-Narayan
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Michael A. Gatzoulis
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Dudley J. Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Sanjay K. Prasad
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - David N. Firmin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
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Raphael CE, Spoon DB, Bell MR, Psaltis PJ, Kidd S, Loh SX, Lennon RJ, Singh M, Rihal C, Gulati R. Effect of Preprocedural Thrombocytopenia on Prognosis After Percutaneous Coronary Intervention. Mayo Clin Proc 2016; 91:1035-44. [PMID: 27492910 DOI: 10.1016/j.mayocp.2016.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess early and late outcomes, including bleeding, in patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS We performed a retrospective single-center study of patients with preprocedural thrombocytopenia (platelet count ≤100,000/μL; n=204) undergoing PCI between 2003 and 2015. Inhospital and late outcomes were compared with those of a matched control group without thrombocytopenia (n=1281). RESULTS The most common causes of thrombocytopenia were liver disease, immune-mediated disease, and hematologic malignant neoplasms. Inhospital bleeding events after PCI were similar in patients with thrombocytopenia and matched controls (24 of 146 [16.4%] vs 179 of 1281 [14.0%]; P=.40) and were largely classified as minor using the Bleeding Academic Research Consortium (BARC) classification (89% BARC 1 or 2). There was no significant difference in inhospital death (4 of 146 [2.7%] vs 71 of 1281 [2.0%]; P=.56), but patients with thrombocytopenia had higher rates of platelet and red blood cell transfusion (18 of 146 [12.3%] vs 93 of 1281 [7.2%]; P=.05). During long-term follow-up, Kaplan-Meier estimated rates of bleeding events (BARC ≥2) were higher for thrombocytopenia (at 5 years, 7.9% vs 3.6%; P=.03). Patients with thrombocytopenia had a similar risk of long-term cardiac mortality, but significantly higher rates of noncardiac mortality (at 5 years, 28% vs 21%; P=.02). CONCLUSION This study suggests that short-term outcomes after PCI in patients with thrombocytopenia were favorable. On long-term follow-up, thrombocytopenia was associated with a higher risk of long-term noncardiac mortality and bleeding.
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Affiliation(s)
| | - Daniel B Spoon
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Malcolm R Bell
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Shu X Loh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Charanjit Rihal
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Raphael CE, Spoon D, Lennon R, Crusan D, Singh M, Lerman A, Rihal C, Gersh B, Gulati R. GENDER DIFFERENCES IN CAUSE OF DEATH FOLLOWING PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30330-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Mitchell FM, Prasad SK, Greil GF, Drivas P, Vassiliou VS, Raphael CE. Cardiovascular magnetic resonance: Diagnostic utility and specific considerations in the pediatric population. World J Clin Pediatr 2016; 5:1-15. [PMID: 26862497 PMCID: PMC4737683 DOI: 10.5409/wjcp.v5.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/10/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance is a non-invasive imaging modality which is emerging as important tool for the investigation and management of pediatric cardiovascular disease. In this review we describe the key technical and practical differences between scanning children and adults, and highlight some important considerations that must be taken into account for this patient population. Using case examples commonly seen in clinical practice, we discuss the important clinical applications of cardiovascular magnetic resonance, and briefly highlight key future developments in this field.
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Merinopoulos I, Raphael CE, Yardley A, Goonewardene M, Vassiliou VS. Device-identified atrial fibrillation at pacing clinics. Should it guide anticoagulation? Int J Cardiol 2016; 207:378-81. [PMID: 26826369 DOI: 10.1016/j.ijcard.2016.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/25/2015] [Accepted: 01/01/2016] [Indexed: 11/30/2022]
Abstract
In recent years, there has been a significant increase in the number of devices implanted following improvement in their safety profile, extension of indications and reduction in cost. Although the reason remains largely the beneficial effect on heart rhythm stabilisation, implanted devices might also have additional advantages, notably identification of silent arrhythmia. Should clinicians therefore act on device-identified atrial fibrillation (AF) and should such identification be used to guide anticoagulation management? This review evaluates the current evidence on the management of device-identified asymptomatic AF.
