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Aggarwal V, Giri J, Visovatti SH, Mahmud E, Matsubara H, Madani M, Rogers F, Gopalan D, Rosenfield K, McLaughlin VV. Status and Future Directions for Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease With and Without Pulmonary Hypertension: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1090-e1107. [PMID: 38450477 DOI: 10.1161/cir.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Balloon pulmonary angioplasty continues to gain traction as a treatment option for patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. Recent European Society of Cardiology guidelines on pulmonary hypertension now give balloon pulmonary angioplasty a Class 1 recommendation for inoperable and residual chronic thromboembolic pulmonary hypertension. Not surprisingly, chronic thromboembolic pulmonary hypertension centers are rapidly initiating balloon pulmonary angioplasty programs. However, we need a comprehensive, expert consensus document outlining critical concepts, including identifying necessary personnel and expertise, criteria for patient selection, and a standardized approach to preprocedural planning and establishing criteria for evaluating procedural efficacy and safety. Given this lack of standards, the balloon pulmonary angioplasty skill set is learned through peer-to-peer contact and training. This document is a state-of-the-art, comprehensive statement from key thought leaders to address this gap in the current clinical practice of balloon pulmonary angioplasty. We summarize the current status of the procedure and provide a consensus opinion on the role of balloon pulmonary angioplasty in the overall care of patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. We also identify knowledge gaps, provide guidance for new centers interested in initiating balloon pulmonary angioplasty programs, and highlight future directions and research needs for this emerging therapy.
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Kianzad A, Baccelli A, Braams NJ, Andersen S, van Wezenbeek J, Wessels JN, Celant LR, Vos AE, Davies R, Lo Giudice F, Haji G, Rinaldo RF, Vigo B, Gopalan D, Symersky P, Winkelman JA, Boonstra A, Nossent EJ, Tim Marcus J, Vonk Noordegraaf A, Meijboom LJ, de Man FS, Andersen A, Howard LS, Bogaard HJ. Long-term effects of pulmonary endarterectomy on pulmonary hemodynamics, cardiac function, and exercise capacity in chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2024; 43:580-593. [PMID: 38000764 DOI: 10.1016/j.healun.2023.11.011] [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] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/06/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Long-term changes in exercise capacity and cardiopulmonary hemodynamics after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have been poorly described. METHODS We analyzed the data from 2 prospective surgical CTEPH cohorts in Hammersmith Hospital, London, and Amsterdam UMC. A structured multimodal follow-up was adopted, consisting of right heart catheterization, cardiac magnetic resonance imaging, and cardiopulmonary exercise testing before and after PEA. Preoperative predictors of residual pulmonary hypertension (PH; mean pulmonary artery pressure >20 mm Hg and pulmonary vascular resistance ≥2 WU) and long-term exercise intolerance (VO2max <80%) at 18 months were analyzed. RESULTS A total of 118 patients (61 from London and 57 from Amsterdam) were included in the analysis. Both cohorts displayed a significant improvement of pulmonary hemodynamics, right ventricular (RV) function, and exercise capacity 6 months after PEA. Between 6 and 18 months after PEA, there were no further improvements in hemodynamics and RV function, but the proportion of patients with impaired exercise capacity was high and slightly increased over time (52%-59% from 6 to 18 months). Long-term exercise intolerance was common and associated with preoperative diffusion capacity for carbon monoxide (DLCO), preoperative mixed venous oxygen saturation, and postoperative PH and right ventricular ejection fraction (RVEF). Clinically significant RV deterioration (RVEF decline >3%; 5 [9%] of 57 patients) and recurrent PH (5 [14%] of 36 patients) rarely occurred beyond 6 months after PEA. Age and preoperative DLCO were predictors of residual PH post-PEA. CONCLUSIONS Restoration in exercise tolerance, cardiopulmonary hemodynamics, and RV function occurs within 6 months. No substantial changes occurred between 6 and 18 months after PEA in the Amsterdam cohort. Nevertheless, long-term exercise intolerance is common and associated with postoperative RV function.
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Affiliation(s)
- Azar Kianzad
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Andrea Baccelli
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Natalia J Braams
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Stine Andersen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Jessie van Wezenbeek
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Jeroen N Wessels
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Lucas R Celant
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Anna E Vos
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands
| | - Rachel Davies
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Francesco Lo Giudice
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gulammehdi Haji
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rocco F Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Beatrice Vigo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Carlo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Deepa Gopalan
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Petr Symersky
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, the Netherlands
| | - Jacobus A Winkelman
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, the Netherlands
| | - Anco Boonstra
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Esther J Nossent
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - J Tim Marcus
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Frances S de Man
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
| | - Asger Andersen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Luke S Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Harm Jan Bogaard
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands.
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Peverelli M, Maughan RT, Gopalan D, Dweck MR, Dey D, Buch MH, Rudd JHF, Tarkin JM. Use of coronarycomputed tomography for cardiovascular risk assessment in immune-mediated inflammatory diseases. Heart 2024; 110:545-551. [PMID: 38238078 DOI: 10.1136/heartjnl-2022-321403] [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: 10/18/2023] [Accepted: 12/05/2023] [Indexed: 02/15/2024] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs) are recognised risk factors for accelerated atherosclerotic cardiovascular disease (CVD), particularly in younger individuals and women who lack traditional CVD risk factors. Reflective of the critical role that inflammation plays in the formation, progression and rupture of atherosclerotic plaques, research into immune mechanisms of CVD has led to the identification of a range of therapeutic targets that are the subject of ongoing clinical trials. Several key inflammatory pathways implicated in the pathogenesis of atherosclerosis are targeted in people with IMIDs. However, cardiovascular risk continues to be systematically underestimated by conventional risk assessment tools in the IMID population, resulting in considerable excess CVD burden and mortality. Hence, there is a pressing need to improve methods for CVD risk-stratification among patients with IMIDs, to better guide the use of statins and other prognostic interventions. CT coronary angiography (CTCA) is the current first-line investigation for diagnosing and assessing the severity of coronary atherosclerosis in many individuals with suspected angina. Whether CTCA is also useful in the general population for reclassifying asymptomatic individuals and improving long-term prognosis remains unknown. However, in the context of IMIDs, it is conceivable that the information provided by CTCA, including state-of-the-art assessments of coronary plaque, could be an important clinical adjunct in this high-risk patient population. This narrative review discusses the current literature about the use of coronary CT for CVD risk-stratification in three of the most common IMIDs including rheumatoid arthritis, psoriasis and systemic lupus erythematosus.
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Affiliation(s)
- Marta Peverelli
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | | | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
- Department of Radiology, Cambridge University Hospitals NHS Trust, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maya H Buch
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - James H F Rudd
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
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Wall C, Weir-McCall J, Tweed K, Hoole SP, Gopalan D, Huang Y, Corovic A, Peverelli M, Dey D, Bennett MR, Rudd JHF, Kydd A, Bhagra S, Tarkin JM. CT pericoronary adipose tissue density predicts coronary allograft vasculopathy and adverse clinical outcomes after cardiac transplantation. Eur Heart J Cardiovasc Imaging 2024:jeae069. [PMID: 38493483 DOI: 10.1093/ehjci/jeae069] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
AIMS To assess pericoronary adipose tissue (PCAT) density on Coronary Computed Tomography Angiography (CCTA) as a marker of inflammatory disease activity in coronary allograft vasculopathy (CAV). METHODS AND RESULTS PCAT density, lesion volumes, and total vessel volume-to-myocardial mass ratio (V/M) were retrospectively measured in 126 CCTAs from 94 heart transplant patients (mean age 49 [SD 14.5] years, 40% female) who underwent imaging between 2010 to 2021; age and sex-matched controls; and patients with atherosclerosis. PCAT density was higher in transplant patients with CAV (n = 40; -73.0 HU [SD 9.3]) than without CAV (n = 86; -77.9 HU [SD 8.2]), and controls (n = 12; -86.2 HU [SD 5.4]), p < 0.01 for both. Unlike patients with atherosclerotic coronary artery disease (n = 32), CAV lesions were predominantly non-calcified, comprised of mostly fibrous or fibrofatty tissue. V/M was lower in patients with CAV than without (32.4 mm3/g [SD 9.7] vs. 41.4 mm3/g [SD 12.3], p < 0.0001). PCAT density and V/M improved the ability to predict CAV from AUC 0.75 to 0.85 when added to donor age and donor hypertension status (p < 0.0001). PCAT density above -66 HU was associated with a greater incidence of all-cause mortality (OR 18.0 [95%CI 3.25-99.6], p < 0.01) and the composite endpoint of death, CAV progression, acute rejection, and coronary revascularization (OR 7.47 [95%CI 1.8-31.6], p = 0.01) over 5.3 (SD 2.1) years. CONCLUSIONS Heart transplant patients with CAV have higher PCAT density and lower V/M than those without. Increased PCAT density is associated with adverse clinical outcomes. These CCTA metrics could be useful for diagnosis and monitoring of CAV severity.
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Affiliation(s)
- Christopher Wall
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Weir-McCall
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Katharine Tweed
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Yuan Huang
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Andrej Corovic
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Marta Peverelli
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, California
| | - Martin R Bennett
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - James H F Rudd
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Anna Kydd
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Sai Bhagra
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
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Lechartier B, Boucly A, Solinas S, Gopalan D, Dorfmüller P, Radonic T, Sitbon O, Montani D. Pulmonary veno-occlusive disease: illustrative cases and literature review. Eur Respir Rev 2024; 33:230156. [PMID: 38232988 DOI: 10.1183/16000617.0156-2023] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/11/2023] [Indexed: 01/19/2024] Open
Abstract
Pulmonary veno-occlusive disease (PVOD), also known as "pulmonary arterial hypertension (PAH) with overt features of venous/capillary involvement", is a rare cause of PAH characterised by substantial small pulmonary vein and capillary involvement, leading to increased pulmonary vascular resistance and right ventricular failure. Environmental risk factors have been associated with the development of PVOD, such as occupational exposure to organic solvents and chemotherapy, notably mitomycin. PVOD may also be associated with a mutation in the EIF2AK4 gene in heritable forms of disease. Distinguishing PVOD from PAH is critical for guiding appropriate management. Chest computed tomography typically displays interlobular septal thickening, ground-glass opacities and mediastinal lymphadenopathy. Life-threatening pulmonary oedema is a complication of pulmonary vasodilator therapy that can occur with any class of PAH drugs in PVOD. Early referral to a lung transplant centre is essential due to the poor response to therapy when compared with other forms of PAH. Histopathological analysis of lung explants reveals microvascular remodelling with typical fibrous veno-occlusive lesions. This review covers the main features distinguishing PVOD from PAH and two clinical cases that illustrate the challenges of PVOD management.
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Affiliation(s)
- Benoit Lechartier
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Respiratory Division, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Athénaïs Boucly
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Sabina Solinas
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Deepa Gopalan
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | - Peter Dorfmüller
- Institut für Pathologie, Universitätsklinikum Giessen/Marburg, Giessen, Germany
- Deutsches Zentrum für Lungenforschung (DZL), Giessen, Germany
| | - Teodora Radonic
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Pathology, Boelelaan Amsterdam, The Netherlands Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Olivier Sitbon
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - David Montani
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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van de Veerdonk MC, Roosma L, Trip P, Gopalan D, Vonk Noordegraaf A, Dorfmüller P, Nossent EJ. Clinical-imaging-pathological correlation in pulmonary hypertension associated with left heart disease. Eur Respir Rev 2024; 33:230144. [PMID: 38417969 PMCID: PMC10900069 DOI: 10.1183/16000617.0144-2023] [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] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/25/2023] [Indexed: 03/01/2024] Open
Abstract
Pulmonary hypertension (PH) is highly prevalent in patients with left heart disease (LHD) and negatively impacts prognosis. The most common causes of PH associated with LHD (PH-LHD) are left heart failure and valvular heart disease. In LHD, passive backward transmission of increased left-sided filling pressures leads to isolated post-capillary PH. Additional pulmonary vasoconstriction and remodelling lead to a higher vascular load and combined pre- and post-capillary PH. The increased afterload leads to right ventricular dysfunction and failure. Multimodality imaging of the heart plays a central role in the diagnostic work-up and follow-up of patients with PH-LHD. Echocardiography provides information about the estimated pulmonary artery pressure, morphology and function of the left and right side of the heart, and valvular abnormalities. Cardiac magnetic resonance imaging is the gold standard for volumetric measurements and provides myocardial tissue characterisation. Computed tomography of the thorax may show general features of PH and/or LHD and is helpful in excluding other PH causes. Histopathology reveals a spectrum of pre- and post-capillary vasculopathy, including intimal fibrosis, media smooth muscle cell hyperplasia, adventitial fibrosis and capillary congestion. In this paper, we provide an overview of clinical, imaging and histopathological findings in PH-LHD based on three clinical cases.
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Affiliation(s)
- Marielle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lize Roosma
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Pia Trip
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Deepa Gopalan
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Peter Dorfmüller
- Department of Pathology, University Hospital Giessen and Marburg (UKGM), German Centre for Lung Research (DZL) and Institute for Lung Health (ILH), Giessen, Germany
| | - Esther J Nossent
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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Bhuva A, Charles-Edwards G, Ashmore J, Lipton A, Benbow M, Grainger D, Lobban T, Gopalan D, Slade A, Roditi G, Manisty C. Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices. Heart 2024; 110:e3. [PMID: 36104218 DOI: 10.1136/heartjnl-2022-320810] [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] [Indexed: 11/04/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) is increasingly a fundamental component of the diagnostic pathway across a range of conditions. Historically, the presence of a cardiac implantable electronic device (CIED) has been a contraindication for MRI, however, development of MR Conditional devices that can be scanned under strict protocols has facilitated the provision of MRI for patients. Additionally, there is growing safety data to support MR scanning in patients with CIEDs that do not have MR safety labelling or with MR Conditional CIEDs where certain conditions are not met, where the clinical justification is robust. This means that almost all patients with cardiac devices should now have the same access to MRI scanning in the National Health Service as the general population. Provision of MRI to patients with CIED, however, remains limited in the UK, with only half of units accepting scan requests even for patients with MR Conditional CIEDs. Service delivery requires specialist equipment and robust protocols to ensure patient safety and facilitate workflows, meanwhile demanding collaboration between healthcare professionals across many disciplines. This document provides consensus recommendations from across the relevant stakeholder professional bodies and patient groups to encourage provision of safe MRI for patients with CIEDs.
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Affiliation(s)
- Anish Bhuva
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Geoff Charles-Edwards
- Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Representative for the British Institute of Radiology, London, UK
| | - Jonathan Ashmore
- Department of Medical Physics and Bioengineering, NHS Highland, Inverness, UK
- Representative for Institute of Physics and Engineering in Medicine, York, UK
| | | | - Matthew Benbow
- Department of Radiology, Royal Bournemouth Hospital, Bournemouth, UK
- Representative for British Association of MR Radiographers, Sheffield, UK
| | - David Grainger
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Trudie Lobban
- Arrhythmia Alliance & Atrial Fibrillation Association, Stratford upon Avon, UK
| | - Deepa Gopalan
- Department of Radiology, Imperial College London, London, UK
- Representative for Royal College of Radiologists, London, UK
| | - Alistair Slade
- Cardiology, Royal Cornwall Hospitals NHS Trust, Truro, UK
- Representative for British Heart Rhythm Society, Chipping Norton, UK
| | - Giles Roditi
- Radiology, Glasgow Royal Infirmary, Glasgow, UK
- Representative of the British Society of Cardiovascular Imaging and British Society of Cardiovascular CT, London, UK
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Representative of British Cardiovascular Society, London, UK
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Condliffe R, Dorfmüller P, Gopalan D, Sitbon O, Vonk Noordegraaf A. From the microscopic to the macroscopic: clinical-radiological-pathological correlation in pulmonary hypertension. Eur Respir Rev 2023; 32:230237. [PMID: 38123237 PMCID: PMC10731445 DOI: 10.1183/16000617.0237-2023] [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] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
Pulmonary hypertension (PH) is defined as the presence of a mean pulmonary arterial pressure >20 mmHg [1]. This simple haemodynamic definition encompasses a heterogenous collection of conditions. It is now appreciated that although treatable forms of PH are relatively rare, PH itself is not an uncommon entity, affecting ∼1% of the global population [1]. Current international guidelines describe five classification groups: group 1 (pulmonary arterial hypertension (PAH)), group 2 (PH associated with left heart disease), group 3 (PH associated with lung disease), group 4 (PH associated with pulmonary arterial obstructions) and group 5 (PH with unclear and/or multifactorial causes) figure 1 [1]. These groups are characterised by shared clinical, haemodynamic and radiological features which are underpinned by common histopathological changes. This editorial introduces a new European Respiratory Review series focusing on clinical, radiological and histopathological features in pulmonary hypertension. https://bit.ly/3RtiFVK
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Affiliation(s)
- Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
- National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, UK
| | - Peter Dorfmüller
- Department of Pathology, University Hospital of Giessen and Marburg, Giessen, Germany
- Institute for Lung Health, Giessen, Germany
| | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Olivier Sitbon
- INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
- Faculté Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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Lichtblau M, Mayer L, Gopalan D, Dorfmüller P, Ulrich S. Clinical-radiological-pathological correlation in pulmonary hypertension with unclear and/or multifactorial mechanisms. Eur Respir Rev 2023; 32:230119. [PMID: 38123234 PMCID: PMC10731469 DOI: 10.1183/16000617.0119-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023] Open
Abstract
Ever since the second world symposium on pulmonary hypertension (PH) held in Evian, France, in 1998, PH has been classified into five major clinical groups. Group 5 PH includes a variety of distinct conditions with unclear and/or multifactorial underlying pathologies. Management of these patients is challenging as the number of patients within these groups is often small, not all individuals with certain underlying conditions are affected by PH and patients exhibit distinct symptoms due to different underlying diseases. Studies and clinical trials in these groups are largely lacking and mostly restricted to case series and registry reports. Nonetheless, the worldwide burden of group 5 PH is estimated to be significant in terms of the prevalence of some associated diseases. Group 5 PH encompasses six subgroups, including haematological disorders (inherited and acquired chronic haemolytic anaemia and chronic myeloproliferative disorders), systemic disorders (sarcoidosis, pulmonary Langerhans's cell histiocytosis and neurofibromatosis type 1), metabolic disorders (glycogen storage diseases and Gaucher disease), chronic renal failure with or without haemodialysis, pulmonary tumour thrombotic microangiopathy and fibrosing mediastinitis.
