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Baker RR, Muthurangu V, Rega M, Walsh SB, Steeden JA. Rapid 2D 23Na MRI of the calf using a denoising convolutional neural network. Magn Reson Imaging 2024; 110:184-194. [PMID: 38642779 DOI: 10.1016/j.mri.2024.04.027] [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: 03/06/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE 23Na MRI can be used to quantify in-vivo tissue sodium concentration (TSC), but the inherently low 23Na signal leads to long scan times and/or noisy or low-resolution images. Reconstruction algorithms such as compressed sensing (CS) have been proposed to mitigate low signal-to-noise ratio (SNR); although, these can result in unnatural images, suboptimal denoising and long processing times. Recently, machine learning has been increasingly used to denoise 1H MRI acquisitions; however, this approach typically requires large volumes of high-quality training data, which is not readily available for 23Na MRI. Here, we propose using 1H data to train a denoising convolutional neural network (CNN), which we subsequently demonstrate on prospective 23Na images of the calf. METHODS 1893 1H fat-saturated transverse slices of the knee from the open-source fastMRI dataset were used to train denoising CNNs for different levels of noise. Synthetic low SNR images were generated by adding gaussian noise to the high-quality 1H k-space data before reconstruction to create paired training data. For prospective testing, 23Na images of the calf were acquired in 10 healthy volunteers with a total of 150 averages over ten minutes, which were used as a reference throughout the study. From this data, images with fewer averages were retrospectively reconstructed using a non-uniform fast Fourier transform (NUFFT) as well as CS, with the NUFFT images subsequently denoised using the trained CNN. RESULTS CNNs were successfully applied to 23Na images reconstructed with 50, 40 and 30 averages. Muscle and skin apparent TSC quantification from CNN-denoised images were equivalent to those from CS images, with <0.9 mM bias compared to reference values. Estimated SNR was significantly higher in CNN-denoised images compared to NUFFT, CS and reference images. Quantitative edge sharpness was equivalent for all images. For subjective image quality ranking, CNN-denoised images ranked equally best with reference images and significantly better than NUFFT and CS images. CONCLUSION Denoising CNNs trained on 1H data can be successfully applied to 23Na images of the calf; thus, allowing scan time to be reduced from ten minutes to two minutes with little impact on image quality or apparent TSC quantification accuracy.
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Affiliation(s)
- Rebecca R Baker
- UCL Centre for Medical Imaging, University College London, London, UK; UCL Centre for Translational Cardiovascular Imaging, University College London, London, UK.
| | - Vivek Muthurangu
- UCL Centre for Translational Cardiovascular Imaging, University College London, London, UK.
| | - Marilena Rega
- Institute of Nuclear Medicine, University College Hospital, London, UK.
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London, UK.
| | - Jennifer A Steeden
- UCL Centre for Translational Cardiovascular Imaging, University College London, London, UK.
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Baker RR, Muthurangu V, Rega M, Montalt‐Tordera J, Rot S, Solanky BS, Gandini Wheeler‐Kingshott CAM, Walsh SB, Steeden JA. 2D sodium MRI of the human calf using half-sinc excitation pulses and compressed sensing. Magn Reson Med 2024; 91:325-336. [PMID: 37799019 PMCID: PMC10962573 DOI: 10.1002/mrm.29841] [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: 01/02/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Sodium MRI can be used to quantify tissue sodium concentration (TSC) in vivo; however, UTE sequences are required to capture the rapidly decaying signal. 2D MRI enables high in-plane resolution but typically has long TEs. Half-sinc excitation may enable UTE; however, twice as many readouts are necessary. Scan time can be minimized by reducing the number of signal averages (NSAs), but at a cost to SNR. We propose using compressed sensing (CS) to accelerate 2D half-sinc acquisitions while maintaining SNR and TSC. METHODS Ex vivo and in vivo TSC were compared between 2D spiral sequences with full-sinc (TE = 0.73 ms, scan time ≈ 5 min) and half-sinc excitation (TE = 0.23 ms, scan time ≈ 10 min), with 150 NSAs. Ex vivo, these were compared to a reference 3D sequence (TE = 0.22 ms, scan time ≈ 24 min). To investigate shortening 2D scan times, half-sinc data was retrospectively reconstructed with fewer NSAs, comparing a nonuniform fast Fourier transform to CS. Resultant TSC and image quality were compared to reference 150 NSAs nonuniform fast Fourier transform images. RESULTS TSC was significantly higher from half-sinc than from full-sinc acquisitions, ex vivo and in vivo. Ex vivo, half-sinc data more closely matched the reference 3D sequence, indicating improved accuracy. In silico modeling confirmed this was due to shorter TEs minimizing bias caused by relaxation differences between phantoms and tissue. CS was successfully applied to in vivo, half-sinc data, maintaining TSC and image quality (estimated SNR, edge sharpness, and qualitative metrics) with ≥50 NSAs. CONCLUSION 2D sodium MRI with half-sinc excitation and CS was validated, enabling TSC quantification with 2.25 × 2.25 mm2 resolution and scan times of ≤5 mins.