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Affiliation(s)
| | - Claire E Raphael
- Department of Cardiology, Royal Brompton Hospital, London and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust and Imperial College London, UK; Department of Cardiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Alaina Yardley
- Department of Cardiac Physiology, Papworth Hospital, Cambridge, UK
| | | | - Vassilios S Vassiliou
- Department of Cardiology, Royal Brompton Hospital, London and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust and Imperial College London, UK.
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Vassiliou V, Wassilew K, Malley T, Raphael CE, Schofield RS, Kirby K, Bowman AD, Symmonds K, Spottiswoode BS, Greiser A, Pierce I, Firmin D, Gatehouse P, Pennell DJ, Prasad S. Incremental benefit in correlation with histology of native T1 mapping, partition coefficient and extracellular volume fraction in patients with aortic stenosis. Journal of Cardiovascular Magnetic Resonance 2016. [PMCID: PMC5032579 DOI: 10.1186/1532-429x-18-s1-o48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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38
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Vassiliou V, Heng EL, Sharma P, Nyktari E, Raphael CE, Chin CW, Drivas P, Smith GC, Symmonds K, Mathew GL, Wage R, Ali A, Greiser A, Alpendurada F, Dweck MR, Pennell DJ, Gatehouse P, Prasad SK. Reproducibility of T1 mapping 11-heart beat MOLLI Sequence. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328491 DOI: 10.1186/1532-429x-17-s1-w26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Raphael CE, Hsu LY, Greve AM, Cooper R, Gatehouse P, Wage R, Vassiliou V, Ali A, de Silva R, Stables RH, Di Mario C, Parker KH, Pennell DJ, Arai AE, Prasad SK. Wave intensity analysis and assessment of myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328451 DOI: 10.1186/1532-429x-17-s1-q72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Keegan J, Raphael CE, Simpson R, Parker KH, de Silva R, Di Mario C, Prasad SK, Firmin D. Validation of high temporal resolution spiral phase velocity mapping of coronary artery blood flow against Doppler flow wire. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328957 DOI: 10.1186/1532-429x-17-s1-o78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pennell DJ, Baksi AJ, Prasad SK, Raphael CE, Kilner PJ, Mohiaddin RH, Alpendurada F, Babu-Narayan SV, Schneider J, Firmin DN. Review of Journal of Cardiovascular Magnetic Resonance 2014. J Cardiovasc Magn Reson 2015; 17:99. [PMID: 26589839 PMCID: PMC4654908 DOI: 10.1186/s12968-015-0203-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/08/2015] [Indexed: 01/19/2023] Open
Abstract
There were 102 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2014, which is a 6% decrease on the 109 articles published in 2013. The quality of the submissions continues to increase. The 2013 JCMR Impact Factor (which is published in June 2014) fell to 4.72 from 5.11 for 2012 (as published in June 2013). The 2013 impact factor means that the JCMR papers that were published in 2011 and 2012 were cited on average 4.72 times in 2013. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25% and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication.
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Affiliation(s)
- D J Pennell
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
| | - A J Baksi
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
| | - S K Prasad
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
| | - C E Raphael
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
| | - P J Kilner
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
| | - R H Mohiaddin
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
| | - F Alpendurada
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
| | - S V Babu-Narayan
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
| | - J Schneider
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
| | - D N Firmin
- Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College, Sydney Street, London, SW 3 6NP, UK.