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Affiliation(s)
- Mona Lichtblau
- University and University Hospital of Zurich, Zurich, Switzerland
| | - Laura Mayer
- University and University Hospital of Zurich, Zurich, Switzerland
| | - Deepa Gopalan
- Imperial College London, London, UK
- Cambridge University Hospital, Cambridge, UK
| | - Peter Dorfmüller
- Universitätsklinikum Gießen und Marburg GmbH, Pathology Department, Giessen, Germany
| | - Silvia Ulrich
- University and University Hospital of Zurich, Zurich, Switzerland
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10
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Verbelen T, Godinas L, Dorfmüller P, Gopalan D, Condliffe R, Delcroix M. Clinical-radiological-pathological correlation in chronic thromboembolic pulmonary hypertension. Eur Respir Rev 2023; 32:230149. [PMID: 38123236 PMCID: PMC10731457 DOI: 10.1183/16000617.0149-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and potentially life-threatening complication of acute pulmonary embolism. It is characterised by persistent fibro-thrombotic pulmonary vascular obstructions and elevated pulmonary artery pressure leading to right heart failure. The diagnosis is based on two steps, as follows: 1) suspicion based on symptoms, echocardiography and ventilation/perfusion scan and 2) confirmation with right heart catheterisation, computed tomography pulmonary angiography and, in most cases, digital subtraction angiography. The management of CTEPH requires a multimodal approach, involving medical therapy, interventional procedures and surgical intervention. This clinical-radiological-pathological correlation paper illustrates the diagnostic and therapeutic management of two patients. The first had chronic thromboembolic pulmonary disease without pulmonary hypertension at rest but with significant physical limitation and was successfully treated with pulmonary endarterectomy. The second patient had CTEPH associated with splenectomy and was considered unsuitable for surgery because of exclusive subsegmental lesions combined with severe pulmonary hypertension. The patient benefited from multimodal treatment involving medical therapy followed by multiple sessions of balloon pulmonary angioplasty. Both patients had normalised functional capacity and pulmonary haemodynamics 3-6 months after the interventional treatment. These two examples show that chronic thromboembolic pulmonary diseases are curable if diagnosed promptly and referred to CTEPH centres for specialist treatment.
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Affiliation(s)
- Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Laurent Godinas
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven, Belgium
- Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - Peter Dorfmüller
- Institut für Pathologie, Universitätsklinikum Giessen/Marburg and Deutsches Zentrum für Lungenforschung (DZL), Giessen, Germany
| | - Deepa Gopalan
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven, Belgium
- Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
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11
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Condliffe R, Durrington C, Hameed A, Lewis RA, Venkateswaran R, Gopalan D, Dorfmüller P. Clinical-radiological-pathological correlation in pulmonary arterial hypertension. Eur Respir Rev 2023; 32:230138. [PMID: 38123231 PMCID: PMC10731450 DOI: 10.1183/16000617.0138-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/21/2023] [Indexed: 12/23/2023] Open
Abstract
Pulmonary hypertension (PH) is defined by the presence of a mean pulmonary arterial pressure >20 mmHg. Current guidelines describe five groups of PH with shared pathophysiological and clinical features. In this paper, the first of a series covering all five PH classification groups, the clinical, radiological and pathological features of pulmonary arterial hypertension (PAH) will be reviewed. PAH may develop in the presence of associated medical conditions or a family history, following exposure to certain medications or drugs, or may be idiopathic in nature. Although all forms of PAH share common histopathological features, the presence of certain pulmonary arterial abnormalities, such as plexiform lesions, and extent of co-existing pulmonary venous involvement differs between the different subgroups. Radiological investigations are key to diagnosing the correct form of PH and a systematic approach to interpretation, especially of computed tomography, is essential.
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Affiliation(s)
- Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
- National Institute for Health and Care Research Sheffield Biomedical Research Centre, Sheffield, UK
- These authors contributed equally to this work
| | - Charlotte Durrington
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Abdul Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Robert A Lewis
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Rajamiyer Venkateswaran
- Department of Heart and Lung Transplantation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
- These authors contributed equally to this work
| | - Peter Dorfmüller
- Department of Pathology, University Hospital of Giessen and Marburg, Giessen, Germany
- Institute for Lung Health, Giessen, Germany
- These authors contributed equally to this work
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12
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Bohoran TA, Parke KS, Graham-Brown MPM, Meisuria M, Singh A, Wormleighton J, Adlam D, Gopalan D, Davies MJ, Williams B, Brown M, McCann GP, Giannakidis A. Resource efficient aortic distensibility calculation by end to end spatiotemporal learning of aortic lumen from multicentre multivendor multidisease CMR images. Sci Rep 2023; 13:21794. [PMID: 38066222 PMCID: PMC10709583 DOI: 10.1038/s41598-023-48986-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
Aortic distensibility (AD) is important for the prognosis of multiple cardiovascular diseases. We propose a novel resource-efficient deep learning (DL) model, inspired by the bi-directional ConvLSTM U-Net with densely connected convolutions, to perform end-to-end hierarchical learning of the aorta from cine cardiovascular MRI towards streamlining AD quantification. Unlike current DL aortic segmentation approaches, our pipeline: (i) performs simultaneous spatio-temporal learning of the video input, (ii) combines the feature maps from the encoder and decoder using non-linear functions, and (iii) takes into account the high class imbalance. By using multi-centre multi-vendor data from a highly heterogeneous patient cohort, we demonstrate that the proposed method outperforms the state-of-the-art method in terms of accuracy and at the same time it consumes [Formula: see text] 3.9 times less fuel and generates [Formula: see text] 2.8 less carbon emissions. Our model could provide a valuable tool for exploring genome-wide associations of the AD with the cognitive performance in large-scale biomedical databases. By making energy usage and carbon emissions explicit, the presented work aligns with efforts to keep DL's energy requirements and carbon cost in check. The improved resource efficiency of our pipeline might open up the more systematic DL-powered evaluation of the MRI-derived aortic stiffness.
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Affiliation(s)
- Tuan Aqeel Bohoran
- School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Kelly S Parke
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Mitul Meisuria
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Joanne Wormleighton
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Deepa Gopalan
- Imperial College London & Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, WC1E 6DD, UK
| | - Morris Brown
- Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Archontis Giannakidis
- School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK.
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13
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Schoenmakers E, Marelli F, Jørgensen HF, Visser WE, Moran C, Groeneweg S, Avalos C, Jurgens SJ, Figg N, Finigan A, Wali N, Agostini M, Wardle-Jones H, Lyons G, Rusk R, Gopalan D, Twiss P, Visser JJ, Goddard M, Nashef SAM, Heijmen R, Clift P, Sinha S, Pirruccello JP, Ellinor PT, Busch-Nentwich EM, Ramirez-Solis R, Murphy MP, Persani L, Bennett M, Chatterjee K. Selenoprotein deficiency disorder predisposes to aortic aneurysm formation. Nat Commun 2023; 14:7994. [PMID: 38042913 PMCID: PMC10693596 DOI: 10.1038/s41467-023-43851-6] [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] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023] Open
Abstract
Aortic aneurysms, which may dissect or rupture acutely and be lethal, can be a part of multisystem disorders that have a heritable basis. We report four patients with deficiency of selenocysteine-containing proteins due to selenocysteine Insertion Sequence Binding Protein 2 (SECISBP2) mutations who show early-onset, progressive, aneurysmal dilatation of the ascending aorta due to cystic medial necrosis. Zebrafish and male mice with global or vascular smooth muscle cell (VSMC)-targeted disruption of Secisbp2 respectively show similar aortopathy. Aortas from patients and animal models exhibit raised cellular reactive oxygen species, oxidative DNA damage and VSMC apoptosis. Antioxidant exposure or chelation of iron prevents oxidative damage in patient's cells and aortopathy in the zebrafish model. Our observations suggest a key role for oxidative stress and cell death, including via ferroptosis, in mediating aortic degeneration.
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Affiliation(s)
- Erik Schoenmakers
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Federica Marelli
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, 20149, Milano, Italy
| | - Helle F Jørgensen
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - W Edward Visser
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carla Moran
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stefan Groeneweg
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carolina Avalos
- Department of Paediatric Endocrinology, Clinica Alemana de Santiago, Vitacura, Chile
| | - Sean J Jurgens
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Nichola Figg
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Alison Finigan
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Neha Wali
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Maura Agostini
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | | | - Greta Lyons
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Rosemary Rusk
- Department of Cardiology, Addenbrookes Hospital, Cambridge, UK
| | - Deepa Gopalan
- Department of Radiology, Addenbrookes Hospital, Cambridge, UK
| | - Philip Twiss
- Cambridge Genomics Laboratory, Addenbrookes Hospital, Cambridge, UK
| | - Jacob J Visser
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martin Goddard
- Department of Pathology, Royal Papworth Hospital, Cambridge, UK
| | - Samer A M Nashef
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Robin Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul Clift
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Sanjay Sinha
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - James P Pirruccello
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Michael P Murphy
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
| | - Luca Persani
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, 20149, Milano, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20100, Milano, Italy
| | - Martin Bennett
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Krishna Chatterjee
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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14
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Gopalan D, Riley JYJ, Leong K, Alsanjari S, Auger W, Lindholm P. Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy. Tomography 2023; 9:1787-1798. [PMID: 37888734 PMCID: PMC10611069 DOI: 10.3390/tomography9050142] [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] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
CT pulmonary angiography is commonly used in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). This work was conducted to determine if cardiac chamber size on CTPA may also be useful for predicting the outcome of CTEPH treatment. A retrospective analysis of paired CTPA and right heart hemodynamics in 33 consecutive CTEPH cases before and after pulmonary thromboendarterectomy (PTE) was performed. Semiautomated and manual CT biatrial and biventricular size quantifications were correlated with mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and cardiac output. The baseline indexed right atrioventricular volumes were twice the left atrioventricular volumes, with significant (p < 0.001) augmentation of left heart filling following PTE. Except for the left atrial volume to cardiac index, all other chamber ratios significantly correlated with hemodynamics. Left to right ventricular ratio cut point <0.82 has high sensitivity (91% and 97%) and specificity (88% and 85%) for identifying significant elevations of mPAP and PVR, respectively (AUC 0.90 and 0.95), outperforming atrial ratios (sensitivity 78% and 79%, specificity 82% and 92%, and AUC 0.86 and 0.91). Manual LV:RV basal dimension ratio correlates strongly with semiautomated volume ratio (r 0.77, 95% CI 0.64-0.85) and is an expeditious alternative with comparable prognostic utility (AUC 0.90 and 0.95). LV:RV dimension ratio of <1.03 and ≤0.99 (alternatively expressed as RV:LV ratio of >0.97 and ≥1.01) is a simple metric that can be used for CTEPH outcome prediction.
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Affiliation(s)
- Deepa Gopalan
- Department of Physiology and Pharmacology, Karolinska Institute, 171 77 Stockholm, Sweden;
- Department of Radiology, Imperial College Hospital NHS Trust, London W12 0HS, UK;
| | - Jan Y. J. Riley
- Department of Diagnostic Imaging, Monash Health, Melbourne 3168, Australia;
| | - Kai’en Leong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne 3052, Australia;
| | - Senan Alsanjari
- Department of Radiology, Imperial College Hospital NHS Trust, London W12 0HS, UK;
| | - William Auger
- Department of Pulmonary Medicine, University of California, San Diego, CA 92037, USA;
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institute, 171 77 Stockholm, Sweden;
- Department of Emergency Medicine, University of California, San Diego, CA 92103, USA
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15
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Salem AM, Davis J, Gopalan D, Rudd JHF, Clarke SC, Schofield PM, Bennett MR, Brown AJ, Obaid DR. Characteristics of conventional high-risk coronary plaques and a novel CT defined thin-cap fibroatheroma in patients undergoing CCTA with stable chest pain. Clin Imaging 2023; 101:69-76. [PMID: 37311397 DOI: 10.1016/j.clinimag.2023.06.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) can identify high-risk coronary plaque types. However, the inter-observer variability for high-risk plaque features, including low attenuation plaque (LAP), positive remodelling (PR), and the Napkin-Ring sign (NRS), may reduce their utility, especially amongst less experienced readers. METHODOLOGY In a prospective study, we compared the prevalence, location and inter-observer variability of both conventional CT-defined high-risk plaques with a novel index based on quantifying the ratio of necrotic core to fibrous plaque using individualised X-ray attenuation cut-offs (the CT-defined thin-cap fibroatheroma - CT-TCFA) in 100 patients followed-up for 7 years. RESULTS In total, 346 plaques were identified in all patients. Seventy-two (21%) of all plaques were classified by conventional CT parameters as high-risk (either NRS or PR and LAP combined), and 43 (12%) of plaques were considered high-risk using the novel CT-TCFA definition of (Necrotic Core/fibrous plaque ratio of >0.9). The majority (80%) of the high-risk plaques (LAP&PR, NRS and CT-TCFA) were located in the proximal and mid-LAD and RCA. The kappa co-efficient of inter-observer variability (k) for NRS was 0.4 and for PR and LAP combined 0.4. While the kappa co-efficient of inter-observer variability (k) for the new CT-TCFA definition was 0.7. During follow-up, patients with either conventional high-risk plaques or CT-TCFAs were significantly more likely to have MACE (Major adverse cardiovascular events) compared to patients without coronary plaques (p value 0.03 & 0.03, respectively). CONCLUSION The novel CT-TCFA is associated with MACE and has improved inter-observer variability compared with current CT-defined high-risk plaques.
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Affiliation(s)
- Ahmed M Salem
- Cardiology Department, Swansea Bay University Health Board, UK; Institute of Life Sciences-2, Swansea University Medical School, UK
| | - Joel Davis
- Southampton General Hospital, Southampton, UK
| | | | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Sarah C Clarke
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Adam J Brown
- The School of Clinical Sciences at Monash Health, Melbourne, Australia
| | - Daniel R Obaid
- Cardiology Department, Swansea Bay University Health Board, UK; Institute of Life Sciences-2, Swansea University Medical School, UK.