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Affiliation(s)
- Rebecca R. Baker
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUK
| | - Vivek Muthurangu
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUK
| | - Marilena Rega
- Institute of Nuclear MedicineUniversity College HospitalLondonUK
| | | | - Samuel Rot
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Bhavana S. Solanky
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Claudia A. M. Gandini Wheeler‐Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Digital Neuroscience Research UnitIRCCS Mondino FoundationPaviaItaly
| | | | - Jennifer A. Steeden
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUK
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Yao T, St. Clair N, Miller GF, Dorfman AL, Fogel MA, Ghelani S, Krishnamurthy R, Lam CZ, Quail M, Robinson JD, Schidlow D, Slesnick TC, Weigand J, Steeden JA, Rathod RH, Muthurangu V. A Deep Learning Pipeline for Assessing Ventricular Volumes from a Cardiac MRI Registry of Patients with Single Ventricle Physiology. Radiol Artif Intell 2024; 6:e230132. [PMID: 38166332 PMCID: PMC10831511 DOI: 10.1148/ryai.230132] [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: 04/22/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 01/04/2024]
Abstract
Purpose To develop an end-to-end deep learning (DL) pipeline for automated ventricular segmentation of cardiac MRI data from a multicenter registry of patients with Fontan circulation (Fontan Outcomes Registry Using CMR Examinations [FORCE]). Materials and Methods This retrospective study used 250 cardiac MRI examinations (November 2007-December 2022) from 13 institutions for training, validation, and testing. The pipeline contained three DL models: a classifier to identify short-axis cine stacks and two U-Net 3+ models for image cropping and segmentation. The automated segmentations were evaluated on the test set (n = 50) by using the Dice score. Volumetric and functional metrics derived from DL and ground truth manual segmentations were compared using Bland-Altman and intraclass correlation analysis. The pipeline was further qualitatively evaluated on 475 unseen examinations. Results There were acceptable limits of agreement (LOA) and minimal biases between the ground truth and DL end-diastolic volume (EDV) (bias: -0.6 mL/m2, LOA: -20.6 to 19.5 mL/m2) and end-systolic volume (ESV) (bias: -1.1 mL/m2, LOA: -18.1 to 15.9 mL/m2), with high intraclass correlation coefficients (ICCs > 0.97) and Dice scores (EDV, 0.91 and ESV, 0.86). There was moderate agreement for ventricular mass (bias: -1.9 g/m2, LOA: -17.3 to 13.5 g/m2) and an ICC of 0.94. There was also acceptable agreement for stroke volume (bias: 0.6 mL/m2, LOA: -17.2 to 18.3 mL/m2) and ejection fraction (bias: 0.6%, LOA: -12.2% to 13.4%), with high ICCs (>0.81). The pipeline achieved satisfactory segmentation in 68% of the 475 unseen examinations, while 26% needed minor adjustments, 5% needed major adjustments, and in 0.4%, the cropping model failed. Conclusion The DL pipeline can provide fast standardized segmentation for patients with single ventricle physiology across multiple centers. This pipeline can be applied to all cardiac MRI examinations in the FORCE registry. Keywords: Cardiac, Adults and Pediatrics, MR Imaging, Congenital, Volume Analysis, Segmentation, Quantification Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
| | | | - Gabriel F. Miller
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Adam L. Dorfman
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Mark A. Fogel
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Sunil Ghelani
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Rajesh Krishnamurthy
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Christopher Z. Lam
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Michael Quail
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Joshua D. Robinson
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - David Schidlow
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Timothy C. Slesnick
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Justin Weigand
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Jennifer A. Steeden
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Rahul H. Rathod
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Vivek Muthurangu
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
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Montalt-Tordera J, Steeden JA, Muthurangu V. Editorial for "Automatic Time-Resolved Cardiovascular Segmentation of 4D Flow MRI Using Deep Learning". J Magn Reson Imaging 2023; 57:204-205. [PMID: 35510802 DOI: 10.1002/jmri.28220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - Jennifer A Steeden
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, University College London, London, UK
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Brown JT, Saigal A, Karia N, Patel RK, Razvi Y, Constantinou N, Steeden JA, Mandal S, Kotecha T, Fontana M, Goldring J, Muthurangu V, Knight DS. Ongoing Exercise Intolerance Following COVID-19: A Magnetic Resonance-Augmented Cardiopulmonary Exercise Test Study. J Am Heart Assoc 2022; 11:e024207. [PMID: 35470679 PMCID: PMC9238618 DOI: 10.1161/jaha.121.024207] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Indexed: 12/18/2022]
Abstract
Background Ongoing exercise intolerance of unclear cause following COVID-19 infection is well recognized but poorly understood. We investigated exercise capacity in patients previously hospitalized with COVID-19 with and without self-reported exercise intolerance using magnetic resonance-augmented cardiopulmonary exercise testing. Methods and Results Sixty subjects were enrolled in this single-center prospective observational case-control study, split into 3 equally sized groups: 2 groups of age-, sex-, and comorbidity-matched previously hospitalized patients following COVID-19 without clearly identifiable postviral complications and with either self-reported reduced (COVIDreduced) or fully recovered (COVIDnormal) exercise capacity; a group of age- and sex-matched healthy controls. The COVIDreducedgroup had the lowest peak workload (79W [Interquartile range (IQR), 65-100] versus controls 104W [IQR, 86-148]; P=0.01) and shortest exercise duration (13.3±2.8 minutes versus controls 16.6±3.5 minutes; P=0.008), with no differences in these parameters between COVIDnormal patients and controls. The COVIDreduced group had: (1) the lowest peak indexed oxygen uptake (14.9 mL/minper kg [IQR, 13.1-16.2]) versus controls (22.3 mL/min per kg [IQR, 16.9-27.6]; P=0.003) and COVIDnormal patients (19.1 mL/min per kg [IQR, 15.4-23.7]; P=0.04); (2) the lowest peak indexed cardiac output (4.7±1.2 L/min per m2) versus controls (6.0±1.2 L/min per m2; P=0.004) and COVIDnormal patients (5.7±1.5 L/min per m2; P=0.02), associated with lower indexed stroke volume (SVi:COVIDreduced 39±10 mL/min per m2 versus COVIDnormal 43±7 mL/min per m2 versus controls 48±10 mL/min per m2; P=0.02). There were no differences in peak tissue oxygen extraction or biventricular ejection fractions between groups. There were no associations between COVID-19 illness severity and peak magnetic resonance-augmented cardiopulmonary exercise testing metrics. Peak indexed oxygen uptake, indexed cardiac output, and indexed stroke volume all correlated with duration from discharge to magnetic resonance-augmented cardiopulmonary exercise testing (P<0.05). Conclusions Magnetic resonance-augmented cardiopulmonary exercise testing suggests failure to augment stroke volume as a potential mechanism of exercise intolerance in previously hospitalized patients with COVID-19. This is unrelated to disease severity and, reassuringly, improves with time from acute illness.