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Raphael CE, Vassiliou V, Alpendurada F, Prasad SK, Pennell DJ, Mohiaddin RH. Clinical value of cardiovascular magnetic resonance in patients with MR-conditional pacemakers. Eur Heart J Cardiovasc Imaging 2015; 17:1178-85. [PMID: 26588986 DOI: 10.1093/ehjci/jev305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/22/2015] [Indexed: 02/07/2023] Open
Abstract
AIMS Magnetic resonance (MR) conditional pacemakers are increasingly implanted into patients who may need cardiovascular MR (CMR) subsequent to device implantation. We assessed the added value of CMR for diagnosis and management in this population. METHODS AND RESULTS CMR and pacing data from consecutive patients with MR conditional pacemakers were retrospectively reviewed. Images were acquired at 1.5 T (Siemens Magnetom Avanto). The indication for CMR and any resulting change in management was recorded. The quality of CMR was rated by an observer blinded to clinical details, and data on pacemaker and lead parameters were collected pre- and post-CMR. Seventy-two CMR scans on 69 patients performed between 2011 and 2015 were assessed. All scans were completed successfully with no significant change in lead thresholds or pacing parameters. Steady-state free precession (SSFP) cine imaging resulted in a greater frequency of non-diagnostic imaging (22 vs. 1%, P < 0.01) compared with gradient echo sequences (GRE). Right-sided pacemakers were associated with less artefact than left-sided pacemakers. Late gadolinium enhancement imaging was performed in 59 scans with only 2% of segments rated of non-diagnostic quality. The CMR data resulted in a new diagnosis in 27 (38%) of examinations; clinical management was changed in a further 18 (25%). CONCLUSIONS CMR in patients with MR conditional pacemakers provided diagnostic or management-changing information in the majority (63%) of our cohort. The use of gradient echo cine sequences can reduce rates of non-diagnostic imaging. Right-sided device implantation may be considered in patients likely to require CMR examination.
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Affiliation(s)
- Claire E Raphael
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Vassilis Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Francisco Alpendurada
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Sanjay K Prasad
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Dudley J Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
| | - Raad H Mohiaddin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, Sydney Street, London SW3 6NP, UK
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Cole GD, Patel SJ, Zaman N, Barron AJ, Raphael CE, Mayet J, Francis DP. "Triple therapy" of heart failure with angiotensin-converting enzyme inhibitor, beta-blocker, and aldosterone antagonist may triple survival time: shouldn't we tell patients? JACC Heart Fail 2015; 2:545-8. [PMID: 25301161 DOI: 10.1016/j.jchf.2014.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/25/2014] [Accepted: 04/03/2014] [Indexed: 01/09/2023]
Abstract
Prescription and adherence to medical therapy for heart failure are disappointing despite convincing randomized controlled trial (RCT) evidence for angiotensin-converting enzyme inhibition, beta-blockade, and aldosterone antagonism. In this study, we report an imbalanced approach amongst clinicians, who describe focusing during patient consultations on perceived risks of therapy rather than survival benefits. Only one-half of clinicians mention increased lifespan, and very few suggest to the patient how large this gain might be. We calculate from the available RCT data that, for patients whose lifespan is limited by heart failure, triple therapy triples lifespan.
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Affiliation(s)
- Graham D Cole
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom.
| | - Sheetal J Patel
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Nabeela Zaman
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Anthony J Barron
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Claire E Raphael
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Jamil Mayet
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Darrel P Francis
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom
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Keegan J, Raphael CE, Parker K, Simpson RM, Strain S, de Silva R, Di Mario C, Collinson J, Stables RH, Wage R, Drivas P, Sugathapala M, Prasad SK, Firmin DN. Validation of high temporal resolution spiral phase velocity mapping of temporal patterns of left and right coronary artery blood flow against Doppler guidewire. J Cardiovasc Magn Reson 2015; 17:85. [PMID: 26428627 PMCID: PMC4591589 DOI: 10.1186/s12968-015-0189-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/10/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Temporal patterns of coronary blood flow velocity can provide important information on disease state and are currently assessed invasively using a Doppler guidewire. A non-invasive alternative would be beneficial as it would allow study of a wider patient population and serial scanning. METHODS A retrospectively-gated breath-hold spiral phase velocity mapping sequence (TR 19 ms) was developed at 3 Tesla. Velocity maps were acquired in 8 proximal right and 15 proximal left coronary arteries of 18 subjects who had previously had a Doppler guidewire study at the time of coronary angiography. Cardiovascular magnetic resonance (CMR) velocity-time curves were processed semi-automatically and compared with corresponding invasive Doppler data. RESULTS When corrected for differences in heart rate between the two studies, CMR mean velocity through the cardiac cycle, peak systolic velocity (PSV) and peak diastolic velocity (PDV) were approximately 40 % of the peak Doppler values with a moderate - good linear relationship between the two techniques (R(2): 0.57, 0.64 and 0.79 respectively). CMR values of PDV/PSV showed a strong linear relationship with Doppler values with a slope close to unity (0.89 and 0.90 for right and left arteries respectively). In individual vessels, plots of CMR velocities at all cardiac phases against corresponding Doppler velocities showed a consistent linear relationship between the two with high R(2) values (mean +/-SD: 0.79 +/-.13). CONCLUSIONS High temporal resolution breath-hold spiral phase velocity mapping underestimates absolute values of coronary flow velocity but allows accurate assessment of the temporal patterns of blood flow.