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16
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Gopalan D, Riley JY, Leong K, Guo HH, Zamanian RT, Hsi A, Auger W, Lindholm P. Pulmonary Vein Sign on Computed Tomography Pulmonary Angiography in Proximal and Distal Chronic Thromboembolic Pulmonary Hypertension With Hemodynamic Correlation. J Thorac Imaging 2023; 38:159-164. [PMID: 36919975 PMCID: PMC10128904 DOI: 10.1097/rti.0000000000000706] [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] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Pulmonary vein sign (PVS) indicates abnormal pulmonary venous flow on computed tomography pulmonary angiography (CTPA) is a frequent finding in proximal chronic thromboembolic pulmonary hypertension (CTEPH). PVS's occurrence in distal CTEPH and correlation to disease severity is unknown. Using right heart catheterization data, we evaluated the relationship between PVS and CTEPH disease distribution and severity. MATERIALS AND METHOD A total of 93 consecutive CTEPH cases with both CTPA and right heart catheterization were identified in this retrospective multi-institutional study. After excluding 17 cases with suboptimal CTPA, there were 52 proximal and 24 distal CTEPH cases. Blood flow in the major pulmonary veins was graded qualitatively. Subgroup analysis of PVS was performed in 38 proximal CTEPH cases before and after pulmonary endarterectomy. RESULTS PVS was more frequent in proximal (79%) than distal CTEPH (29%) ( P <0.001). No significant difference was noted in invasive mean pulmonary artery pressure (46±11 and 41±12 mm Hg) or pulmonary vascular resistance (9.4±4.5 and 8.4±4.8 WU) between the 2 groups. In the subgroup analysis, PVS was present in 29/38 patients (76%) before surgery. Postoperatively, 33/38 cases (87%, P <0.001) had normal venous flow (mean pulmonary artery pressure 46±11 and 25; pulmonary vascular resistance 9.2±4.3 and 2.6 WU preop and postop, respectively). CONCLUSION PVS is a common feature in proximal but infrequent findings in distal CTEPH. PVS does not correlate with hemodynamic severity. PVS resolution was seen in the majority of patients following successful endarterectomy.
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Affiliation(s)
- Deepa Gopalan
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | | | - Kai’en Leong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Roham T. Zamanian
- Division of Pulmonary, Allergy, & Critical Care Medicine
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine
| | - Andrew Hsi
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine
| | | | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
- Department of Emergency Medicine, University of California, San Diego, CA
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17
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Leong K, Howard L, Giudice FL, Davies R, Haji G, Gibbs S, Gopalan D. Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status. Pulm Circ 2023; 13:e12116. [PMID: 36843875 PMCID: PMC9947220 DOI: 10.1002/pul2.12116] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/19/2022] [Accepted: 07/10/2022] [Indexed: 11/05/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension may be cured by pulmonary endarterectomy (PEA). Thromboembolic disease distribution/PEA success primarily determines prognosis but risk scoring criteria may be adjunctive. Right ventriculoarterial (RV-PA) and ventriculoatrial (RV-right atrium [RA]) coupling may be evaluated by cardiac MRI (CMR) feature tracking deformation/strain assessment. We characterized biatrial and biventricular CMR feature tracking (FT) strain parameters following PEA and tested the ability of CMR FT to identify REVEAL 2.0 high-risk status. We undertook a retrospective single-center cross-sectional study of patients (n = 57) who underwent PEA (2015-2020). All underwent pre and postoperative catheterization and CMR. Pulmonary arterial hypertension validated risk scores were calculated. Significant postoperative improvements were observed in mean pulmonary artery pressure (mPAP) (pre-op 45 ± 11 mmHg vs. post-op 26 ± 11 mmHg; p < 0.001) and PVR however a large proportion had residual pulmonary hypertension (45%; mPAP ≥25 mmHg). PEA augmented left heart filling with left ventricular end diastolic volume index and left atrial volume index increment. Left ventricular ejection fraction was unchanged postoperatively but LV global longitudinal strain improved (pre-op median -14.2% vs. post-op -16.0%; p < 0.001). Right ventricular (RV) geometry and function also improved with reduction in RV mass. Most had uncoupled RV-PA relationships which recovered (pre-op right ventricular free wall longitudinal strain -13.2 ± 4.8%, RV stroke volume/right ventricular end systolic volume ratio 0.78 ± 0.53 vs. post-op -16.8 ± 4.2%, 1.32 ± 0.55; both p < 0.001). Postoperatively, there were six REVEAL 2.0 high-risk patients, best predicted by impaired RA strain which was superior to traditional volumetric parameters (area under the curve [AUC] 0.99 vs. RVEF AUC 0.88). CMR deformation/strain evaluation can offer insights into coupling recovery; RA strain may be an expeditious surrogate for the more laborious REVEAL 2.0 score.
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Affiliation(s)
- Kai'En Leong
- Department of RadiologyImperial College Healthcare NHS Trust/Hammersmith HospitalLondonUK,Department of CardiologyThe Royal Melbourne HospitalVictoriaAustralia
| | - Luke Howard
- National Pulmonary Hypertension ServiceImperial College Healthcare NHS TrustLondonUK,National Heart & Lung InstituteImperial College LondonLondonUK
| | - Francesco Lo Giudice
- National Pulmonary Hypertension ServiceImperial College Healthcare NHS TrustLondonUK,Department of CardiologyImperial College Healthcare NHS Trust/Hammersmith HospitalLondonUK
| | - Rachel Davies
- National Pulmonary Hypertension ServiceImperial College Healthcare NHS TrustLondonUK
| | - Gulammehdi Haji
- National Pulmonary Hypertension ServiceImperial College Healthcare NHS TrustLondonUK
| | - Simon Gibbs
- National Heart & Lung InstituteImperial College LondonLondonUK,Imperial College LondonLondonUK
| | - Deepa Gopalan
- Department of RadiologyImperial College Healthcare NHS Trust/Hammersmith HospitalLondonUK,Imperial College LondonLondonUK,Department of RadiologyCambridge University Hospitals NHS TrustCambridgeUK
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18
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Ćorović A, Wall C, Nus M, Gopalan D, Huang Y, Imaz M, Zulcinski M, Peverelli M, Uryga A, Lambert J, Bressan D, Maughan RT, Pericleous C, Dubash S, Jordan N, Jayne DR, Hoole SP, Calvert PA, Dean AF, Rassl D, Barwick T, Iles M, Frontini M, Hannon G, Manavaki R, Fryer TD, Aloj L, Graves MJ, Gilbert FJ, Dweck MR, Newby DE, Fayad ZA, Reynolds G, Morgan AW, Aboagye EO, Davenport AP, Jørgensen HF, Mallat Z, Bennett MR, Peters JE, Rudd JHF, Mason JC, Tarkin JM. Somatostatin Receptor PET/MR Imaging of Inflammation in Patients With Large Vessel Vasculitis and Atherosclerosis. J Am Coll Cardiol 2023; 81:336-354. [PMID: 36697134 PMCID: PMC9883634 DOI: 10.1016/j.jacc.2022.10.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Assessing inflammatory disease activity in large vessel vasculitis (LVV) can be challenging by conventional measures. OBJECTIVES We aimed to investigate somatostatin receptor 2 (SST2) as a novel inflammation-specific molecular imaging target in LVV. METHODS In a prospective, observational cohort study, in vivo arterial SST2 expression was assessed by positron emission tomography/magnetic resonance imaging (PET/MRI) using 68Ga-DOTATATE and 18F-FET-βAG-TOCA. Ex vivo mapping of the imaging target was performed using immunofluorescence microscopy; imaging mass cytometry; and bulk, single-cell, and single-nucleus RNA sequencing. RESULTS Sixty-one participants (LVV: n = 27; recent atherosclerotic myocardial infarction of ≤2 weeks: n = 25; control subjects with an oncologic indication for imaging: n = 9) were included. Index vessel SST2 maximum tissue-to-blood ratio was 61.8% (P < 0.0001) higher in active/grumbling LVV than inactive LVV and 34.6% (P = 0.0002) higher than myocardial infarction, with good diagnostic accuracy (area under the curve: ≥0.86; P < 0.001 for both). Arterial SST2 signal was not elevated in any of the control subjects. SST2 PET/MRI was generally consistent with 18F-fluorodeoxyglucose PET/computed tomography imaging in LVV patients with contemporaneous clinical scans but with very low background signal in the brain and heart, allowing for unimpeded assessment of nearby coronary, myocardial, and intracranial artery involvement. Clinically effective treatment for LVV was associated with a 0.49 ± 0.24 (standard error of the mean [SEM]) (P = 0.04; 22.3%) reduction in the SST2 maximum tissue-to-blood ratio after 9.3 ± 3.2 months. SST2 expression was localized to macrophages, pericytes, and perivascular adipocytes in vasculitis specimens, with specific receptor binding confirmed by autoradiography. SSTR2-expressing macrophages coexpressed proinflammatory markers. CONCLUSIONS SST2 PET/MRI holds major promise for diagnosis and therapeutic monitoring in LVV. (PET Imaging of Giant Cell and Takayasu Arteritis [PITA], NCT04071691; Residual Inflammation and Plaque Progression Long-Term Evaluation [RIPPLE], NCT04073810).
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Affiliation(s)
- Andrej Ćorović
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Christopher Wall
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Meritxell Nus
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom; Department of Radiology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Yuan Huang
- Engineering and Physical Sciences Research Council Centre for Mathematical Imaging in Healthcare, University of Cambridge, Cambridge, United Kingdom
| | - Maria Imaz
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Michal Zulcinski
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Marta Peverelli
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom; Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Anna Uryga
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jordi Lambert
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Dario Bressan
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Robert T Maughan
- Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Charis Pericleous
- Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Suraiya Dubash
- Department of Oncology, University College London NHS Trust, London, United Kingdom; Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Natasha Jordan
- Department of Rheumatology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - David R Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital NHS Trust, Cambridge, United Kingdom
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth Hospital NHS Trust, Cambridge, United Kingdom
| | - Andrew F Dean
- Department of Histopathology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Doris Rassl
- Department of Histopathology, Royal Papworth Hospital NHS Trust, Cambridge, United Kingdom
| | - Tara Barwick
- Department of Radiology, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom; Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Mark Iles
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Mattia Frontini
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, United Kingdom
| | - Greg Hannon
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Roido Manavaki
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Luigi Aloj
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Zahi A Fayad
- BioMedical Engineering & Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gary Reynolds
- Department of Rheumatology, University of Newcastle, Newcastle, United Kingdom
| | - Ann W Morgan
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eric O Aboagye
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Anthony P Davenport
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Helle F Jørgensen
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ziad Mallat
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Martin R Bennett
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - James E Peters
- Centre for Inflammatory Disease, Imperial College London, London, United Kingdom
| | - James H F Rudd
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Justin C Mason
- Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom; Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
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19
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Abstract
Multimodality cardiovascular imaging is an essential component of the clinical management of patients with large-vessel vasculitis (LVV), a chronic, relapsing and remitting inflammatory disease of the aorta and its major branches. Imaging is needed to confirm the initial diagnosis, to survey the extent and severity of arterial involvement, to screen for cardiovascular complications and for subsequent long-term disease monitoring. Indeed, diagnosing LVV can be challenging due to the non-specific nature of the presenting symptoms, which often evoke a broad differential. Identification of disease flares and persistent residual arteritis following conventional treatments for LVV present additional clinical challenges. However, by identifying and tracking arterial inflammation and injury, multimodality imaging can help direct the use of disease-modifying treatments that suppress inflammation and prevent or slow disease progression. Each of the non-invasive imaging modalities can provide unique and complementary information, contributing to different aspects of the overall clinical assessment. This article provides a focused review of the many roles of multimodality imaging in LVV.
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Affiliation(s)
- Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Heart & Lung Research Institute, Cambridge, UK
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
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20
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Ćorović A, Gopalan D, Wall C, Peverelli M, Hoole SP, Calvert PA, Manavaki R, Fryer TD, Aloj L, Graves MJ, Bennett MR, Rudd JH, Tarkin JM. Novel Approach for Assessing Postinfarct Myocardial Injury and Inflammation Using Hybrid Somatostatin Receptor Positron Emission Tomography/Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2023; 16:e014538. [PMID: 36649455 PMCID: PMC9848209 DOI: 10.1161/circimaging.122.014538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Andrej Ćorović
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Trust, United Kingdom (D.G.)
| | - Christopher Wall
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - Marta Peverelli
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - Stephen P. Hoole
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
- Department of Cardiology, Royal Papworth Hospital NHS Trust, United Kingdom (S.P.H., P.A.C.)
| | - Patrick A. Calvert
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
- Department of Cardiology, Royal Papworth Hospital NHS Trust, United Kingdom (S.P.H., P.A.C.)
| | - Roido Manavaki
- Department of Radiology (R.M., L.A., M.J.G.), University of Cambridge, United Kingdom
| | - Tim D. Fryer
- Department of Clinical Neurosciences (T.D.F.), University of Cambridge, United Kingdom
| | - Luigi Aloj
- Department of Radiology (R.M., L.A., M.J.G.), University of Cambridge, United Kingdom
| | - Martin J. Graves
- Department of Radiology (R.M., L.A., M.J.G.), University of Cambridge, United Kingdom
| | - Martin R. Bennett
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - James H.F. Rudd
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - Jason M. Tarkin
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
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21
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Gopalan D, Riley J, Leong K, Alsanjari S, Ariff B, Auger W, Lindholm P. Biatrial Volumetric Assessment by Non-ECG-Gated CT Pulmonary Angiography Correlated with Transthoracic Echocardiography in Patients with Normal Diastology. Tomography 2022; 8:2761-2771. [PMID: 36412689 PMCID: PMC9680340 DOI: 10.3390/tomography8060230] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
Atrial size is a predictor of cardiovascular mortality. Non-ECG-gated computed tomography pulmonary angiography (CTPA) is a common test for cardiopulmonary evaluation but normative values for biatrial volumes are lacking. We derived normal CT biatrial volumes using manual and semiautomated segmentation with contemporaneous transthoracic echocardiography (TTE) to confirm normal diastology. Thirty-five consecutive cases in sinus rhythm with no history of cardio-vascular, renal, or pulmonary disease and normal diastolic function were selected. Planimetric CTPA measurements were compared to TTE volumes measured using area length method. TTE and CTPA derived normal LAVi and RAVi were 27 + 5 and 20 + 6 mL/m2, and 30 + 8 and 29 + 9 mL/m2, respectively. Bland-Altman analysis revealed an underestimation of biatrial volumes by TTE. TTE-CT mean biases for LAV and RAV were -5.7 + 12.0 mL and -16.2 + 14.8 mL, respectively. The CT intraclass correlation coefficients (ICC 95% CI) for LA and RA volumes were 0.99 (0.96-1.00) and 0.96 (0.76-0.99), respectively. There was excellent correlation (p < 0.001) between the semiautomated and manual measurements for LA (r 0.99, 95% CI 0.98-0.99) and RA (r 0.99, 95% CI 0.99-1.00). Atrial volumetric assessment on CTPA is easy and reproducible and can provide additional metric in cardiopulmonary assessment.
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Affiliation(s)
- Deepa Gopalan
- Department of Physiology & Pharmacology, Karolinska Institute, 17177 Stockholm, Sweden
- Department of Radiology, Imperial College Healthcare, London W12 0HS, UK
- Correspondence:
| | - Jan Riley
- Department of Radiology, Monash Health, Melbourne 3168, Australia
| | - Kai’En Leong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne 3052, Australia
| | - Senan Alsanjari
- Department of Radiology, Imperial College Healthcare, London W12 0HS, UK
| | - Ben Ariff
- Department of Radiology, Imperial College Healthcare, London W12 0HS, UK
| | - Willam Auger
- Department of Pulmonary Medicine, University of California, San Diego, CA 92037, USA
| | - Peter Lindholm
- Department of Physiology & Pharmacology, Karolinska Institute, 17177 Stockholm, Sweden
- Department of Emergency Medicine, University of California, San Diego, CA 92103, USA
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22
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Corovic A, Nus M, Peverelli M, Gopalan D, Calvert PA, Hoole SP, Manavaki R, Fryer T, Aloj L, Graves MJ, Dweck MR, Newby DE, Mallat Z, Rudd JHF, Tarkin JM. Imaging of post-infarct myocardial inflammation with 68Ga-DOTATATE PET/MRI. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.321] [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: 11/14/2022] Open
Abstract
Abstract
Background
After myocardial infarction (MI), inflammation and its resolution modulate the extent of myocardial damage. 68Ga-DOTATATE is a PET tracer that binds to somatostatin receptor 2 (SST2), which is up-regulated in pro-inflammatory macrophages [1].
Purpose
We investigated 68Ga-DOTATATE PET/MRI for quantifying post-infarct myocardial inflammation.
Methods
In this prospective observational cohort study, participants with MI underwent 68Ga-DOTATATE PET/MRI at baseline (t0: <2 weeks post-MI) and 3 months (t3M). Patients with prior MI, heart failure, coronary revascularisation, or contraindication to PET/MRI, were excluded. Blood samples were taken at the time of imaging for high sensitivity CRP (hsCRP), high sensitivity troponin I (hsTnI), NTproBNP and peripheral blood monocyte subset counts measured by mass cytometry. 68Ga-DOTATATE maximum Standardised Uptake Values (SUV) and Tissue-to-Background Ratios (TBR) adjusted for blood pool activity were compared in the infarct defined by late gadolinium enhancement (LGE) MRI to remote myocardium at t0 and t3M.
Results
Thirty-two patients (mean age 59 [SD 9] years; 26 [81%] male and 6 [19%] female), comprised of 18 (56%) patients with ST elevation MI and 14 (44%) with non-ST elevation MI, were enrolled. Mean peak troponin was 16,953ng/L (range 408 to >25,000ng/L), and 16 (52%) patients had left ventricular impairment (ejection fraction <50%).