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Affiliation(s)
- James T. Brown
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Anita Saigal
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Nina Karia
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Rishi K. Patel
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - Yousuf Razvi
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - Natalie Constantinou
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | | | - Swapna Mandal
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Tushar Kotecha
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Marianna Fontana
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - James Goldring
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Vivek Muthurangu
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Daniel S. Knight
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
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Brown JT, Kotecha T, Steeden JA, Fontana M, Denton CP, Coghlan JG, Knight DS, Muthurangu V. Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study. J Cardiovasc Magn Reson 2021; 23:118. [PMID: 34706740 PMCID: PMC8554852 DOI: 10.1186/s12968-021-00817-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Exercise intolerance in systemic sclerosis (SSc) is typically attributed to cardiopulmonary limitations. However, problems with skeletal muscle oxygen extraction have not been fully investigated. This study used cardiovascular magnetic resonance (CMR)-augmented cardiopulmonary exercise testing (CMR-CPET) to simultaneously measure oxygen consumption and cardiac output. This allowed calculation of arteriovenous oxygen content gradient, a recognized marker of oxygen extraction. We performed CMR-CPET in 4 groups: systemic sclerosis (SSc); systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH); non-connective tissue disease pulmonary hypertension (NC-PAH); and healthy controls. METHODS We performed CMR-CPET in 60 subjects (15 in each group) using a supine ergometer following a ramped exercise protocol until exhaustion. Values for oxygen consumption, cardiac output and oxygen content gradient, as well as ventricular volumes, were obtained at rest and peak-exercise for all subjects. In addition, T1 and T2 maps were acquired at rest, and the most recent clinical measures (hemoglobin, lung function, 6-min walk, cardiac and catheterization) were collected. RESULTS All patient groups had reduced peak oxygen consumption compared to healthy controls (p < 0.022). The SSc and SSc-PAH groups had reduced peak oxygen content gradient compared to healthy controls (p < 0.03). Conversely, the SSc-PAH and NC-PH patients had reduced peak cardiac output compared to healthy controls and SSc patients (p < 0.006). Higher hemoglobin was associated with higher peak oxygen content gradient (p = 0.025) and higher myocardial T1 was associated with lower peak stroke volume (p = 0.011). CONCLUSIONS Reduced peak oxygen consumption in SSc patients is predominantly driven by reduced oxygen content gradient and in SSc-PAH patients this was amplified by reduced peak cardiac output. Trial registration The study is registered with ClinicalTrials.gov Protocol Registration and Results System (ClinicalTrials.gov ID: 100358).
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Affiliation(s)
- James T Brown
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Tushar Kotecha
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Jennifer A Steeden
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marianna Fontana
- Royal Free Hospital, London, UK
- Division of Medicine, University College London, London, UK
| | - Christopher P Denton
- Royal Free Hospital, London, UK
- Division of Medicine, University College London, London, UK
| | | | - Daniel S Knight
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London, UK.
- Centre for Cardiovascular Imaging, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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7
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Jaubert O, Montalt‐Tordera J, Knight D, Coghlan GJ, Arridge S, Steeden JA, Muthurangu V. Real-time deep artifact suppression using recurrent U-Nets for low-latency cardiac MRI. Magn Reson Med 2021; 86:1904-1916. [PMID: 34032308 PMCID: PMC8613539 DOI: 10.1002/mrm.28834] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/22/2021] [Accepted: 04/17/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Real-time low latency MRI is performed to guide various cardiac interventions. Real-time acquisitions often require iterative image reconstruction strategies, which lead to long reconstruction times. In this study, we aim to reconstruct highly undersampled radial real-time data with low latency using deep learning. METHODS A 2D U-Net with convolutional long short-term memory layers is proposed to exploit spatial and preceding temporal information to reconstruct highly accelerated tiny golden radial data with low latency. The network was trained using a dataset of breath-hold CINE data (including 770 time series from 7 different orientations). Synthetic paired data were created by retrospectively undersampling the magnitude images, and the network was trained to recover the target images. In the spirit of interventional imaging, the network was trained and tested for varying acceleration rates and orientations. Data were prospectively acquired and reconstructed in real time in 1 healthy subject interactively and in 3 patients who underwent catheterization. Images were visually compared to sliding window and compressed sensing reconstructions and a conventional Cartesian real-time sequence. RESULTS The proposed network generalized well to different acceleration rates and unseen orientations for all considered metrics in simulated data (less than 4% reduction in structural similarity index compared to similar acceleration and orientation-specific networks). The proposed reconstruction was demonstrated interactively, successfully depicting catheters in vivo with low latency (39 ms, including 19 ms for deep artifact suppression) and an image quality comparing favorably to other reconstructions. CONCLUSION Deep artifact suppression was successfully demonstrated in the time-critical application of non-Cartesian real-time interventional cardiac MR.