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Affiliation(s)
- Jennifer Keegan
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Claire E Raphael
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Kim Parker
- Department of Bioengineering, Imperial College London, London, UK.
| | - Robin M Simpson
- Radiological Physics, University Medical Centre, Freiburg, Germany.
| | - Stephen Strain
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Ranil de Silva
- National Heart and Lung Institute, Imperial College London, London, UK.
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Carlo Di Mario
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Julian Collinson
- Department of Cardiology, Chelsea and Westminster Hospital, London, UK.
| | - Rod H Stables
- Institue of Cardiovascular Science and Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Ricardo Wage
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Peter Drivas
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Malindie Sugathapala
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Sanjay K Prasad
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - David N Firmin
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
- National Heart and Lung Institute, Imperial College London, London, UK.
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Abstract
INTRODUCTION Constrictive pericarditis is characterized by constriction of the heart secondary to pericardial inflammation. Cardiovascular magnetic resonance (CMR) imaging is useful imaging modality for addressing the challenges of confirming this diagnosis. It can be used to exclude other causes of right heart failure, such as pulmonary hypertension or myocardial infarction, determine whether the pericardium is causing constriction and differentiate it from restrictive cardiomyopathy, which also causes impaired cardiac filling. CASE PRESENTATION A 77-year-old man from a country with high incidence of tuberculosis presented with severe dyspnea. Echocardiography revealed a small left ventricle with normal systolic and mildly impaired diastolic function. Left heart catheterization revealed non-obstructive coronary disease, not felt contributory to the dyspnea. Anatomy imaging with cardiovascular magnetic resonance imaging (CMR) showed global, severely thickened pericardium. Short tau inversion recovery (STIR) sequences for detection of oedema/ inflammation showed increased signal intensity and free breathing sequences confirmed septal flattening on inspiration. Late gadolinium imaging confirmed enhancement in the pericardium, with all findings suggestive of pericardial inflammation and constriction. CONCLUSIONS CMR with STIR sequences, free breathing sequences and late gadolinium imaging can prove extremely useful for diagnosing constrictive pericarditis.
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Affiliation(s)
- Gary Tse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- School of Medicine, Imperial College London, London, UK
| | - Aamir Ali
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | | | - Sanjay Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Claire E Raphael
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- School of Medicine, Imperial College London, London, UK
- Corresponding authors: Claire E Raphael, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK. Vassilis Vassiliou, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK. Tel: +44-2073518800, Fax: +44-2073518816, E-mail:
| | - Vassilis Vassiliou
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- Corresponding authors: Claire E Raphael, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK. Vassilis Vassiliou, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK. Tel: +44-2073518800, Fax: +44-2073518816, E-mail:
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Tse G, Ali A, Prasad SK, Vassiliou V, Raphael CE. Atypical case of post-partum cardiomyopathy: an overlap syndrome with arrhythmogenic right ventricular cardiomyopathy? BJR Case Rep 2015; 1:20150182. [PMID: 30363137 PMCID: PMC6159128 DOI: 10.1259/bjrcr.20150182] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/21/2022] Open
Abstract
A middle-aged female patient presented with increasing dyspnoea following delivery of her second child. Echocardiography showed left ventricular (LV) dilatation and severe global impairment of systolic function (ejection fraction < 10%) but normal right ventricular (RV) dimensions. Plasma B-type natriuretic peptide level was elevated. Post-partum cardiomyopathy (PPCM) was considered and after initiating appropriate heart failure pharmacotherapy, her symptoms improved significantly. Cardiovascular MR showed RV free wall dyskinesia and aneurysms at the LV apex, RV free wall and RV outflow tract. Genetic analysis showed a C11842T substitution in the titin gene (TTN). This is the first case to propose an overlap syndrome of PPCM and arrhythmogenic RV cardiomyopathy.