68Ga-DOTATATE PET signal co-localised with myocardial LGE and focal oedema (arrows) on T2-weighted MRI (Fig. 1; asterisk: culprit artery) and had excellent ability to discriminate infarct from remote regions (t0: infarct SUV 2.41 vs. remote 1.58, p<0.0001; t0: infarct TBR 5.08 vs. 3.35, p<0.0001; Fig. 2a).
At 100 (SD 13) days after MI (n=23 patients), residual 68Ga-DOTATATE uptake in the infarct remained higher than remote myocardium (t3M: infarct SUV 1.88 vs. remote 1.27, p<0.0001; t3M: infarct TBR 3.96 vs. remote 2.73, p<0.0001), but was reduced compared to baseline (SUV −22%, p<0.0001; TBR −22%, p=0.002; Fig. 2b).
Reduction in infarct 68Ga-DOTATATE uptake was consistent with overall decreases in hsCRP (2.16 vs. 8.76 mg/L), hsTnI (19 vs. 1365 ng/L) and NTproBNP (372 vs. 959 pg/mL) at t3M vs. t0 (n=23, all p<0.05). Focal oedema on MRI was resolved in 17 (74%) patients at t3M. Infarct-to-remote TBR ratio at t0 was correlated with hsTnI (r=0.35, p<0.05). At t3M (n=9 samples) vs t0 (n=20 samples), there was a reduction in % classical-to-non-classical ratio of peripheral monocytes (mean 6.5 [SD 3.8] vs. 14.4 [SD 11.2], p=0.005).
Conclusions
This is the first prospective study of serial 68Ga-DOTATATE PET/MRI in patients after MI. Here we show that 68Ga-DOTATATE tracks resolving myocardial inflammation. Ongoing work as part of this study seeks to confirm the cellular origin of infarct-related 68Ga-DOTATATE PET signal and SST2 expression within inflamed myocardial tissue, and test its longer-term association with ischaemic myocardial remodelling.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome TrustBritish Heart Foundation
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Affiliation(s)
- A Corovic
- University of Cambridge , Cambridge , United Kingdom
| | - M Nus
- University of Cambridge , Cambridge , United Kingdom
| | - M Peverelli
- University of Cambridge , Cambridge , United Kingdom
| | - D Gopalan
- Cambridge University Hospitals NHS Foundation Trust , Cambridge , United Kingdom
| | - P A Calvert
- Royal Papworth Hospital NHS Foundation Trust , Cambridge , United Kingdom
| | - S P Hoole
- Royal Papworth Hospital NHS Foundation Trust , Cambridge , United Kingdom
| | - R Manavaki
- University of Cambridge , Cambridge , United Kingdom
| | - T Fryer
- University of Cambridge , Cambridge , United Kingdom
| | - L Aloj
- University of Cambridge , Cambridge , United Kingdom
| | - M J Graves
- University of Cambridge , Cambridge , United Kingdom
| | - M R Dweck
- University of Edinburgh , Edinburgh , United Kingdom
| | - D E Newby
- University of Edinburgh , Edinburgh , United Kingdom
| | - Z Mallat
- University of Cambridge , Cambridge , United Kingdom
| | - J H F Rudd
- University of Cambridge , Cambridge , United Kingdom
| | - J M Tarkin
- University of Cambridge , Cambridge , United Kingdom
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23
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Tarkin J, Corovic A, Wall C, Nus M, Gopalan D, Huang Y, Imaz M, Zulcinski M, Reynolds G, Morgan AW, Jorgensen HF, Mallat Z, Peters JE, Rudd JHF, Mason JC. Somatostatin receptor PET/MR imaging of large vessel inflammation in active compared with inactive vasculitis and atherosclerosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.320] [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: 11/13/2022] Open
Abstract
Abstract
Background
Use of 18F-FDG PET in large vessel vasculitis (LVV) is limited by non-specific uptake due to arterial remodelling and/or atherosclerosis leading to diagnostic uncertainty.
Purpose
To investigate somatostatin receptor 2 (SST2) as a novel inflammation-specific PET imaging target in LVV.
Methods
In a prospective observational cohort study, we tested the ability of PET/MRI using two somatostatin receptor tracers (68Ga-DOTATATE and 18F-FET-βAG-TOCA) to differentiate active from inactive LVV, and aortic atherosclerosis in patients with recent myocardial infarction. Ex vivo mapping of the imaging target was performed using immunofluorescence microscopy, imaging mass cytometry, and bulk, single-cell and single-nuclei RNA sequencing of temporal artery biopsies from LVV patients.
Results
Sixty-one participants were included (LVV, n=27; myocardial infarction ≤2 weeks, n=25; control subjects with an oncological indication for imaging, n=9). LVV patients (mean age 58 [SD 16] years; 78% female; 63% active or grumbling disease) had giant cell arteritis (n=13), Takayasu arteritis (n=13), or unspecified LVV (n=1). Baseline index vessel SST2 PET maximum tissue-to-blood ratio (TBRmax) was 61.8% (95% CI 31.5–99.0%, p<0.0001) higher in patients with active/grumbling LVV than inactive LVV, and 34.6% (95% CI 15.1–57.6%, p=0.0002) higher than recent myocardial infarction (Fig. 1a–c; arrow: PET signal; arrowhead: aortic thickening; asterisk: aortic atherosclerosis), with good diagnostic accuracy (AUC ≥0.86, p<0.001 for both). None of the control subjects without LVV or MI had increased arterial SST2 PET signal (Fig. 1d).
Mean aortic TBRmax was strongly correlated with Indian Takayasu Clinical Activity Score (r=0.82 [95% CI 0.46–0.95], p=0.001) and maximum wall thickness on MRI (r=0.68 [95% CI 0.31–0.87], p=0.002). SST2 PET/MRI was generally consistent with 18F-FDG PET/CT in LVV patients with contemporaneous scans (Fig. 1a, b), but with very low background signal in the brain and heart allowing for unimpeded assessment of nearby coronary, myocardial, and intracranial artery involvement. On follow-up imaging after a mean 9.3 (SD 3.2) months, clinically effective treatment for LVV was associated with a 0.49 ±SEM 0.24 (p=0.04; 22.3%) reduction in SST2 PET TBRmax, with good scan-scan repeatability in inactive LVV patients with no change in treatment (ICC 0.86, 95% CI 0.04–0.99).
SST2 localised to macrophages, pericytes, and perivascular adipocytes in inflamed arterial specimens (Fig. 2; a: H&E; b: imaging mass cytometry; arrow: SST2/CD68 co-staining). SSTR2-expressing macrophages co-expressed pro-inflammatory markers (S100A8, S100A9). Specific SST2 radioligand binding was confirmed by autoradiography in LVV specimens.
Conclusion
This is the first study to examine SST2 PET/MRI in LVV and to provide histological and gene expression data for validation. Here we show this novel approach holds major promise for diagnosis and therapeutic monitoring in LVV.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome Trust; Imperial NIHR Biomedical Research Centre
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Affiliation(s)
- J Tarkin
- University of Cambridge , Cambridge , United Kingdom
| | - A Corovic
- University of Cambridge , Cambridge , United Kingdom
| | - C Wall
- University of Cambridge , Cambridge , United Kingdom
| | - M Nus
- University of Cambridge , Cambridge , United Kingdom
| | - D Gopalan
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - Y Huang
- University of Cambridge , Cambridge , United Kingdom
| | - M Imaz
- University of Cambridge , Cambridge , United Kingdom
| | - M Zulcinski
- University of Leeds , Leeds , United Kingdom
| | - G Reynolds
- Newcastle University , Newcastle-Upon-Tyne , United Kingdom
| | - A W Morgan
- University of Leeds , Leeds , United Kingdom
| | - H F Jorgensen
- University of Cambridge , Cambridge , United Kingdom
| | - Z Mallat
- University of Cambridge , Cambridge , United Kingdom
| | - J E Peters
- Imperial College London , London , United Kingdom
| | - J H F Rudd
- University of Cambridge , Cambridge , United Kingdom
| | - J C Mason
- Imperial College London , London , United Kingdom
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24
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Seneschall C, Ferguson C, Gopalan D, Salisbury E. Correction to: Long term central venous catheters for haemodialysis causing an extra-cardiac right-to-left shunt. J Nephrol 2022; 35:1549. [PMID: 35583598 DOI: 10.1007/s40620-022-01357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Charlotte Seneschall
- Imperial College London, London, UK. .,Imperial College Healthcare NHS Trust, London, UK.
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25
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Leong K, Howard L, Lo Giudice F, Pavey H, Davies R, Haji G, Gibbs S, Gopalan D. MRI Feature Tracking Strain in Pulmonary Hypertension: Utility of Combined Left Atrial Volumetric and Deformation Assessment in Distinguishing Post- From Pre-capillary Physiology. Front Cardiovasc Med 2022; 9:787656. [PMID: 35369294 PMCID: PMC8968034 DOI: 10.3389/fcvm.2022.787656] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
AimsPulmonary hypertension (PH) is dichotomized into pre- and post-capillary physiology by invasive catheterization. Imaging, particularly strain assessment, may aid in classification and be helpful with ambiguous hemodynamics. We sought to define cardiac MRI (CMR) feature tracking biatrial peak reservoir and biventricular peak systolic strain in pre- and post-capillary PH and examine the performance of peak left atrial strain in distinguishing the 2 groups compared to TTE.Methods and ResultsRetrospective cross-sectional study from 1 Jan 2015 to 31 Dec 2020; 48 patients (22 pre- and 26 post-capillary) were included with contemporaneous TTE, CMR and catheterization. Mean pulmonary artery pressures were higher in the pre-capillary cohort (55 ± 14 vs. 42 ± 9 mmHg; p < 0.001) as was pulmonary vascular resistance (median 11.7 vs. 3.7 WU; p < 0.001). Post-capillary patients had significantly larger left atria (60 ± 22 vs. 25 ± 9 ml/m2; p < 0.001). There was no difference in right atrial volumes between groups (60 ± 21 vs. 61 ± 29 ml/m2; p = 0.694), however peak RA strain was lower in post-capillary PH patients (8.9 ± 5.5 vs. 18.8 ± 7.0%; p < 0.001). In the post-capillary group, there was commensurately severe peak strain impairment in both atria (LA strain 9.0 ± 5.8%, RA strain 8.9 ± 5.5%). CMR LAVi and peak LA strain had a multivariate AUC of 0.98 (95% CI 0.89–1.00; p < 0.001) for post-capillary PH diagnosis which was superior to TTE.ConclusionCMR volumetric and deformation assessment of the left atrium can highly accurately distinguish post- from pre-capillary PH.
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Affiliation(s)
- Kai'En Leong
- Department of Radiology, Imperial College National Health Service Trust/Hammersmith Hospital, London, United Kingdom
- Department of Cardiology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Luke Howard
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Francesco Lo Giudice
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
- Department of Cardiology, Imperial College National Health Service Trust/Hammersmith Hospital, London, United Kingdom
| | - Holly Pavey
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Davies
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
| | - Gulammehdi Haji
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
| | - Simon Gibbs
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Imperial College National Health Service Trust/Hammersmith Hospital, London, United Kingdom
- Department of Radiology, Cambridge University Hospitals National Health Service Trust, Cambridge, United Kingdom
- *Correspondence: Deepa Gopalan
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Williams MC, Weir-McCall J, Moss AJ, Schmitt M, Stirrup J, Holloway B, Gopalan D, Deshpande A, Hughes GM, Agrawal B, Nicol E, Roditi G, Shambrook J, Bull R. Radiologist opinions regarding reporting incidental coronary and cardiac calcification on thoracic CT. BJR Open 2022; 4:20210057. [PMID: 36105421 PMCID: PMC9459857 DOI: 10.1259/bjro.20210057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/07/2022] [Accepted: 02/12/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives Coronary and cardiac calcification are frequent incidental findings on non-gated thoracic computed tomography (CT). However, radiologist opinions and practices regarding the reporting of incidental calcification are poorly understood. Methods UK radiologists were invited to complete this online survey, organised by the British Society of Cardiovascular Imaging (BSCI). Questions included anonymous information on subspecialty, level of training and reporting practices for incidental coronary artery, aortic valve, mitral and thoracic aorta calcification. Results The survey was completed by 200 respondents: 10% trainees and 90% consultants. Calcification was not reported by 11% for the coronary arteries, 22% for the aortic valve, 35% for the mitral valve and 37% for the thoracic aorta. Those who did not subspecialise in cardiac imaging were less likely to report coronary artery calcification (p = 0.005), aortic valve calcification (p = 0.001) or mitral valve calcification (p = 0.008), but there was no difference in the reporting of thoracic aorta calcification. Those who did not subspecialise in cardiac imaging were also less likely to provide management recommendations for coronary artery calcification (p < 0.001) or recommend echocardiography for aortic valve calcification (p < 0.001), but there was no difference for mitral valve or thoracic aorta recommendations. Conclusion Incidental coronary artery, valvular and aorta calcification are frequently not reported on thoracic CT and there are differences in reporting practices based on subspeciality. Advances in knowledge On routine thoracic CT, 11% of radiologists do not report coronary artery calcification. Radiologist reporting practices vary depending on subspeciality but not level of training.
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Affiliation(s)
- Michelle C Williams
- BHF Centre for Cardiovascular Science and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | | | - Alastair J Moss
- British Heart Foundation Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Matthias Schmitt
- North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Ben Holloway
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Aparna Deshpande
- Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | | | | | - Edward Nicol
- Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, London, UK
| | - Giles Roditi
- Dept. of Radiology, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow, UK; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Wall C, Huang Y, Le EPV, Ćorović A, Uy CP, Gopalan D, Ma C, Manavaki R, Fryer TD, Aloj L, Graves MJ, Tombetti E, Ariff B, Bambrough P, Hoole SP, Rusk RA, Jayne DR, Dweck MR, Newby D, Fayad ZA, Bennett MR, Peters JE, Slomka P, Dey D, Mason JC, Rudd JHF, Tarkin JM. Pericoronary and periaortic adipose tissue density are associated with inflammatory disease activity in Takayasu arteritis and atherosclerosis. Eur Heart J Open 2021; 1:oeab019. [PMID: 34661196 PMCID: PMC8508012 DOI: 10.1093/ehjopen/oeab019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 12/20/2022]
Abstract
AIMS To examine pericoronary adipose tissue (PCAT) and periaortic adipose tissue (PAAT) density on coronary computed tomography angiography for assessing arterial inflammation in Takayasu arteritis (TAK) and atherosclerosis. METHODS AND RESULTS PCAT and PAAT density was measured in coronary (n = 1016) and aortic (n = 108) segments from 108 subjects [TAK + coronary artery disease (CAD), n = 36; TAK, n = 18; atherosclerotic CAD, n = 32; matched controls, n = 22]. Median PCAT and PAAT densities varied between groups (mPCAT: P < 0.0001; PAAT: P = 0.0002). PCAT density was 7.01 ± standard error of the mean (SEM) 1.78 Hounsfield Unit (HU) higher in coronary segments from TAK + CAD patients than stable CAD patients (P = 0.0002), and 8.20 ± SEM 2.04 HU higher in TAK patients without CAD than controls (P = 0.0001). mPCAT density was correlated with Indian Takayasu Clinical Activity Score (r = 0.43, P = 0.001) and C-reactive protein (r = 0.41, P < 0.0001) and was higher in active vs. inactive TAK (P = 0.002). mPCAT density above -74 HU had 100% sensitivity and 95% specificity for differentiating active TAK from controls [area under the curve = 0.99 (95% confidence interval 0.97-1)]. The association of PCAT density and coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography (PET) equated to an increase of 2.44 ± SEM 0.77 HU in PCAT density for each unit increase in 68Ga-DOTATATE maximum tissue-to-blood ratio (P = 0.002). These findings remained in multivariable sensitivity analyses adjusted for potential confounders. CONCLUSIONS PCAT and PAAT density are higher in TAK than atherosclerotic CAD or controls and are associated with clinical, biochemical, and PET markers of inflammation. Owing to excellent diagnostic accuracy, PCAT density could be useful as a clinical adjunct for assessing disease activity in TAK.