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Affiliation(s)
- Olivier Jaubert
- Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Javier Montalt‐Tordera
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Dan Knight
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Gerry J. Coghlan
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Simon Arridge
- Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Jennifer A. Steeden
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Vivek Muthurangu
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
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Montalt-Tordera J, Quail M, Steeden JA, Muthurangu V. Reducing Contrast Agent Dose in Cardiovascular MR Angiography with Deep Learning. J Magn Reson Imaging 2021; 54:795-805. [PMID: 33619859 PMCID: PMC9681557 DOI: 10.1002/jmri.27573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/20/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022] Open
Abstract
Background Contrast‐enhanced magnetic resonance angiography (MRA) is used to assess various cardiovascular conditions. However, gadolinium‐based contrast agents (GBCAs) carry a risk of dose‐related adverse effects. Purpose To develop a deep learning method to reduce GBCA dose by 80%. Study Type Retrospective and prospective. Population A total of 1157 retrospective and 40 prospective congenital heart disease patients for training/validation and testing, respectively. Field Strength/Sequence A 1.5 T, T1‐weighted three‐dimensional (3D) gradient echo. Assessment A neural network was trained to enhance low‐dose (LD) 3D MRA using retrospective synthetic data and tested with prospective LD data. Image quality for LD (LD‐MRA), enhanced LD (ELD‐MRA), and high‐dose (HD‐MRA) was assessed in terms of signal‐to‐noise ratio (SNR), contrast‐to‐noise ratio (CNR), and a quantitative measure of edge sharpness and scored for perceptual sharpness and contrast on a 1–5 scale. Diagnostic confidence was assessed on a 1–3 scale. LD‐ and ELD‐MRA were assessed against HD‐MRA for sensitivity/specificity and agreement of vessel diameter measurements (aorta and pulmonary arteries). Statistical Tests SNR, CNR, edge sharpness, and vessel diameters were compared between LD‐, ELD‐, and HD‐MRA using one‐way repeated measures analysis of variance with post‐hoc t‐tests. Perceptual quality and diagnostic confidence were compared using Friedman's test with post‐hoc Wilcoxon signed‐rank tests. Sensitivity/specificity was compared using McNemar's test. Agreement of vessel diameters was assessed using Bland–Altman analysis. Results SNR, CNR, edge sharpness, perceptual sharpness, and perceptual contrast were lower (P < 0.05) for LD‐MRA compared to ELD‐MRA and HD‐MRA. SNR, CNR, edge sharpness, and perceptual contrast were comparable between ELD and HD‐MRA, but perceptual sharpness was significantly lower. Sensitivity/specificity was 0.824/0.921 for LD‐MRA and 0.882/0.960 for ELD‐MRA. Diagnostic confidence was 2.72, 2.85, and 2.92 for LD, ELD, and HD‐MRA, respectively (PLD‐ELD, PLD‐HD < 0.05). Vessel diameter measurements were comparable, with biases of 0.238 (LD‐MRA) and 0.278 mm (ELD‐MRA). Data Conclusion Deep learning can improve contrast in LD cardiovascular MRA. Level of Evidence Level 2 Technical Efficacy Stage 2
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Affiliation(s)
- Javier Montalt-Tordera
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, London, WC1N 1EH, UK
| | - Michael Quail
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, London, WC1N 1EH, UK.,Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, London, WC1N 1EH, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, London, WC1N 1EH, UK
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9
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Steeden JA, Quail M, Gotschy A, Mortensen KH, Hauptmann A, Arridge S, Jones R, Muthurangu V. Rapid whole-heart CMR with single volume super-resolution. J Cardiovasc Magn Reson 2020; 22:56. [PMID: 32753047 PMCID: PMC7405461 DOI: 10.1186/s12968-020-00651-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Three-dimensional, whole heart, balanced steady state free precession (WH-bSSFP) sequences provide delineation of intra-cardiac and vascular anatomy. However, they have long acquisition times. Here, we propose significant speed-ups using a deep-learning single volume super-resolution reconstruction, to recover high-resolution features from rapidly acquired low-resolution WH-bSSFP images. METHODS A 3D residual U-Net was trained using synthetic data, created from a library of 500 high-resolution WH-bSSFP images by simulating 50% slice resolution and 50% phase resolution. The trained network was validated with 25 synthetic test data sets. Additionally, prospective low-resolution data and high-resolution data were acquired in 40 patients. In the prospective data, vessel diameters, quantitative and qualitative image quality, and diagnostic scoring was compared between the low-resolution, super-resolution and reference high-resolution WH-bSSFP data. RESULTS The synthetic test data showed a significant increase in image quality of the low-resolution images after super-resolution reconstruction. Prospectively acquired low-resolution data was acquired ~× 3 faster than the prospective high-resolution data (173 s vs 488 s). Super-resolution reconstruction of the low-resolution data took < 1 s per volume. Qualitative image scores showed super-resolved images had better edge sharpness, fewer residual artefacts and less image distortion than low-resolution images, with similar scores to high-resolution data. Quantitative image scores showed super-resolved images had significantly better edge sharpness than low-resolution or high-resolution images, with significantly better signal-to-noise ratio than high-resolution data. Vessel diameters measurements showed over-estimation in the low-resolution measurements, compared to the high-resolution data. No significant differences and no bias was found in the super-resolution measurements in any of the great vessels. However, a small but significant for the underestimation was found in the proximal left coronary artery diameter measurement from super-resolution data. Diagnostic scoring showed that although super-resolution did not improve accuracy of diagnosis, it did improve diagnostic confidence compared to low-resolution imaging. CONCLUSION This paper demonstrates the potential of using a residual U-Net for super-resolution reconstruction of rapidly acquired low-resolution whole heart bSSFP data within a clinical setting. We were able to train the network using synthetic training data from retrospective high-resolution whole heart data. The resulting network can be applied very quickly, making these techniques particularly appealing within busy clinical workflow. Thus, we believe that this technique may help speed up whole heart CMR in clinical practice.