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Affiliation(s)
- G Tse
- School of Medicine, Imperial College London, UK
| | - A Ali
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, UK
| | - S K Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, UK
| | - V Vassiliou
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, UK
| | - C E Raphael
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, UK
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Cole GD, Dhutia NM, Shun-Shin MJ, Willson K, Harrison J, Raphael CE, Zolgharni M, Mayet J, Francis DP. Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation. Int J Cardiovasc Imaging 2015; 31:1303-14. [PMID: 26141526 PMCID: PMC4572050 DOI: 10.1007/s10554-015-0659-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/08/2015] [Indexed: 12/04/2022]
Abstract
Left ventricular function can be evaluated by qualitative grading and by eyeball estimation of ejection fraction (EF). We sought to define the reproducibility of these techniques, and how they are affected by image quality, experience and accreditation. Twenty apical four-chamber echocardiographic cine loops (Online Resource 1–20) of varying image quality and left ventricular function were anonymized and presented to 35 operators. Operators were asked to provide (1) a one-phrase grading of global systolic function (2) an “eyeball” EF estimate and (3) an image quality rating on a 0–100 visual analogue scale. Each observer viewed every loop twice unknowingly, a total of 1400 viewings. When grading LV function into five categories, an operator’s chance of agreement with another operator was 50 % and with themself on blinded re-presentation was 68 %. Blinded eyeball LVEF re-estimates by the same operator had standard deviation (SD) of difference of 7.6 EF units, with the SD across operators averaging 8.3 EF units. Image quality, defined as the average of all operators’ assessments, correlated with EF estimate variability (r = −0.616, p < 0.01) and visual grading agreement (r = 0.58, p < 0.01). However, operators’ own single quality assessments were not a useful forewarning of their estimate being an outlier, partly because individual quality assessments had poor within-operator reproducibility (SD of difference 17.8). Reproducibility of visual grading of LV function and LVEF estimation is dependent on image quality, but individuals cannot themselves identify when poor image quality is disrupting their LV function estimate. Clinicians should not assume that patients changing in grade or in visually estimated EF have had a genuine clinical change.
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Affiliation(s)
- Graham D Cole
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London, W2 1LA, UK.
| | - Niti M Dhutia
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London, W2 1LA, UK
| | - Matthew J Shun-Shin
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London, W2 1LA, UK
| | - Keith Willson
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London, W2 1LA, UK
| | - James Harrison
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | - Massoud Zolgharni
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London, W2 1LA, UK
| | - Jamil Mayet
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London, W2 1LA, UK
| | - Darrel P Francis
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London, W2 1LA, UK
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Strain S, Keegan J, Raphael CE, Simpson R, Sugathapala MH, Prasad SK, Firmin D. Abstracts of the 2015 SCMR/EuroCMR Joint Scientific Sessions, February 4-7, 2015, Nice, France. J Cardiovasc Magn Reson 2015; 17 Suppl 1:M1-W36. [PMID: 25708723 PMCID: PMC4328492 DOI: 10.1186/1532-429x-17-s1-m1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Raphael CE, Finegold JA, Barron AJ, Whinnett ZI, Mayet J, Linde C, Cleland JG, Levy WC, Francis DP. The effect of duration of follow-up and presence of competing risk on lifespan-gain from implantable cardioverter defibrillator therapy: who benefits the most? Eur Heart J 2015; 36:1676-88. [DOI: 10.1093/eurheartj/ehv102] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/16/2015] [Indexed: 11/14/2022] Open
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Gordon D, Raphael CE, Vassiliou V. Assisted dying - should the UK change its stance? Med Sci Law 2015; 55:71-77. [PMID: 25628340 DOI: 10.1177/0025802414566708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Along with an increasing interest in assisted dying by many European and North American countries, some of which have already modified their existing laws to accommodate this, the interest in assisted dying in the UK has increased once again following Lord Falconer's Assisted Dying for the Terminally Ill Bill. Drawing on examples from countries where similar assisted dying laws are already in place, this article analyses and contextualises the proposed bill and discusses its potential pitfalls and benefits for the UK.
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