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Affiliation(s)
- Christopher Wall
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Yuan Huang
- EPSRC Centre for Mathematical Imaging in Healthcare, University of Cambridge, Cambridge, UK
| | - Elizabeth P V Le
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Andrej Ćorović
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Christopher P Uy
- Vascular Sciences, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - Chuoxin Ma
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Roido Manavaki
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Luigi Aloj
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Enrico Tombetti
- Department of biomedical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Ben Ariff
- Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - Paul Bambrough
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK CB2 0AY, UK
| | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK CB2 0AY, UK
| | - Rosemary A Rusk
- Department of Cardiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
| | - David R Jayne
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - David Newby
- Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Zahi A Fayad
- BioMedical Engineering & Imaging Institute, Icahn School of Medicine at Mt Sinai, Gustave L. Levy Place, New York, NY 10029-5674, USA
| | - Martin R Bennett
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - James E Peters
- Centre for Inflammatory Diseases, Imperial College London, London, UK
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Los Angeles, CA, 90048, USA
| | - Justin C Mason
- Vascular Sciences, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
- Vascular Sciences, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
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Kudo T, Lahey R, Hirschfeld CB, Williams MC, Lu B, Alasnag M, Bhatia M, Henry Bom HS, Dautov T, Fazel R, Karthikeyan G, Keng FY, Rubinshtein R, Better N, Cerci RJ, Dorbala S, Raggi P, Shaw LJ, Villines TC, Vitola JV, Choi AD, Malkovskiy E, Goebel B, Cohen YA, Randazzo M, Pascual TN, Pynda Y, Dondi M, Paez D, Einstein AJ, Einstein AJ, Paez D, Dondi M, Better N, Cerci R, Dorbala S, Pascual TN, Raggi P, Shaw LJ, Villines TC, Vitola JV, Williams MC, Pynda Y, Hinterleitner G, Lu Y, Morozova O, Xu Z, Hirschfeld CB, Cohen Y, Goebel B, Malkovskiy E, Randazzo M, Choi A, Lopez-Mattei J, Parwani P, Nasery MN, Goda A, Shirka E, Benlabgaa R, Bouyoucef S, Medjahedi A, Nailli Q, Agolti M, Aguero RN, Alak MDC, Alberguina LG, Arroñada G, Astesiano A, Astesiano A, Norton CB, Benteo P, Blanco J, Bonelli JM, Bustos JJ, Cabrejas R, Cachero J, Campisi R, Canderoli A, Carames S, Carrascosa P, Castro R, Cendoya O, Cognigni LM, Collaud C, Collaud C, Cortes C, Courtis J, Cragnolino D, Daicz M, De La Vega A, De Maria ST, Del Riego H, Dettori F, Deviggiano A, Dragonetti L, Embon M, Enriquez RE, Ensinas J, Faccio F, Facello A, Topping W, Tweed K, Weir-Mccall J, Abbara S, Abbasi T, Abbott B, Abohashem S, Abramson S, Al-Abboud T, Al-Mallah M, Garofalo D, Almousalli O, Ananthasubramaniam K, Kumar MA, Askew J, Attanasio L, Balmer-Swain M, Bayer RR, Bernheim A, Bhatti S, Bieging E, Geronazzo R, Blankstein R, Bloom S, Blue S, Bluemke D, Borges A, Branch K, Bravo P, Brothers J, Budoff M, Bullock-Palmer R, Gonza N, Burandt A, Burke FW, Bush K, Candela C, Capasso E, Cavalcante J, Chang D, Chatterjee S, Chatzizisis Y, Cheezum M, Gutierrez L, Chen T, Chen J, Chen M, Choi A, Clarcq J, Cordero A, Crim M, Danciu S, Decter B, Dhruva N, Guzzo MA, Doherty N, Doukky R, Dunbar A, Duvall W, Edwards R, Esquitin K, Farah H, Fentanes E, Ferencik M, Fisher D, Guzzo MA, Fitzpatrick D, Foster C, Fuisz T, Gannon M, Gastner L, Gerson M, Ghoshhajra B, Goldberg A, Goldner B, Gonzalez J, Hasbani V, Gore R, Gracia-López S, Hage F, Haider A, Haider S, Hamirani Y, Hassen K, Hatfield M, Hawkins C, Hawthorne K, Huerin M, Heath N, Hendel R, Hernandez P, Hill G, Horgan S, Huffman J, Hurwitz L, Iskandrian A, Janardhanan R, Jellis C, Jäger V, Jerome S, Kalra D, Kaviratne S, Kay F, Kelly F, Khalique O, Kinkhabwala M, Iii GK, Kircher J, Kirkbride R, Lewkowicz JM, Kontos M, Kottam A, Krepp J, Layer J, Lee SH, Leppo J, Lesser J, Leung S, Lewin H, Litmanovich D, López De Munaín MNA, Liu Y, Lopez-Mattei J, Magurany K, Markowitz J, Marn A, Matis SE, Mckenna M, Mcrae T, Mendoza F, Merhige M, Lotti JM, Min D, Moffitt C, Moncher K, Moore W, Morayati S, Morris M, Mossa-Basha M, Mrsic Z, Murthy V, Nagpal P, Marquez A, Napier K, Nelson K, Nijjar P, Osman M, Parwani P, Passen E, Patel A, Patil P, Paul R, Phillips L, Masoli O, Polsani V, Poludasu R, Pomerantz B, Porter T, Prentice R, Pursnani A, Rabbat M, Ramamurti S, Rich F, Luna HR, Masoli OH, Robinson A, Robles K, Rodríguez C, Rorie M, Rumberger J, Russell R, Sabra P, Sadler D, Schemmer M, Schoepf UJ, Mastrovito E, Shah S, Shah N, Shanbhag S, Sharma G, Shayani S, Shirani J, Shivaram P, Sigman S, Simon M, Slim A, Mayoraz M, Smith D, Smith A, Soman P, Sood A, Srichai-Parsia MB, Streeter J, T A, Tawakol A, Thomas D, Thompson R, Melado GE, Torbet T, Trinidad D, Ullery S, Unzek S, Uretsky S, Vallurupalli S, Verma V, Waller A, Wang E, Ward P, Mele A, Weissman G, Wesbey G, White K, Winchester D, Wolinsky D, Yost S, Zgaljardic M, Alonso O, Beretta M, Ferrando R, Merani MF, Kapitan M, Mut F, Djuraev O, Rozikhodjaeva G, Le Ngoc H, Mai SH, Nguyen XC, Meretta AH, Molteni S, Montecinos M, Noguera E, Novoa C, Sueldo CP, Ascani SP, Pollono P, Pujol MP, Radzinschi A, Raimondi G, Redruello M, Rodríguez M, Rodríguez M, Romero RL, Acuña AR, Rovaletti F, San Miguel L, Solari L, Strada B, Traverso S, Traverzo SS, Espeche MDHV, Weihmuller JS, Wolcan J, Zeffiro S, Sakanyan M, Beuzeville S, Boktor R, Butler P, Calcott J, Carr L, Chan V, Chao C, Chong W, Dobson M, Downie D, Dwivedi G, Elison B, Engela J, Francis R, Gaikwad A, Basavaraj AG, Goodwin B, Greenough R, Hamilton-Craig C, Hsieh V, Joshi S, Lederer K, Lee K, Lee J, Magnussen J, Mai N, Mander G, Murton F, Nandurkar D, Neill J, O'Rourke E, O'Sullivan P, Pandos G, Pathmaraj K, Pitman A, Poulter R, Premaratne M, Prior D, Ridley L, Rutherford N, Salehi H, Saunders C, Scarlett L, Seneviratne S, Shetty D, Shrestha G, Shulman J, Solanki V, Stanton T, Stuart M, Stubbs M, Swainson I, Taubman K, Taylor A, Thomas P, Unger S, Upton A, Vamadevan S, Van Gaal W, Verjans J, Voutnis D, Wayne V, Wilson P, Wong D, Wong K, Younger J, Feuchtner G, Mirzaei S, Weiss K, Maroz-Vadalazhskaya N, Gheysens O, Homans F, Moreno-Reyes R, Pasquet A, Roelants V, Van De Heyning CM, Ríos RA, Soldat-Stankovic V, Stankovic S, Albernaz Siqueira MH, Almeida A, Alves Togni PH, Andrade JH, Andrade L, Anselmi C, Araújo R, Azevedo G, Bezerra S, Biancardi R, Grossman GB, Brandão S, Pianta DB, Carreira L, Castro B, Chang T, Cunali F, Cury R, Dantas R, de Amorim Fernandes F, De Lorenzo A, De Macedo Filho R, Erthal F, Fernandes F, Fernandes J, Fernandes F, De Souza TF, Alves WF, Ghini B, Goncalves L, Gottlieb I, Hadlich M, Kameoka V, Lima R, Lima A, Lopes RW, Machado e Silva R, Magalhães T, Silva FM, Mastrocola LE, Medeiros F, Meneghetti JC, Naue V, Naves D, Nolasco R, Nomura C, Oliveira JB, Paixao E, De Carvalho FP, Pinto I, Possetti P, Quinta M, Nogueira Ramos RR, Rocha R, Rodrigues A, Rodrigues C, Romantini L, Sanches A, Santana S, Sara da Silva L, Schvartzman P, Matushita CS, Senra T, Shiozaki A, Menezes de Siqueira ME, Siqueira C, Smanio P, Soares CE, Junior JS, Bittencourt MS, Spiro B, Mesquita CT, Torreao J, Torres R, Uellendahl M, Monte GU, Veríssimo O, Cabeda EV, Pedras FV, Waltrick R, Zapparoli M, Naseer H, Garcheva-Tsacheva M, Kostadinova I, Theng Y, Abikhzer G, Barette R, Chow B, Dabreo D, Friedrich M, Garg R, Hafez MN, Johnson C, Kiess M, Leipsic J, Leung E, Miller R, Oikonomou A, Probst S, Roifman I, Small G, Tandon V, Trivedi A, White J, Zukotynski K, Canessa J, Muñoz GC, Concha C, Hidalgo P, Lovera C, Massardo T, Vargas LS, Abad P, Arturo H, Ayala S, Benitez L, Cadena A, Caicedo C, Moncayo AC, Moncayo AC, Gomez S, Gutierrez Villamil CT, Jaimes C, Londoño J, Londoño Blair JL, Pabon L, Pineda M, Rojas JC, Ruiz D, Escobar MV, Vasquez A, Vergel D, Zuluaga A, Gamboa IB, Castro G, González U, Baric A, Batinic T, Franceschi M, Paar MH, Jukic M, Medakovic P, Persic V, Prpic M, Punda A, Batista JF, Gómez Lauchy JM, Gutierrez YM, Gutierrez YM, Menéndez R, Peix A, Rochela L, Panagidis C, Petrou I, Engelmann V, Kaminek M, Kincl V, Lang O, Simanek M, Abdulla J, Bøttcher M, Christensen M, Gormsen LC, Hasbak P, Hess S, Holdgaard P, Johansen A, Kyhl K, Norgaard BL, Øvrehus KA, Rønnow Sand NP, Steffensen R, Thomassen A, Zerahn B, Perez A, Escorza Velez GA, Velez MS, Abdel Aziz IS, Abougabal M, Ahmed T, Allam A, Asfour A, Hassan M, Hassan A, Ibrahim A, Kaffas S, Kandeel A, Ali MM, Mansy A, Maurice H, Nabil S, Shaaban M, Flores AC, Poksi A, Knuuti J, Kokkonen V, Larikka M, Uusitalo V, Bailly M, Burg S, Deux JF, Habouzit V, Hyafil F, Lairez O, Proffit F, Regaieg H, Sarda-Mantel L, Tacher V, Schneider RP, Ayetey H, Angelidis G, Archontaki A, Chatziioannou S, Datseris I, Fragkaki C, Georgoulias P, Koukouraki S, Koutelou M, Kyrozi E, Repasos E, Stavrou P, Valsamaki P, Gonzalez C, Gutierrez G, Maldonado A, Buga K, Garai I, Maurovich-Horvat P, Schmidt E, Szilveszter B, Várady E, Banthia N, Bhagat JK, Bhargava R, Bhat V, Bhatia M, Choudhury P, Chowdekar VS, Irodi A, Jain S, Joseph E, Kumar S, Girijanandan Mahapatra PD, Mitra D, Mittal BR, Ozair A, Patel C, Patel T, Patel R, Patel S, Saxena S, Sengupta S, Singh S, Singh B, Sood A, Verma A, Affandi E, Alam PS, Edison E, Gunawan G, Hapkido H, Hidayat B, Huda A, Mukti AP, Prawiro D, Soeriadi EA, Syawaluddin H, Albadr A, Assadi M, Emami F, Houshmand G, Maleki M, Rostami MT, Zakavi SR, Zaid EA, Agranovich S, Arnson Y, Bar-Shalom R, Frenkel A, Knafo G, Lugassi R, Maor Moalem IS, Mor M, Muskal N, Ranser S, Shalev A, Albano D, Alongi P, Arnone G, Bagatin E, Baldari S, Bauckneht M, Bertelli P, Bianco F, Bonfiglioli R, Boni R, Bruno A, Bruno I, Busnardo E, Califaretti E, Camoni L, Carnevale A, Casoni R, Cavallo AU, Cavenaghi G, Chierichetti F, Chiocchi M, Cittanti C, Colletta M, Conti U, Cossu A, Cuocolo A, Cuzzocrea M, De Rimini ML, De Vincentis G, Del Giudice E, Del Torto A, Della Tommasina V, Durmo R, Erba PA, Evangelista L, Faletti R, Faragasso E, Farsad M, Ferro P, Florimonte L, Frantellizzi V, Fringuelli FM, Gatti M, Gaudiano A, Gimelli A, Giubbini R, Giuffrida F, Ialuna S, Laudicella R, Leccisotti L, Leva L, Liga R, Liguori C, Longo G, Maffione M, Mancini ME, Marcassa C, Milan E, Nardi B, Pacella S, Pepe G, Pontone G, Pulizzi S, Quartuccio N, Rampin L, Ricci F, Rossini P, Rubini G, Russo V, Sacchetti GM, Sambuceti G, Scarano M, Sciagrà R, Sperandio M, Stefanelli A, Ventroni G, Zoboli S, Baugh D, Chambers D, Madu E, Nunura F, Asano H, Chimura CM, Fujimoto S, Fujisue K, Fukunaga T, Fukushima Y, Fukuyama K, Hashimoto J, Ichikawa Y, Iguchi N, Imai M, Inaki A, Ishimura H, Isobe S, Kadokami T, Kato T, Kudo T, Kumita S, Maruno H, Mataki H, Miyagawa M, Morimoto R, Moroi M, Nagamachi S, Nakajima K, Nakata T, Nakazato R, Nanasato M, Naya M, Norikane T, Ohta Y, Okayama S, Okizaki A, Otomi Y, Otsuka H, Saito M, Sakata SY, Sarai M, Sato D, Shiraishi S, Suwa Y, Takanami K, Takehana K, Taki J, Tamaki N, Taniguchi Y, Teragawa H, Tomizawa N, Tsujita K, Umeji K, Wakabayashi Y, Yamada S, Yamazaki S, Yoneyama T, Rawashdeh M, Batyrkhanov D, Dautov T, Makhdomi K, Ombati K, Alkandari F, Garashi M, Coie TL, Rajvong S, Kalinin A, Kalnina M, Haidar M, Komiagiene R, Kviecinskiene G, Mataciunas M, Vajauskas D, Picard C, Karim NKA, Reichmuth L, Samuel A, Allarakha MA, Naojee AS, Alexanderson-Rosas E, Barragan E, González-Montecinos AB, Cabada M, Rodriguez DC, Carvajal-Juarez I, Cortés V, Cortés F, De La Peña E, Gama-Moreno M, González L, Ramírez NG, Jiménez-Santos M, Matos L, Monroy E, Morelos M, Ornelas M, Ortga Ramirez JA, Preciado-Anaya A, Preciado-Gutiérrez ÓU, Barragan AP, Rosales Uvera SG, Sandoval S, Tomas MS, Sierra-Galan LM, Sierra-Galan LM, Siu S, Vallejo E, Valles M, Faraggi M, Sereegotov E, Ilic S, Ben-Rais N, Alaoui NI, Taleb S, Pa Myo KP, Thu PS, Ghimire RK, Rajbanshi B, Barneveld P, Glaudemans A, Habets J, Koopmans KP, Manders J, Pool S, Scholte A, Scholtens A, Slart R, Thimister P, Van Asperen EJ, Veltman N, Verschure D, Wagenaar N, Edmond J, Ellis C, Johnson K, Keenan R, Kueh SH(A, Occleshaw C, Sasse A, To A, Van Pelt N, Young C, Cuadra T, Roque Vanegas HB, Soli IA, Issoufou DM, Ayodele T, Madu C, Onimode Y, Efros-Monsen E, Forsdahl SH, Hildre Dimmen JM, Jørgensen A, Krohn I, Løvhaugen P, Bråten AT, Al Dhuhli H, Al Kindi F, Al-Bulushi N, Jawa Z, Tag N, Afzal MS, Fatima S, Younis MN, Riaz M, Saadullah M, Herrera Y, Lenturut-Katal D, Vázquez MC, Ortellado J, Akhter A, Cao D, Cheung S, Dai X, Gong L, Han D, Hou Y, Li C, Li T, Li D, Li S, Liu J, Liu H, Lu B, Ng MY, Sun K, Tang G, Wang J, Wang X, Wang ZQ, Wang Y, Wang Y, Wu J, Wu Z, Xia L, Xiao J, Xu L, Yang Y, Yin W, Yu J, Yuan L, Zhang T, Zhang L, Zhang YG, Zhang X, Zhu L, Alfaro A, Abrihan P, Barroso A, Cruz E, Gomez MR, Magboo VP, Medina JM, Obaldo J, Pastrana D, Pawhay CM, Quinon A, Tang JM, Tecson B, Uson KJ, Uy M, Kostkiewicz M, Kunikowska J, Bettencourt N, Cantinho G, Ferreira A, Syed G, Arnous S, Atyani S, Byrne A, Gleeson T, Kerins D, Meehan C, Murphy D, Murphy M, Murray J, O'Brien J, Bang JI, Bom H, Cho SG, Hong CM, Jang SJ, Jeong YH, Kang WJ, Kim JY, Lee J, Namgung CK, So Y, Won KS, Majstorov V, Vavlukis M, Salobir BG, Štalc M, Benedek T, Benedek I, Mititelu R, Stan CA, Ansheles A, Dariy O, Drozdova O, Gagarina N, Gulyaev VM, Itskovich I, Karalkin A, Kokov A, Migunova E, Pospelov V, Ryzhkova D, Saifullina G, Sazonova S, Sergienko V, Shurupova I, Trifonova T, Ussov WY, Vakhromeeva M, Valiullina N, Zavadovsky K, Zhuravlev K, Alasnag M, Okarvi S, Saranovic DS, Keng F, Jason See JH, Sekar R, Yew MS, Vondrak A, Bejai S, Bennie G, Bester R, Engelbrecht G, Evbuomwan O, Gongxeka H, Vuuren MJ, Kaplan M, Khushica P, Lakhi H, Louw L, Malan N, Milos K, Modiselle M, More S, Naidoo M, Scholtz L, Vangu M, Aguadé-Bruix S, Blanco I, Cabrera A, Camarero A, Casáns-Tormo I, Cuellar-Calabria H, Flotats A, Fuentes Cañamero ME, García ME, Jimenez-Heffernan A, Leta R, Diaz JL, Lumbreras L, Marquez-Cabeza JJ, Martin F, Martinez de Alegria A, Medina F, Canal MP, Peiro V, Pubul-Nuñez V, Rayo Madrid JI, Rey CR, Perez RR, Ruiz J, Hernández GS, Sevilla A, Zeidán N, Nanayakkara D, Udugama C, Simonsson M, Alkadhi H, Buechel RR, Burger P, Ceriani L, De Boeck B, Gräni C, Juillet de Saint Lager Lucas A, Kamani CH, Kawel-Boehm N, Manka R, Prior JO, Rominger A, Vallée JP, Khiewvan B, Premprabha T, Thientunyakit T, Sellem A, Kir KM, Sayman H, Sebikali MJ, Muyinda Z, Kmetyuk Y, Korol P, Mykhalchenko O, Pliatsek V, Satyr M, Albalooshi B, Ahmed Hassan MI, Anderson J, Bedi P, Biggans T, Bularga A, Bull R, Burgul R, Carpenter JP, Coles D, Cusack D, Deshpande A, Dougan J, Fairbairn T, Farrugia A, Gopalan D, Gummow A, Ramkumar PG, Hamilton M, Harbinson M, Hartley T, Hudson B, Joshi N, Kay M, Kelion A, Khokhar A, Kitt J, Lee K, Low C, Mak SM, Marousa N, Martin J, Mcalindon E, Menezes L, Morgan-Hughes G, Moss A, Murray A, Nicol E, Patel D, Peebles C, Pugliese F, Luis Rodrigues JC, Rofe C, Sabharwal N, Schofield R, Semple T, Sharma N, Strouhal P, Subedi D. Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia. JACC: Asia 2021; 1:187-199. [PMID: 36338167 PMCID: PMC9627847 DOI: 10.1016/j.jacasi.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/12/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Abstract
Background The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.