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Affiliation(s)
- Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
| | - Michael Quail
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Alexander Gotschy
- Great Ormond Street Hospital, London, WC1N 3JH, UK
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | | | - Andreas Hauptmann
- Department of Computer Science, University College London, London, WC1E 6BT, UK
- Research Unit of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Simon Arridge
- Department of Computer Science, University College London, London, WC1E 6BT, UK
| | - Rodney Jones
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK
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Quail MA, Segers P, Steeden JA, Muthurangu V. Correction to: The aorta after coarctation repair - effects of calibre and curvature on arterial haemodynamics. J Cardiovasc Magn Reson 2019; 21:31. [PMID: 31122264 PMCID: PMC6533728 DOI: 10.1186/s12968-019-0540-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In the original version of this article [1], published on 11 April 2019, there is 1 error in the 'Conclusion' paragraph of the abstract.
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Affiliation(s)
- Michael A Quail
- Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Patrick Segers
- IBiTech-bioMMeda, iMinds Medical IT, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Jennifer A Steeden
- Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Vivek Muthurangu
- Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
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11
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Quail MA, Segers P, Steeden JA, Muthurangu V. The aorta after coarctation repair - effects of calibre and curvature on arterial haemodynamics. J Cardiovasc Magn Reson 2019; 21:22. [PMID: 30975162 PMCID: PMC6458643 DOI: 10.1186/s12968-019-0534-7] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aortic shape has been proposed as an important determinant of adverse haemodynamics following coarctation repair. However, previous studies have not demonstrated a consistent relationship between shape and vascular load. In this study, 3D aortic shape was evaluated using principal component analysis (PCA), allowing investigation of the relationship between 3D shape and haemodynamics. METHODS Sixty subjects (38 male, 25.0 ± 7.8 years) with repaired coarctation were recruited. Central aortic haemodynamics including wave intensity analysis were measured noninvasively using a combination of blood pressure and phase contrast cardiovascular magnetic resonance (CMR). 3D curvature and radius data were derived from CMR angiograms. PCA was separately performed on 3D radius and curvature data to assess the role of arch geometry on haemodynamics. Clinical findings were corroborated using 1D vascular models. RESULTS There were no independent associations between 3D curvature and any hemodynamic parameters. However, the magnitude of the backwards compression wave was related to the 1st (r = - 0.36, p = 0.005), 3rd (r = 0.27, p = 0.036) and 4th (r = - 0.31, p = 0.017) principle components of radius. The 4th principle componentof radius also correlated with central aortic systolic pressure. These aortas had larger aortic roots, more transverse arch hypoplasia and narrower aortic isthmuses. CONCLUSIONS There are major modes of variation in 3D aortic shape after coarctation repair witha modest association between variation in aortic radius and pathological wave reflections, but not with 3D curvature. Taken together, these data suggest that shape is not the major determinant of vascular load following coarctation repair, and calibre is more important than curvature.
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Affiliation(s)
- Michael A. Quail
- Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, WC1N 3JH UK
| | - Patrick Segers
- IBiTech-bioMMeda, iMinds Medical IT, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Jennifer A. Steeden
- Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, WC1N 3JH UK
| | - Vivek Muthurangu
- Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, WC1N 3JH UK
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12
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Steeden JA, Kowalik GT, Tann O, Hughes M, Mortensen KH, Muthurangu V. Real-time assessment of right and left ventricular volumes and function in children using high spatiotemporal resolution spiral bSSFP with compressed sensing. J Cardiovasc Magn Reson 2018; 20:79. [PMID: 30518390 PMCID: PMC6282387 DOI: 10.1186/s12968-018-0500-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Real-time cardiovascular magnetic resonance (CMR) assessment of ventricular volumes and function enables data acquisition during free-breathing. The requirement for high spatiotemporal resolution in children necessitates the use of highly accelerated imaging techniques. METHODS A novel real-time balanced steady state free precession (bSSFP) spiral sequence reconstructed using Compressed Sensing (CS) was prospectively validated against the breath-hold clinical standard for assessment of ventricular volumes in 60 children with congenital heart disease. Qualitative image scoring, quantitative image quality, as well as evaluation of biventricular volumes was performed. Standard BH and real-time measures were compared using the paired t-test and agreement for volumetric measures were evaluated using Bland Altman analysis. RESULTS Acquisition time for the entire short axis stack (~ 13 slices) using the spiral real-time technique was ~ 20 s, compared to ~ 348 s for the standard breath hold technique. Qualitative scores reflected more residual aliasing artefact (p < 0.001) and lower edge definition (p < 0.001) in spiral real-time images than standard breath hold images, with lower quantitative edge sharpness and estimates of image contrast (p < 0.001). There was a small but statistically significant (p < 0.05) overestimation of left ventricular (LV) end-systolic volume (1.0 ± 3.5 mL), and underestimation of LV end-diastolic volume (- 1.7 ± 4.6 mL), LV stroke volume (- 2.6 ± 4.8 mL) and LV ejection fraction (- 1.5 ± 3.0%) using the real-time technique. We also observed a small underestimation of right ventricular stroke volume (- 1.8 ± 4.9 mL) and ejection fraction (- 1.4 ± 3.7%) using the real-time imaging technique. No difference in inter-observer or intra-observer variability were observed between the BH and real-time sequences. CONCLUSIONS Real-time bSSFP imaging using spiral trajectories combined with a compressed sensing reconstruction showed good agreement for quantification of biventricular metrics in children with heart disease, despite slightly lower image quality. This technique holds the potential for free breathing data acquisition, with significantly shorter scan times in children.