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de Perrot M, Gopalan D, Jenkins D, Lang IM, Fadel E, Delcroix M, Benza R, Heresi GA, Kanwar M, Granton JT, McInnis M, Klok FA, Kerr KM, Pepke-Zaba J, Toshner M, Bykova A, Armini AMD, Robbins IM, Madani M, McGiffin D, Wiedenroth CB, Mafeld S, Opitz I, Mercier O, Uber PA, Frantz RP, Auger WR. Evaluation and management of patients with chronic thromboembolic pulmonary hypertension - consensus statement from the ISHLT. J Heart Lung Transplant 2021; 40:1301-1326. [PMID: 34420851 DOI: 10.1016/j.healun.2021.07.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023] Open
Abstract
ISHLT members have recognized the importance of a consensus statement on the evaluation and management of patients with chronic thromboembolic pulmonary hypertension. The creation of this document required multiple steps, including the engagement of the ISHLT councils, approval by the Standards and Guidelines Committee, identification and selection of experts in the field, and the development of 6 working groups. Each working group provided a separate section based on an extensive literature search. These sections were then coalesced into a single document that was circulated to all members of the working groups. Key points were summarized at the end of each section. Due to the limited number of comparative trials in this field, the document was written as a literature review with expert opinion rather than based on level of evidence.
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Affiliation(s)
- Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London & Cambridge University Hospital, Cambridge, UK
| | - David Jenkins
- National Pulmonary Endarterectomy Service, Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Irene M Lang
- Department of Cardiology, Pulmonary Hypertension Unit, Medical University of Vienna, Vienna, Austria
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart Lung Transplantation, Marie-Lannelongue Hospital, Paris Saclay University, Le Plessis-Robinson, France
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, Pulmonary Hypertension Centre, UZ Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU, Leuven, Belgium
| | - Raymond Benza
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Gustavo A Heresi
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Manreet Kanwar
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - John T Granton
- Division of Respirology, University Health Network, Toronto, Ontario, Canada
| | - Micheal McInnis
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Frederikus A Klok
- Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim M Kerr
- University of California San Diego Medical Health, Division of Pulmonary Critical Care and Sleep Medicine, San Diego, California
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS foundation Trust, Cambridge, Cambridgeshire, UK
| | - Mark Toshner
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS foundation Trust, Cambridge, Cambridgeshire, UK; Heart Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Anastasia Bykova
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrea M D' Armini
- Unit of Cardiac Surgery, Intrathoracic-Trasplantation and Pulmonary Hypertension, University of Pavia, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Ivan M Robbins
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Madani
- Department of Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, California
| | - David McGiffin
- Department of Cardiothoracic Surgery, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Christoph B Wiedenroth
- Department of Thoracic Surgery, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Sebastian Mafeld
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart Lung Transplantation, Marie-Lannelongue Hospital, Paris Saclay University, Le Plessis-Robinson, France
| | - Patricia A Uber
- Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Robert P Frantz
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - William R Auger
- Pulmonary Hypertension and CTEPH Research Program, Temple Heart and Vascular Institute, Temple University, Lewis Katz School of Medicine, Philadelphia, Pennsylvania
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30
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Delcroix M, Torbicki A, Gopalan D, Sitbon O, Klok FA, Lang I, Jenkins D, Kim NH, Humbert M, Jais X, Vonk Noordegraaf A, Pepke-Zaba J, Brénot P, Dorfmuller P, Fadel E, Ghofrani HA, Hoeper MM, Jansa P, Madani M, Matsubara H, Ogo T, Grünig E, D'Armini A, Galie N, Meyer B, Corkery P, Meszaros G, Mayer E, Simonneau G. ERS statement on chronic thromboembolic pulmonary hypertension. Eur Respir J 2021; 57:13993003.02828-2020. [PMID: 33334946 DOI: 10.1183/13993003.02828-2020] [Citation(s) in RCA: 238] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/05/2020] [Indexed: 12/25/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, either symptomatic or not. The occlusion of proximal pulmonary arteries by fibrotic intravascular material, in combination with a secondary microvasculopathy of vessels <500 µm, leads to increased pulmonary vascular resistance and progressive right heart failure. The mechanism responsible for the transformation of red clots into fibrotic material remnants has not yet been elucidated. In patients with pulmonary hypertension, the diagnosis is suspected when a ventilation/perfusion lung scan shows mismatched perfusion defects, and confirmed by right heart catheterisation and vascular imaging. Today, in addition to lifelong anticoagulation, treatment modalities include surgery, angioplasty and medical treatment according to the localisation and characteristics of the lesions.This statement outlines a review of the literature and current practice concerning diagnosis and management of CTEPH. It covers the definitions, diagnosis, epidemiology, follow-up after acute pulmonary embolism, pathophysiology, treatment by pulmonary endarterectomy, balloon pulmonary angioplasty, drugs and their combination, rehabilitation and new lines of research in CTEPH.It represents the first collaboration of the European Respiratory Society, the International CTEPH Association and the European Reference Network-Lung in the pulmonary hypertension domain. The statement summarises current knowledge, but does not make formal recommendations for clinical practice.
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Affiliation(s)
- Marion Delcroix
- Clinical Dept of Respiratory Diseases, Pulmonary Hypertension Center, UZ Leuven, Leuven, Belgium .,BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium.,Co-chair
| | - Adam Torbicki
- Dept of Pulmonary Circulation, Thrombo-embolic Diseases and Cardiology, Center of Postgraduate Medical Education, ECZ-Otwock, Otwock, Poland.,Section editors
| | - Deepa Gopalan
- Dept of Radiology, Imperial College Hospitals NHS Trusts, London, UK.,Section editors
| | - Olivier Sitbon
- Université Paris-Saclay; Inserm UMR_S 999, Service de Pneumologie, Hôpital Bicêtre (AP-HP), Le Kremlin-Bicêtre, France.,Section editors
| | - Frederikus A Klok
- Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.,Section editors
| | - Irene Lang
- Medical University of Vienna, Vienna, Austria.,Section editors
| | - David Jenkins
- Royal Papworth Hospital, Cambridge University Hospital, Cambridge, UK.,Section editors
| | - Nick H Kim
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, USA.,Section editors
| | - Marc Humbert
- Université Paris-Saclay; Inserm UMR_S 999, Service de Pneumologie, Hôpital Bicêtre (AP-HP), Le Kremlin-Bicêtre, France.,Section editors
| | - Xavier Jais
- Université Paris-Saclay; Inserm UMR_S 999, Service de Pneumologie, Hôpital Bicêtre (AP-HP), Le Kremlin-Bicêtre, France.,Section editors
| | - Anton Vonk Noordegraaf
- Dept of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Section editors
| | - Joanna Pepke-Zaba
- Royal Papworth Hospital, Cambridge University Hospital, Cambridge, UK.,Section editors
| | - Philippe Brénot
- Marie Lannelongue Hospital, Paris-South University, Le Plessis Robinson, France
| | - Peter Dorfmuller
- University of Giessen and Marburg Lung Center, German Center of Lung Research (DZL), Giessen, Germany.,Dept of Medicine, Imperial College London, London, UK.,Dept of Pneumology, Kerckhoff-Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Elie Fadel
- Hannover Medical School, Hannover, Germany
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, German Center of Lung Research (DZL), Giessen, Germany.,Dept of Medicine, Imperial College London, London, UK.,Dept of Pneumology, Kerckhoff-Clinic Bad Nauheim, Bad Nauheim, Germany
| | | | - Pavel Jansa
- 2nd Department of Medicine, Dept of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Michael Madani
- Sulpizio Cardiovascular Centre, University of California, San Diego, CA, USA
| | - Hiromi Matsubara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takeshi Ogo
- National Cerebral and Cardiovascular Centre, Osaka, Japan
| | - Ekkehard Grünig
- Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Andrea D'Armini
- Unit of Cardiac Surgery, Intrathoracic Transplantation and Pulmonary Hypertension, University of Pavia School of Medicine, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | - Bernhard Meyer
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | | | - Eckhard Mayer
- Dept of Thoracic Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.,Equal contribution.,Co-chair
| | - Gérald Simonneau
- Université Paris-Saclay; Inserm UMR_S 999, Service de Pneumologie, Hôpital Bicêtre (AP-HP), Le Kremlin-Bicêtre, France.,Equal contribution.,Co-chair
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31
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Riley JYJ, Leong K, Mortensen KH, Ariff B, Gopalan D. Native aorto-ostial coronary lesions on CT coronary angiogram. Br J Radiol 2021; 94:20210211. [PMID: 33989055 PMCID: PMC8248224 DOI: 10.1259/bjr.20210211] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aorto-ostial coronary lesions (AOLs) are important to detect due to the high risk of catastrophic consequences. Unfortunately, due to the complexities of these lesions, they may be missed on invasive coronary angiography. Computed tomography coronary angiogram (CTCA) is highly sensitive and specific in detecting AOLs, and has the additional advantage of demonstrating the surrounding anatomy. CTCA is particularly useful when assessing for AOL aetiologies in addition to atherosclerotic disease, e.g.Congenital anomalies, extrinsic Compression, Iatrogenic, Arteritis and Other, such as Thrombus, Embolism, Dissection and Spasm. This gives rise to “CIAO (TEDS)” as a proposed aide-mémoire and will form the structure of this pictorial review.
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Affiliation(s)
- Jan Y J Riley
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom.,Department of Diagnostic Imaging, Monash Health, Melbourne, Australia
| | - Kai'En Leong
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Kristian H Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Ben Ariff
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom.,Department of Radiology, Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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32
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Kotecha T, Knight DS, Razvi Y, Kumar K, Vimalesvaran K, Thornton G, Patel R, Chacko L, Brown JT, Coyle C, Leith D, Shetye A, Ariff B, Bell R, Captur G, Coleman M, Goldring J, Gopalan D, Heightman M, Hillman T, Howard L, Jacobs M, Jeetley PS, Kanagaratnam P, Kon OM, Lamb LE, Manisty CH, Mathurdas P, Mayet J, Negus R, Patel N, Pierce I, Russell G, Wolff A, Xue H, Kellman P, Moon JC, Treibel TA, Cole GD, Fontana M. Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance. Eur Heart J 2021; 42:1866-1878. [PMID: 33596594 PMCID: PMC7928984 DOI: 10.1093/eurheartj/ehab075] [Citation(s) in RCA: 235] [Impact Index Per Article: 78.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients. METHODS AND RESULTS One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction; of these, 30% had active myocarditis. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2: COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms). CONCLUSIONS During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected.
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Affiliation(s)
- Tushar Kotecha
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Daniel S Knight
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Yousuf Razvi
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Kartik Kumar
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
| | | | - George Thornton
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Rishi Patel
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Liza Chacko
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - James T Brown
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Clare Coyle
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Donald Leith
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Abhishek Shetye
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
- University College London Hospitals NHS Trust, London, UK
| | - Ben Ariff
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Robert Bell
- Institute of Cardiovascular Science, University College London, UK
- University College London Hospitals NHS Trust, London, UK
| | - Gabriella Captur
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Meg Coleman
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
| | - James Goldring
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Deepa Gopalan
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
| | | | - Toby Hillman
- University College London Hospitals NHS Trust, London, UK
| | - Luke Howard
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Michael Jacobs
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | | | - Prapa Kanagaratnam
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Onn Min Kon
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Lucy E Lamb
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Academic Department of Defence Medicine, Royal Centre for Defence Medicine, Edgbaston, Birmingham, UK
| | - Charlotte H Manisty
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | | | - Jamil Mayet
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Rupert Negus
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Niket Patel
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Georgina Russell
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Anthony Wolff
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD, USA
| | - James C Moon
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Graham D Cole
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Marianna Fontana
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- National Amyloidosis Centre, Division of Medicine, University College London, UK
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Pieri C, Bhuva A, Moralee R, Abiodun A, Gopalan D, Roditi GH, Moon JC, Manisty C. Access to MRI for patients with cardiac pacemakers and implantable cardioverter defibrillators. Open Heart 2021; 8:e001598. [PMID: 34031214 PMCID: PMC8149430 DOI: 10.1136/openhrt-2021-001598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine provision of MRI for patients with cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators) in England, to understand regional variation and assess the impact of guideline changes. METHODS Retrospective data related to MRI scans performed in patients with CIED over the preceding 12 months was collected using a structured survey tool distributed to every National Health Service Trust MRI unit in England. Data were compared with similar data from 2014/2015 and with demand (estimated from local CIED implantation rates and regional population data by sustainability and transformation partnerships (STPs)). RESULTS Responses were received from 212 of 223 (95%) hospitals in England. 112 (53%) MRI units' scan patients with MR-conditional CIEDs (10% also scan non-MR conditional devices), compared with 46% of sites in 2014/2015. Total annual scan volume increased over fourfold between 2014 and 2019 (1090 to 4896 scans). There was widespread geographical variation, with five STPs (total population >3·5 million representing approximately 25 000 patients with CIED) with no local provision. There was no correlation between local demand (CIED implantation rates) and MRI provision (scan volume). Complication rates were extremely low with three events nationally in 12 months (0·06% CIED-MRI scans). CONCLUSIONS Provision of MRI for patients with CIEDs in England increased over fourfold in 4 years, but an estimated 10-fold care gap remains. Almost half of hospitals and 1 in 10 STPs have no service, with no relationship between local supply and demand. Availability of MRI for patients with non-MR conditional devices, although demonstrably safe, remains limited.
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Affiliation(s)
- Christopher Pieri
- Institute of Health Sciences, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Anish Bhuva
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
| | - Russell Moralee
- Department of Radiology, Imperial College London, London, UK
| | - Aderonke Abiodun
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
| | - Deepa Gopalan
- Department of Radiology, University of Glasgow, Glasgow, UK
| | - Giles H Roditi
- Department of Cardiovascular Imaging, Barts Heart Centre, London, Greater London, UK
| | - James C Moon
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
| | - Charlotte Manisty
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
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Jabbour RJ, Rana B, Sutaria N, Frame A, Seligman H, Gopalan D, Ariff B, Mirsadraee S, Barden E, Ruparelia N, Malik IS. Percutaneous devices for the treatment of complex native valve mitral leaflet and aortomitral continuity defects: Review and case series. Cardiovasc Revasc Med 2021; 36:153-163. [PMID: 34366296 DOI: 10.1016/j.carrev.2021.04.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/17/2021] [Indexed: 11/03/2022]
Abstract
Percutaneous closure of paravalvar leaks (PVLs) was once only performed in extreme or non-surgical risk cases not suitable for redo-surgery with tissue or mechanical valves. This technique is now the treatment of choice with long term outcomes that are better than redo operations.123 As interventionalists become more familiar with using PVL devices, more off label device use has been reported in non-surgical cases involving complex native mitral valve regurgitation (NVMR). In this review, we appraise the literature regarding percutaneous treatment of paravalvar leaks and more recently esoteric off label use. We also describe two recent challenging cases where percutaneous devices were used to treat severe leaks that developed as a sequela of previous infective endocarditis. We also provide specific recommendations regarding periprocedural strategy and focus on the importance of device choice to provide an optimal outcome.
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Affiliation(s)
- Richard J Jabbour
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Nilesh Sutaria
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Angela Frame
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Henry Seligman
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Deepa Gopalan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Ben Ariff
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Saeed Mirsadraee
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Edward Barden
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Neil Ruparelia
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
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35
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Thomson D, Joubert I, De Vasconcellos K, Paruk F, Mokogong S, Mathivha R, McCulloch M, Morrow B, Baker D, Rossouw B, Mdladla N, Richards GA, Welkovics N, Levy B, Coetzee I, Spruyt M, Ahmed N, Gopalan D. South African guidelines on the determination of death. South Afr J Crit Care 2021; 37:10.7196/SAJCC.2021v37i1b.466. [PMCID: PMC10193841 DOI: 10.7196/sajcc.2021v37i1b.466] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 05/20/2023] Open
Abstract
Summary
Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis
and legal regulation. This document compiled by the Critical Care Society of Southern Africa outlines the core standards for determination
of death in the hospital context. It aligns with the latest evidence-based research and international guidelines and is applicable to the South
African context and legal system. The aim is to provide clear medical standards for healthcare providers to follow in the determination
of death, thereby promoting safe practices and high-quality care through the use of uniform standards. Adherence to such guidelines will
provide assurance to medical staff, patients, their families and the South African public that the determination of death is always undertaken
with diligence, integrity, respect and compassion, and is in accordance with accepted medical standards and latest scientific evidence.
The consensus guidelines were compiled using the AGREE II checklist with an 18-member expert panel participating in a three-round
modified Delphi process. Checklists and advice sheets were created to assist with application of these guidelines in the clinical environment
(https://criticalcare.org.za/resource/death-determination-checklists/). Key points Brain death and circulatory death are the accepted terms for defining death in the hospital context. Death determination is a clinical diagnosis which can be made with complete certainty provided that all preconditions are met. The determination of death in children is held to the same standard as in adults but cannot be diagnosed in children <36 weeks’ corrected
gestation. Brain-death testing while on extra-corporeal membrane oxygenation is outlined. Recommendations are given on handling family requests for accommodation and on consideration of the potential for organ donation. The use of a checklist combined with a rigorous testing process, comprehensive documentation and adequate counselling of the family
are core tenets of death determination. This is a standard of practice to which all clinicians should adhere in end-of-life care.
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Affiliation(s)
- D Thomson
- Division of Critical Care, Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Peri-operative Medicine, University of Cape Town and Groote Schuur Hospital,
Cape Town, South Africa
| | - K De Vasconcellos
- Department of Critical Care, King Edward VIII Hospital, Durban, South Africa; Discipline of Anaesthesiology and Critical Care, School of Clinical
Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - F Paruk
- Department of Critical Care, University of Pretoria, South Africa
| | - S Mokogong
- Department of Neurosurgery, University of Pretoria, South Africa
| | - R Mathivha
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M McCulloch
- Paediatric Intensive Care Unit and Transplant Unit, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of
Cape Town, South Africa
| | - B Morrow
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa
| | - D Baker
- Department of Adult Critical Care, Livingstone Hospital and Faculty of Health Sciences, Walter Sisulu University, Port Elizabeth, South Africa
| | - B Rossouw
- Paediatric Intensive Care Unit, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - N Mdladla
- Dr George Mukhari Academic Hospital, Sefako Makgatho University, Johannesburg, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Welkovics
- Netcare Unitas Hospital, Centurion, South Africa
| | - B Levy
- Netcare Rosebank Hospital, Johannesburg, South Africa
| | - I Coetzee
- Department of Nursing Science, University of Pretoria, South Africa
| | - M Spruyt
- Busamed Bram Fischer International Airport Hospital, Bloemfontein, South Africa
| | - N Ahmed
- Consolidated Critical Care Unit, Tygerberg Hospital, Department of Surgical Sciences, Department of Anaesthesiology and Critical Care, Faculty
of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - D Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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36
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Thomson D, Joubert I, De Vasconcellos K, Paruk F, Mokogong S, Mathiva R, McCulloch M, Morrow B, Baker D, Rossouw B, Mdladla N, Richards GA, Welkovics N, Levy B, Coetzee I, Spruyt M, Ahmed N, Gopalan D. South African guidelines on the determination of death. S Afr Med J 2021; 111:367-380. [PMID: 37114488 DOI: 10.7196/samj.2021.v111i4b.15200] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis and legal regulation. This document compiled by the Critical Care Society of Southern Africa outlines the core standards for determination of death in the hospital context. It aligns with the latest evidence-based research and international guidelines and is applicable to the South African context and legal system. The aim is to provide clear medical standards for healthcare providers to follow in the determination of death, thereby promoting safe practices and high-quality care through the use of uniform standards. Adherence to such guidelines will provide assurance to medical staff, patients, their families and the South African public that the determination of death is always undertaken with diligence, integrity, respect and compassion, and is in accordance with accepted medical standards and latest scientific evidence. The consensus guidelines were compiled using the AGREE II checklist with an 18-member expert panel participating in a three-round modified Delphi process. Checklists and advice sheets were created to assist with application of these guidelines in the clinical environment (https://criticalcare.org.za/resource/death-determination-checklists/). Key points • Brain death and circulatory death are the accepted terms for defining death in the hospital context. • Death determination is a clinical diagnosis which can be made with complete certainty provided that all preconditions are met. • The determination of death in children is held to the same standard as in adults but cannot be diagnosed in children <36 weeks' corrected gestation. • Brain-death testing while on extra-corporeal membrane oxygenation is outlined. • Recommendations are given on handling family requests for accommodation and on consideration of the potential for organ donation. • The use of a checklist combined with a rigorous testing process, comprehensive documentation and adequate counselling of the family are core tenets of death determination. This is a standard of practice to which all clinicians should adhere in end-of-life care.
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Affiliation(s)
- D Thomson
- Division of Critical Care, Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Peri-operative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - K De Vasconcellos
- Department of Critical Care, King Edward VIII Hospital, Durban, South Africa; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - F Paruk
- Department of Critical Care, University of Pretoria, South Africa
| | - S Mokogong
- Department of Neurosurgery, University of Pretoria, South Africa
| | - R Mathiva
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M McCulloch
- Paediatric Intensive Care Unit and Transplant Unit, Red Cross War Memorial Children's Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - B Morrow
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa
| | - D Baker
- Department of Adult Critical Care, Livingstone Hospital and Faculty of Health Sciences, Walter Sisulu University, Port Elizabeth, South Africa
| | - B Rossouw
- Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - N Mdladla
- Dr George Mukhari Academic Hospital, Sefako Makgatho University, Johannesburg, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Welkovics
- Netcare Unitas Hospital, Centurion, South Africa
| | - B Levy
- Netcare Rosebank Hospital, Johannesburg, South Africa
| | - I Coetzee
- Department of Nursing Science, University of Pretoria, South Africa
| | - M Spruyt
- Busamed Bram Fischer International Airport Hospital, Bloemfontein, South Africa
| | - N Ahmed
- Consolidated Critical Care Unit, Tygerberg Hospital, Department of Surgical Sciences, Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - D Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Dhawan RT, Gopalan D, Howard L, Vicente A, Park M, Manalan K, Wallner I, Marsden P, Dave S, Branley H, Russell G, Dharmarajah N, Kon OM. Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19. Lancet Respir Med 2021; 9:107-116. [PMID: 33217366 PMCID: PMC7833494 DOI: 10.1016/s2213-2600(20)30407-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/18/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022]
Abstract
A compelling body of evidence points to pulmonary thrombosis and thromboembolism as a key feature of COVID-19. As the pandemic spread across the globe over the past few months, a timely call to arms was issued by a team of clinicians to consider the prospect of long-lasting pulmonary fibrotic damage and plan for structured follow-up. However, the component of post-thrombotic sequelae has been less widely considered. Although the long-term outcomes of COVID-19 are not known, should pulmonary vascular sequelae prove to be clinically significant, these have the potential to become a public health problem. In this Personal View, we propose a proactive follow-up strategy to evaluate residual clot burden, small vessel injury, and potential haemodynamic sequelae. A nuanced and physiological approach to follow-up imaging that looks beyond the clot, at the state of perfusion of lung tissue, is proposed as a key triage tool, with the potential to inform therapeutic strategies.
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Affiliation(s)
- Ranju T Dhawan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK; Hybrid Imaging and Therapy Unit, The Wellington Hospital, HCA Healthcare, London, UK.
| | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK; National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, UK; Hybrid Imaging and Therapy Unit, The Wellington Hospital, HCA Healthcare, London, UK
| | - Luke Howard
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK; National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Angelito Vicente
- Hybrid Imaging and Therapy Unit, The Wellington Hospital, HCA Healthcare, London, UK
| | - Mirae Park
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Kavina Manalan
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Ingrid Wallner
- Hybrid Imaging and Therapy Unit, The Wellington Hospital, HCA Healthcare, London, UK
| | - Peter Marsden
- Hybrid Imaging and Therapy Unit, The Wellington Hospital, HCA Healthcare, London, UK; Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Surendra Dave
- Hybrid Imaging and Therapy Unit, The Wellington Hospital, HCA Healthcare, London, UK
| | - Howard Branley
- Respiratory Unit, The Wellington Hospital, HCA Healthcare, London, UK
| | - Georgina Russell
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Nishanth Dharmarajah
- Hybrid Imaging and Therapy Unit, The Wellington Hospital, HCA Healthcare, London, UK
| | - Onn M Kon
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
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38
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Gopalan D, Gibbs JSR. From Early Morphometrics to Machine Learning-What Future for Cardiovascular Imaging of the Pulmonary Circulation? Diagnostics (Basel) 2020; 10:diagnostics10121004. [PMID: 33255668 PMCID: PMC7760106 DOI: 10.3390/diagnostics10121004] [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: 10/24/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
Imaging plays a cardinal role in the diagnosis and management of diseases of the pulmonary circulation. Behind the picture itself, every digital image contains a wealth of quantitative data, which are hardly analysed in current routine clinical practice and this is now being transformed by radiomics. Mathematical analyses of these data using novel techniques, such as vascular morphometry (including vascular tortuosity and vascular volumes), blood flow imaging (including quantitative lung perfusion and computational flow dynamics), and artificial intelligence, are opening a window on the complex pathophysiology and structure-function relationships of pulmonary vascular diseases. They have the potential to make dramatic alterations to how clinicians investigate the pulmonary circulation, with the consequences of more rapid diagnosis and a reduction in the need for invasive procedures in the future. Applied to multimodality imaging, they can provide new information to improve disease characterization and increase diagnostic accuracy. These new technologies may be used as sophisticated biomarkers for risk prediction modelling of prognosis and for optimising the long-term management of pulmonary circulatory diseases. These innovative techniques will require evaluation in clinical trials and may in themselves serve as successful surrogate end points in trials in the years to come.
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Affiliation(s)
- Deepa Gopalan
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
- Imperial College London, London SW7 2AZ, UK;
- Cambridge University Hospital, Cambridge CB2 0QQ, UK
- Correspondence: ; Tel.: +44-77-3000-7780
| | - J. Simon R. Gibbs
- Imperial College London, London SW7 2AZ, UK;
- National Heart & Lung Institute, Imperial College London, London SW3 6LY, UK
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39
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Wall C, Huang Y, Uy C, Le E, Tombetti E, Gopalan D, Manavaki R, Dweck M, Ariff B, Bennett M, Slomka P, Dey D, Mason J, Rudd J, Tarkin J. Pericoronary adipose tissue density is associated with clinical disease activity in Takayasu arteritis and coronary arterial inflammation measured by 68Ga-DOTATATE PET in atherosclerosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0182] [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: 11/14/2022] Open
Abstract
Abstract
Background
Coronary artery disease (CAD) is an under-recognized complication of intense arterial inflammation in Takayasu arteritis (TAK). While pericoronary adipose tissue (PCAT) density is associated with arterial inflammation in CAD patients, this relationship has not previously been studied in TAK patients, nor directly compared with coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography (PET).
Purpose
To compare PCAT density with clinical, biochemical and molecular imaging markers of inflammation in TAK and CAD patients.
Methods
PCAT density was quantified from computed tomography coronary angiography (CTCA) around each of the 17 coronary segments in patients with: (1) TAK and CAD, (2) atherosclerotic CAD, and (3) age and gender-matched healthy controls, using semi-automated software (Autoplaque). In TAK patients, PCAT density was compared to the Indian Takayasu Clinical Activity Score (ITAS) and high-sensitivity C-reactive protein (CRP). In CAD patients, PCAT density was compared to local arterial inflammation measured by coronary motion-frozen 68Ga-DOTATATE PET using image registration software (FusionQuant), and systemic (aortic) inflammation using 18F-fluorodeoxyglucose (FDG) PET. Data was acquired either during routine clinical care or prior research that established 68Ga-DOTATATE as an experimental marker of arterial inflammation that binds macrophage somatostatin receptor-2 in atherosclerotic plaques (NCT02021188).
Results
60 patients were included (TAK, n=20; CAD, n=20; healthy, n=20). Non-calcified plaque burden (TAK: 95.2%; CAD: 90.4%, p<0.0001) and CRP (TAK: 25.2 ±SD 16.1 mg/L; CAD: 2.5 ±SD 1.7 mg/L, p=0.04) were greater in TAK than CAD patients.
PCAT density varied significantly among the three groups (median [IQR] TAK: −72.9 [−81.2 to -66.1] Hounsfield unit [HU]; CAD: −79.9 [−88.0 to −72.2]; healthy: −83.8 [−90.1 to −75.8] HU, p<0.0001). Figure: box-plot showing the distribution of PCAT values by group, with corresponding representative multiplanar reconstructed and cross-sectional CTCA images with surrounding PCAT density displayed by color table in left anterior descending arteries.
PCAT density was significantly associated with ITAS (r=0.61, p=0.004) and CRP (r=0.43, p=0.03) in TAK patients, and coronary 68Ga-DOTATATE maximum tissue-to-blood ratio (r=0.31, p<0.001) in CAD patients. PCAT density was not associated with aortic 18F-FDG uptake in CAD patients, nor subcutaneous (pre-sternal) adipose tissue density in either disease group. No significant patient-level confounders were identified using linear mixed-effects regression modelling.
Conclusion
PCAT density measured by CTCA is greater in TAK than CAD patients, and is associated with clinical and biochemical markers of disease activity in TAK, and coronary arterial inflammation measured by 68Ga-DOTATATE PET in CAD. PCAT could be a useful, easy to measure marker of coronary inflammation and disease activity in both TAK and CAD.