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Affiliation(s)
- Jennifer A. Steeden
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | - Grzegorz T. Kowalik
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | - Oliver Tann
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH UK
| | - Marina Hughes
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH UK
| | - Kristian H. Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH UK
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH UK
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Hauptmann A, Arridge S, Lucka F, Muthurangu V, Steeden JA. Real-time cardiovascular MR with spatio-temporal artifact suppression using deep learning-proof of concept in congenital heart disease. Magn Reson Med 2018; 81:1143-1156. [PMID: 30194880 PMCID: PMC6492123 DOI: 10.1002/mrm.27480] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [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: 03/23/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 12/25/2022]
Abstract
Purpose Real‐time assessment of ventricular volumes requires high acceleration factors. Residual convolutional neural networks (CNN) have shown potential for removing artifacts caused by data undersampling. In this study, we investigated the ability of CNNs to reconstruct highly accelerated radial real‐time data in patients with congenital heart disease (CHD). Methods A 3D (2D plus time) CNN architecture was developed and trained using synthetic training data created from previously acquired breath hold cine images from 250 CHD patients. The trained CNN was then used to reconstruct actual real‐time, tiny golden angle (tGA) radial SSFP data (13 × undersampled) acquired in 10 new patients with CHD. The same real‐time data was also reconstructed with compressed sensing (CS) to compare image quality and reconstruction time. Ventricular volume measurements made using both the CNN and CS reconstructed images were compared to reference standard breath hold data. Results It was feasible to train a CNN to remove artifact from highly undersampled radial real‐time data. The overall reconstruction time with the CNN (including creation of aliased images) was shown to be >5 × faster than the CS reconstruction. In addition, the image quality and accuracy of biventricular volumes measured from the CNN reconstructed images were superior to the CS reconstructions. Conclusion This article has demonstrated the potential for the use of a CNN for reconstruction of real‐time radial data within the clinical setting. Clinical measures of ventricular volumes using real‐time data with CNN reconstruction are not statistically significantly different from gold‐standard, cardiac‐gated, breath‐hold techniques.
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Affiliation(s)
- Andreas Hauptmann
- Department of Computer Science, University College London, London, United Kingdom
| | - Simon Arridge
- Department of Computer Science, University College London, London, United Kingdom
| | - Felix Lucka
- Department of Computer Science, University College London, London, United Kingdom.,Computational Imaging, Centrum Wiskunde and Informatica (CWI), Amsterdam, Netherlands
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
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Ross JC, Hutt DF, Burniston M, Page J, Steeden JA, Gillmore JD, Wechalekar AD, Hawkins PN, Fontana M. Quantitation of 99mTc-DPD uptake in patients with transthyretin-related cardiac amyloidosis. Amyloid 2018; 25:203-210. [PMID: 30486686 DOI: 10.1080/13506129.2018.1520087] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Transthyretin (ATTR) amyloidosis is a rare but serious infiltrative disease associated with a wide spectrum of morphologic and functional cardiac involvement. 99mTc-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD), initially developed as a bone-seeking radiotracer, is remarkably sensitive for imaging cardiac ATTR amyloid deposits. Our aim was to investigate the feasibility and utility of estimating 99mTc-DPD uptake in myocardial tissue; this has the potential to yield reliable quantitative information on cardiac amyloid burden, which is urgently required to monitor disease progression and response to novel treatments. METHODS Three methods of quantitation were developed and tested on 74 patients with proven cardiac ATTR amyloidosis who had recently undergone 99mTc-DPD planar whole-body imaging and SPECT-CT. Quantitative results were compared to measurements of extracellular volume fraction (ECV) by cardiac magnetic resonance imaging, a validated technique for measuring amyloid burden. RESULTS An experienced clinician graded uptake using a widely-used visual scoring system as 1 (n = 15), 2 (n = 39) or 3 (n = 20). Linear correlations between the SPECT and ECV data (p < .001) were demonstrated. None of the methods showed that 99mTc-DPD uptake in the heart was significantly greater in patients with grade-3 uptake than in those with grade-2 uptake. CONCLUSIONS Quantitation of 99mTc-DPD uptake in cardiac transthyretin amyloid deposits is complex and is hindered by competition for radiotracer with amyloid in skeletal muscle. The latter underlies differences in uptake between grade-2 and grade-3 patients, not cardiac uptake.
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Affiliation(s)
- James C Ross
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK.,b Institute of Nuclear Medicine , University College London Hospitals NHS Foundation Trust , London , UK
| | - David F Hutt
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
| | - Maria Burniston
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK.,c Nuclear Medicine Department, Nuclear Medicine , Barts Health NHS Trust , London , UK
| | - Joanne Page
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK.,d Nuclear Medicine Department , Royal Free London NHS Foundation Trust , London , UK
| | - Jennifer A Steeden
- e UCL Centre for Cardiovascular Imaging , University College London , London , UK
| | - Julian D Gillmore
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
| | - Ashutosh D Wechalekar
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
| | - Philip N Hawkins
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
| | - Marianna Fontana
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
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15
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Knight DS, Zumbo G, Barcella W, Steeden JA, Muthurangu V, Martinez-Naharro A, Treibel TA, Abdel-Gadir A, Bulluck H, Kotecha T, Francis R, Rezk T, Quarta CC, Whelan CJ, Lachmann HJ, Wechalekar AD, Gillmore JD, Moon JC, Hawkins PN, Fontana M. Cardiac Structural and Functional Consequences of Amyloid Deposition by Cardiac Magnetic Resonance and Echocardiography and Their Prognostic Roles. JACC Cardiovasc Imaging 2018; 12:823-833. [PMID: 29680336 DOI: 10.1016/j.jcmg.2018.02.016] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [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: 04/19/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This cross-sectional study aimed to describe the functional and structural cardiac abnormalities that occur across a spectrum of cardiac amyloidosis burden and to identify the strongest cardiac functional and structural prognostic predictors in amyloidosis using cardiac magnetic resonance (CMR) and echocardiography. BACKGROUND Cardiac involvement in light chain and transthyretin amyloidosis is the main driver of prognosis and influences treatment strategies. Numerous measures of cardiac structure and function are assessed by multiple imaging modalities in amyloidosis. METHODS A total f 322 subjects (311 systemic amyloidosis and 11 transthyretin gene mutation carriers) underwent comprehensive CMR and transthoracic echocardiography. The probabilities of 11 commonly measured structural and functional cardiac parameters being abnormal with increasing cardiac amyloidosis burden were evaluated. Cardiac amyloidosis burden was quantified using CMR-derived extracellular volume. The prognostic capacities of these parameters to predict death in amyloidosis were assessed using Cox proportional hazards models. RESULTS Left ventricular mass and mitral annular plane systolic excursion by CMR along with strain and E/e' by echocardiography have high probabilities of being abnormal at low cardiac amyloid burden. Reductions in biventricular ejection fractions and elevations in biatrial areas occur at high burdens of infiltration. The probabilities of indexed stroke volume, myocardial contraction fraction, and tricuspid annular plane systolic excursion (TAPSE) being abnormal occur more gradually with increasing extracellular volume. Ninety patients (28%) died during a median follow-up of 22 months (interquartile range: 10 to 38 months). Univariable analysis showed that all imaging markers studied significantly predicted outcome. Multivariable analysis showed that TAPSE (hazard ratio: 1.46; 95% confidence interval: 1.16 to 1.85; p < 0.01) and indexed stroke volume (hazard ratio: 1.24; 95% confidence interval: 1.04 to 1.48; p < 0.05) by CMR were the only independent predictors of mortality. CONCLUSIONS Specific functional and structural abnormalities characterize different burdens of cardiac amyloid deposition. In a multimodality imaging assessment of a large cohort of amyloidosis patients, CMR-derived TAPSE and indexed stroke volume are the strongest prognostic cardiac functional markers.
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Affiliation(s)
- Daniel S Knight
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Giulia Zumbo
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - William Barcella
- Department of Statistical Science, University College London, United Kingdom
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Thomas A Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Amna Abdel-Gadir
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom
| | - Tushar Kotecha
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Rohin Francis
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Tamer Rezk
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Candida C Quarta
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Carol J Whelan
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Helen J Lachmann
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - James C Moon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom.
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16
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Cheang MH, Barber NJ, Khushnood A, Hauser JA, Kowalik GT, Steeden JA, Quail MA, Tullus K, Hothi D, Muthurangu V. A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2018; 20:24. [PMID: 29609642 PMCID: PMC5880006 DOI: 10.1186/s12968-018-0444-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 03/08/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Children with chronic kidney disease (CKD) have increased cardiovascular mortality. Identifying high-risk children who may benefit from further therapeutic intervention is difficult as cardiovascular abnormalities are subtle. Although transthoracic echocardiography may be used to detect sub-clinical abnormalities, it has well-known problems with reproducibility that limit its ability to accurately detect these changes. Cardiovascular magnetic resonance (CMR) is the reference standard method for assessing blood flow, cardiac structure and function. Furthermore, recent innovations enable the assessment of radial and longitudinal myocardial velocity, such that detection of sub-clinical changes is now possible. Thus, CMR may be ideal for cardiovascular assessment in pediatric CKD. This study aims to comprehensively assess cardiovascular function in pediatric CKD using CMR and determine its relationship with CKD severity. METHODS A total of 120 children (40 mild, 40 moderate, 20 severe pre-dialysis CKD subjects and 20 healthy controls) underwent CMR with non-invasive blood pressure (BP) measurements. Cardiovascular parameters measured included systemic vascular resistance (SVR), total arterial compliance (TAC), left ventricular (LV) structure, ejection fraction (EF), cardiac timings, radial and longitudinal systolic and diastolic myocardial velocities. Between group comparisons and regression modelling were used to identify abnormalities in CKD and determine the effects of renal severity on myocardial function. RESULTS The elevation in mean BP in CKD was accompanied by significantly increased afterload (SVR), without evidence of arterial stiffness (TAC) or increased fluid overload. Left ventricular volumes and global function were not abnormal in CKD. However, there was evidence of LV remodelling, prolongation of isovolumic relaxation time and reduced systolic and diastolic myocardial velocities. CONCLUSION Abnormal cardiovascular function is evident in pre-dialysis pediatric CKD. Novel CMR biomarkers may be useful for the detection of subtle abnormalities in this population. Further studies are needed to determine to prognostic value of these biomarkers.
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Affiliation(s)
- Mun Hong Cheang
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | - Nathaniel J. Barber
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | - Abbas Khushnood
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | - Jakob A. Hauser
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | - Gregorz T. Kowalik
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
| | - Jennifer A. Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
| | - Michael A. Quail
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | | | | | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
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17
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Treibel TA, Fontana M, Steeden JA, Nasis A, Yeung J, White SK, Sivarajan S, Punwani S, Pugliese F, Taylor SA, Moon JC, Bandula S. Automatic quantification of the myocardial extracellular volume by cardiac computed tomography: Synthetic ECV by CCT. J Cardiovasc Comput Tomogr 2017; 11:221-226. [PMID: 28268091 DOI: 10.1016/j.jcct.2017.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 11/06/2016] [Revised: 02/11/2017] [Accepted: 02/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The quantification of extracellular volume fraction (ECV) by Cardiac Computed Tomography (CCT) can identify changes in the myocardial interstitium due to fibrosis or infiltration. Current methodologies require laboratory blood hematocrit (Hct) measurement - which complicates the technique. The attenuation of blood (HUblood) is known to change with anemia. We hypothesized that the relationship between Hct and HUblood could be calibrated to rapidly generate a synthetic ECV without formally measuring Hct. METHODS The association between Hct and HUblood was derived from forty non-contrast thoracic CT scans using regression analysis. Synthetic Hct was then used to calculate synthetic ECV, and in turn compared with ECV using blood Hct in a validation cohort with mild interstitial expansion due to fibrosis (aortic stenosis, n = 28, ECVCT = 28 ± 4%) and severe interstitial expansion due to amyloidosis (n = 27; ECVCT = 54 ± 11%, p < 0.001). For histological validation, synthetic ECV was correlated with collagen volume fraction (CVF) in a separate cohort with aortic stenosis (n = 18). All CT scans were performed at 120 kV and 160 mAs. RESULTS HUblood was a good predictor of Hct (R2 = 0.47; p < 0.01), with the regression model (Hct = [0.51 * HUblood] + 17.4) describing the association. Synthetic ECV correlated well with conventional ECV (R2 = 0.96; p < 0.01) with minimal bias and 2SD difference of 5.7%. Synthetic ECV correlated as well as conventional ECV with histological CVF (both R2 = 0.50, p < 0.01). Finally, we implemented an automatic ECV plug-in for offline analysis. CONCLUSION Synthetic ECV by CCT provides instantaneous quantification of the myocardial extracellular space without the need for blood sampling.