PCAT density is greater in TAK than CAD
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Wellcome Trust
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Affiliation(s)
- C Wall
- University of Cambridge, Cambridge, United Kingdom
| | - Y Huang
- University of Cambridge, Cambridge, United Kingdom
| | - C Uy
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - E Le
- University of Cambridge, Cambridge, United Kingdom
| | - E Tombetti
- University Vita-Salute San Raffaele, Milan, Italy
| | - D Gopalan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - R Manavaki
- University of Cambridge, Cambridge, United Kingdom
| | - M Dweck
- University of Edinburgh, Edinburgh, United Kingdom
| | - B Ariff
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M Bennett
- University of Cambridge, Cambridge, United Kingdom
| | - P Slomka
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - D Dey
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - J Mason
- Imperial College London, London, United Kingdom
| | - J Rudd
- University of Cambridge, Cambridge, United Kingdom
| | - J Tarkin
- University of Cambridge, Cambridge, United Kingdom
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40
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Gopalan D, Nordgren-Rogberg A, Le EPV, Pavey H, Tarkin J, Nyrén S, Auger W, Lindholm P. Abnormal Pulmonary Venous Filling: An Adjunct Feature in the Computed Tomography Pulmonary Angiogram Assessment of Chronic Thromboembolic Pulmonary Hypertension. J Am Heart Assoc 2020; 9:e018075. [PMID: 33115320 PMCID: PMC7763423 DOI: 10.1161/jaha.120.018075] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Hypodense filling defects within the pulmonary veins on computed tomography described as pulmonary vein sign (PVS) have been noted in acute pulmonary embolism and shown to be associated with poor prognosis. We evaluated venous flow abnormalities in chronic thromboembolic pulmonary hypertension (CTEPH) to determine its usefulness in the computed tomography assessment of CTEPH. Methods and Results Blinded retrospective computed tomography analysis of 50 proximal CTEPH cases and 3 control groups—50 acute pulmonary embolism, 50 nonthromboembolic cohort, and 50 pulmonary arterial hypertension. Venous flow reduction was assessed by the following: (1) presence of a filling defect of at least 2 cm in a pulmonary vein draining into the left atrium, and (2) left atrium attenuation (>160 Hounsfield units). PVS was most prevalent in CTEPH. Compared with all controls, sensitivity and specificity of PVS for CTEPH is 78.0% and 85.3% (95% CI, 64.0–88.5 and 78.6–90.6, respectively) versus 34.0% and 70.7% (95% CI, 21.2−48.8 and 62.7–77.8) in acute pulmonary embolism, 8.0% and 62% (95% CI, 2.2–19.2 and 53.7–69.8) in nonthromboembolic and 2.0% and 60% (95% CI, 0.1−10.7 and 51.7−67.9) in pulmonary arterial hypertension. In CTEPH, lobar and segmental arterial occlusive disease was most commonly associated with corresponding absent venous flow. PVS detection was highly reproducible (Kappa=0.96, 95% CI, 0.90–1.01, P<0.001). Conclusions PVS is easy to detect with higher sensitivity and specificity in CTEPH compared with acute pulmonary embolism and is not a feature of pulmonary arterial hypertension. Asymmetric enhancement of pulmonary veins may serve as an additional parameter in the computed tomography assessment of CTEPH and can be used to differentiate CTEPH from pulmonary arterial hypertension.
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Affiliation(s)
- Deepa Gopalan
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden.,Imperial College Healthcare NHS Trust London United Kingdom
| | - Anna Nordgren-Rogberg
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden.,Department of Radiology Solna Karolinska University Hospital Stockholm Sweden
| | | | - Holly Pavey
- Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Jason Tarkin
- Department of Medicine University of Cambridge United Kingdom
| | - Sven Nyrén
- Department of Radiology Solna Karolinska University Hospital Stockholm Sweden.,Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | | | - Peter Lindholm
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden.,Department of Emergency Medicine University of California San Diego San Diego CA
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41
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Williams MC, Abbas A, Tirr E, Alam S, Nicol E, Shambrook J, Schmitt M, Hughes GM, Stirrup J, Holloway B, Gopalan D, Deshpande A, Weir-McCall J, Agrawal B, Rodrigues JCL, Brady AJB, Roditi G, Robinson G, Bull R. Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI/BSCCT and BSTI. Br J Radiol 2020; 94:20200894. [PMID: 33053316 PMCID: PMC7774698 DOI: 10.1259/bjr.20200894] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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] [Indexed: 01/23/2023] Open
Abstract
Incidental coronary and cardiac calcification are frequent findings on non-gated thoracic CT. We recommend that the heart is reviewed on all CT scans where it is visualised. Coronary artery calcification is a marker of coronary artery disease and it is associated with an adverse prognosis on dedicated cardiac imaging and on non-gated thoracic CT performed for non-cardiac indications, both with and without contrast. We recommend that coronary artery calcification is reported on all non-gated thoracic CT using a simple patient-based score (none, mild, moderate, severe). Furthermore, we recommend that reports include recommendations for subsequent management, namely the assessment of modifiable cardiovascular risk factors and, if the patient has chest pain, assessment as per standard guidelines. In most cases, this will not necessitate additional investigations. Incidental aortic valve calcification may also be identified on non-gated thoracic CT and should be reported, along with ancillary findings such as aortic root dilation. Calcification may occur in other parts of the heart including mitral valve/annulus, pericardium and myocardium, but in many cases these are an incidental finding without clinical significance.
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Affiliation(s)
- Michelle Claire Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK.,Edinburgh Imaging facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Ausami Abbas
- University Hospital Southampton, Southampton, UK
| | - Erica Tirr
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Shirjel Alam
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Edward Nicol
- Departments of Cardiology and Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | | | | | | | - James Stirrup
- Royal Berkshire Hospital NHS Foundation Trust, Craven Road, Reading, UK
| | | | - Deepa Gopalan
- Imperial College London & Cambridge University Hospital, Cambridge, UK
| | - Aparna Deshpande
- Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | | | - Bobby Agrawal
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Adrian J B Brady
- Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow, UK.,University of Glasgow, University Avenue, Glasgow, UK
| | - Giles Roditi
- Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow, UK
| | | | - Russell Bull
- Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK
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42
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Malik IS, Jabbour RJ, Ruparelia N, Sen S, Hadjizoulou N, Rana B, Chukwuemeka AO, Gopalan D, Kotecha T, Mikhail GW. Rescue Valve-in-Valve-in-Valve TAVR for Acute Transvalvular Aortic Regurgitation. Cardiovasc Revasc Med 2020; 21:11-13. [PMID: 32747197 DOI: 10.1016/j.carrev.2020.07.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for severe symptomatic aortic stenosis (Leon et al., 2016), and recently has also been utilised for bioprosthetic surgical aortic valve (sAVR) failure (valve-in-valve TAVR (ViV-TAVR)) (Yoon et al., 2017; Nalluri et al., 2018). Data supporting ViV-TAVR are limited to observational studies but suggest similar outcomes to re-do sAVR in high risk patients (Barbanti et al., n.d.). Whilst bioprosthetic SAVR failure is well documented, TAVR failure is less well described (Barbanti et al., n.d.). Here, we describe a case of TAVR failure in a previous sAVR resulting in the need for emergent valve-in-valve-in-valve TAVR (ViViV-TAVR).
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Affiliation(s)
- Iqbal S Malik
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
| | - Richard J Jabbour
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Neil Ruparelia
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Sayan Sen
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Nearchos Hadjizoulou
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Bushra Rana
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Andrew O Chukwuemeka
- Dept of Cardiac Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Deepa Gopalan
- Dept of Imaging, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Tushar Kotecha
- Dept of Imaging, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK; Dept of Cardiology, Royal Free Hospital, London, UK
| | - Ghada W Mikhail
- Dept of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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43
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Wise RD, de Vasconcellos K, Gopalan D, Ahmed N, Alli A, Joubert I, Kabambi KF, Mathiva LR, Mdladla N, Mer M, Miller M, Mrara B, Omar S, Paruk F, Richards GA, Skinner D, von Rahden R. Critical Care Society of Southern Africa adult patient blood management guidelines: 2019 Round-table meeting, CCSSA Congress, Durban, 2018. South Afr J Crit Care 2020; 36:10.7196/SAJCC.2020.v36i1b.440. [PMID: 37415775 PMCID: PMC10321416 DOI: 10.7196/sajcc.2020.v36i1b.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 07/08/2023] Open
Abstract
The CCSSA PBM Guidelines have been developed to improve patient blood management in critically ill patients in southern Africa. These consensus recommendations are based on a rigorous process by experts in the field of critical care who are also practicing in South Africa (SA). The process comprised a Delphi process, a round-table meeting (at the CCSSA National Congress, Durban, 2018), and a review of the best available evidence and international guidelines. The guidelines focus on the broader principles of patient blood management and incorporate transfusion medicine (transfusion guidelines), management of anaemia, optimisation of coagulopathy, and administrative and ethical considerations. There are a mix of low-middle and high-income healthcare structures within southern Africa. Blood products are, however, provided by the same not-for-profit non-governmental organisations to both private and public sectors. There are several challenges related to patient blood management in SA due most notably to a high incidence of anaemia, a frequent shortage of blood products, a small donor population, and a healthcare system under financial strain. The rational and equitable use of blood products is important to ensure best care for as many critically ill patients as possible. The summary of the recommendations provides key practice points for the day-to-day management of critically ill patients. A more detailed description of the evidence used to make these recommendations follows in the full clinical guidelines section.
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Affiliation(s)
- R D Wise
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - K de Vasconcellos
- Department of Critical Care, King Edward VIII Hospital, Durban; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - D Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - N Ahmed
- Surgical ICU, Tygerberg Academic Hospital; Department of Surgical Sciences and Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - A Alli
- Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - K F Kabambi
- Department of Anaesthesia and Critical Care, Nelson Mandela Academic Hospital, Mthatha; Department of Surgery, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - L R Mathiva
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - N Mdladla
- Dr George Mukhari Academic Hospital; Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - M Mer
- Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M Miller
- Department of Anaesthesia and Peri-operative Medicine, Division of Critical Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - B Mrara
- Anaesthesia Department, Walter Sisulu University, Mthatha, South Africa
| | - S Omar
- Department of Critical Care, Chris Hani Baragwanath Academic Hospital and School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - F Paruk
- Department of Critical Care, Steve Biko Academic Hospital and Critical Care, School of Medicine, University of Pretoria, South Africa
| | - G A Richards
- Department of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - D Skinner
- Department of Critical Care, King Edward VIII Hospital, Durban; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - R von Rahden
- Private practice (Critical Care), Rodseth and Partners, Pietermaritzburg, South Africa
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44
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Uy CP, Tarkin JM, Gopalan D, Barwick TD, Tombetti E, Youngstein T, Mason JC. The Impact of Integrated Noninvasive Imaging in the Management of Takayasu Arteritis. JACC Cardiovasc Imaging 2020; 14:495-500. [PMID: 32682724 DOI: 10.1016/j.jcmg.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Christopher P Uy
- Department of Rheumatology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom
| | - Jason M Tarkin
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Deepa Gopalan
- Department of Imaging, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom
| | - Tara D Barwick
- Department of Imaging, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom
| | - Enrico Tombetti
- Department of Biomedical and Clinical Sciences "L. Sacco," University of Milan, Milan, Italy
| | - Taryn Youngstein
- Department of Rheumatology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Justin C Mason
- Department of Rheumatology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
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45
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Williams M, Weir-McCall J, Moss A, Schmitt M, Stirrup J, Holloway B, Gopalan D, Deshpande A, Morgan Hughes G, Agrawal B, Nicol E, Roditi G, Shambrook J, Bull R. Radiologist Opinions Regarding Reporting Incidental Coronary And Cardiac Calcification On Thoracic CT. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Tarkin JM, Ćorović A, Wall C, Gopalan D, Rudd JH. Positron emission tomography imaging in cardiovascular disease. Heart 2020; 106:1712-1718. [PMID: 32571959 DOI: 10.1136/heartjnl-2019-315183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/31/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 01/05/2023] Open
Abstract
Positron emission tomography (PET) imaging is useful in cardiovascular disease across several areas, from assessment of myocardial perfusion and viability, to highlighting atherosclerotic plaque activity and measuring the extent of cardiac innervation in heart failure. Other important roles of PET have emerged in prosthetic valve endocarditis, implanted device infection, infiltrative cardiomyopathies, aortic stenosis and cardio-oncology. Advances in scanner technology, including hybrid PET/MRI and total body PET imaging, as well as the development of novel PET tracers and cardiac-specific postprocessing techniques using artificial intelligence will undoubtedly continue to progress the field.
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Affiliation(s)
- Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Andrej Ćorović
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Christopher Wall
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Deepa Gopalan
- Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - James Hf Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
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47
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Tarkin JM, Wall C, Gopalan D, Aloj L, Manavaki R, Fryer TD, Aboagye EO, Bennett MR, Peters JE, Rudd JHF, Mason JC. Novel Approach to Imaging Active Takayasu Arteritis Using Somatostatin Receptor Positron Emission Tomography/Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2020; 13:e010389. [PMID: 32460529 DOI: 10.1161/circimaging.119.010389] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jason M Tarkin
- Division of Cardiovascular Medicine (J.M.T., C.W., M.R.B., J.H.F.R.), University of Cambridge, United Kingdom.,Vascular Sciences, National Heart and Lung Institute (J.M.T., J.C.M.), Imperial College London, United Kingdom
| | - Christopher Wall
- Division of Cardiovascular Medicine (J.M.T., C.W., M.R.B., J.H.F.R.), University of Cambridge, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Trust, United Kingdom (D.G.)
| | - Luigi Aloj
- Department of Radiology (L.A., R.M.), University of Cambridge, United Kingdom
| | - Roido Manavaki
- Department of Radiology (L.A., R.M.), University of Cambridge, United Kingdom
| | - Tim D Fryer
- Department of Clinical Neurosciences (T.D.F.), University of Cambridge, United Kingdom
| | - Eric O Aboagye
- Department of Surgery and Cancer (E.O.A.), Imperial College London, United Kingdom
| | - Martin R Bennett
- Division of Cardiovascular Medicine (J.M.T., C.W., M.R.B., J.H.F.R.), University of Cambridge, United Kingdom
| | - James E Peters
- Department of Immunology and Inflammation (J.E.P.), Imperial College London, United Kingdom.,Health Data Research UK (J.E.P.)
| | - James H F Rudd
- Division of Cardiovascular Medicine (J.M.T., C.W., M.R.B., J.H.F.R.), University of Cambridge, United Kingdom
| | - Justin C Mason
- Vascular Sciences, National Heart and Lung Institute (J.M.T., J.C.M.), Imperial College London, United Kingdom
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48
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Tarkin JM, Gopalan D, Mason JC. A Woman in Her 20s With Chest Pain and Arm Claudication. JAMA Cardiol 2020; 5:482. [PMID: 31995127 DOI: 10.1001/jamacardio.2019.5447] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/14/2022]
Affiliation(s)
- Jason M Tarkin
- National Heart & Lung Institute, Imperial College London, London, England.,Division of Cardiovascular Medicine, University of Cambridge, Cambridge, England
| | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, England
| | - Justin C Mason
- National Heart & Lung Institute, Imperial College London, London, England
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49
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Tarkin JM, Calcagno C, Dweck MR, Evans NR, Chowdhury MM, Gopalan D, Newby DE, Fayad ZA, Bennett MR, Rudd JH. 68Ga-DOTATATE PET Identifies Residual Myocardial Inflammation and Bone Marrow Activation After Myocardial Infarction. J Am Coll Cardiol 2020; 73:2489-2491. [PMID: 31097170 PMCID: PMC6525109 DOI: 10.1016/j.jacc.2019.02.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - James H.F. Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, Box 110, ACCI, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom @jhfrudd
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50
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Mak SM, Gopalan D. Right ventricle in adulthood: CT and MR assessment. Postgrad Med J 2020; 96:487-494. [PMID: 32184259 DOI: 10.1136/postgradmedj-2019-137220] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 11/03/2022]
Abstract
Anatomical complexities coupled with a protracted subclinical disease course, particularly in the early stages, makes the right ventricle (RV) the less studied entity when compared with the left. RV failure is an important predictor of survival in patients with cardiovascular disease. Technological advances have made it possible to visualise and characterise a variety of diseases that affect the RV. This review article will give a broad overview of the main RV pathology to general radiologists in particular those that manifest in adulthood. Congenital heart disease is a vast topic that is beyond the scope of this paper.
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Affiliation(s)
- Sze Mun Mak
- Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, London, UK
| | - Deepa Gopalan
- Radiology, Imperial College NHS Trust, London and Cambridge University Hospital, Cambridge, UK
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