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Affiliation(s)
- Thomas A Treibel
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK.
| | - Marianna Fontana
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK
| | - Jennifer A Steeden
- Institute of Cardiovascular Science, University College London, London, UK; UCL Centre for Medical Image Computing, Department of Medical Physics, London, UK
| | - Arthur Nasis
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Jason Yeung
- Centre for Medical Imaging, University College London, London, UK
| | - Steven K White
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK
| | - Sri Sivarajan
- Centre for Medical Imaging, University College London, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | | | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - James C Moon
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK
| | - Steve Bandula
- Centre for Medical Imaging, University College London, London, UK
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18
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Quail MA, Short R, Pandya B, Steeden JA, Khushnood A, Taylor AM, Segers P, Muthurangu V. Abnormal Wave Reflections and Left Ventricular Hypertrophy Late After Coarctation of the Aorta Repair. Hypertension 2017; 69:501-509. [PMID: 28115510 PMCID: PMC5295491 DOI: 10.1161/hypertensionaha.116.08763] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 11/18/2016] [Revised: 12/04/2016] [Accepted: 12/23/2016] [Indexed: 12/22/2022]
Abstract
Patients with repaired coarctation of the aorta are thought to have increased afterload due to abnormalities in vessel structure and function. We have developed a novel cardiovascular magnetic resonance protocol that allows assessment of central hemodynamics, including central aortic systolic blood pressure, resistance, total arterial compliance, pulse wave velocity, and wave reflections. The main study aims were to (1) characterize group differences in central aortic systolic blood pressure and peripheral systolic blood pressure, (2) comprehensively evaluate afterload (including wave reflections) in the 2 groups, and (3) identify possible biomarkers among covariates associated with elevated left ventricular mass (LVM). Fifty adult patients with repaired coarctation and 25 age- and sex-matched controls were recruited. Ascending aorta area and flow waveforms were obtained using a high temporal-resolution spiral phase-contrast cardiovascular magnetic resonance flow sequence. These data were used to derive central hemodynamics and to perform wave intensity analysis noninvasively. Covariates associated with LVM were assessed using multivariable linear regression analysis. There were no significant group differences (P≥0.1) in brachial systolic, mean, or diastolic BP. However central aortic systolic blood pressure was significantly higher in patients compared with controls (113 versus 107 mm Hg, P=0.002). Patients had reduced total arterial compliance, increased pulse wave velocity, and larger backward compression waves compared with controls. LVM index was significantly higher in patients than controls (72 versus 59 g/m2, P<0.0005). The magnitude of the backward compression waves was independently associated with variation in LVM (P=0.01). Using a novel, noninvasive hemodynamic assessment, we have shown abnormal conduit vessel function after coarctation of the aorta repair, including abnormal wave reflections that are associated with elevated LVM.
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Affiliation(s)
- Michael A Quail
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Rebekah Short
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Bejal Pandya
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Jennifer A Steeden
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Abbas Khushnood
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Andrew M Taylor
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Patrick Segers
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Vivek Muthurangu
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
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19
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Cheang M, Barber NJ, Steeden JA, Kowalik GT, Tullus K, Hothi D, Muthurangu V. Comprehensive cardiovascular assessment of children with chronic kidney disease using exercise cardiac magnetic resonance imaging. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032566 DOI: 10.1186/1532-429x-18-s1-p157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Ako EO, Barber NJ, Kowalik GT, Steeden JA, Porter J, Walker JM, Muthurangu V. MR-Augmented Cardiopulmonary Exercise Testing- a proof of concept in Sickle Cell Disease (SCD). J Cardiovasc Magn Reson 2016. [PMCID: PMC5032132 DOI: 10.1186/1532-429x-18-s1-o69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Barber NJ, Ako EO, Kowalik GT, Cheang MH, Pandya B, Steeden JA, Moledina S, Muthurangu V. Magnetic Resonance–Augmented Cardiopulmonary Exercise Testing. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005282. [DOI: 10.1161/circimaging.116.005282] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022]
Abstract
Background—
Conventional cardiopulmonary exercise testing can objectively measure exercise intolerance but cannot provide comprehensive evaluation of physiology. This requires additional assessment of cardiac output and arteriovenous oxygen content difference. We developed magnetic resonance (MR)–augmented cardiopulmonary exercise testing to achieve this goal and assessed children with right heart disease.
Methods and Results—
Healthy controls (n=10) and children with pulmonary arterial hypertension (PAH; n=10) and repaired tetralogy of Fallot (n=10) underwent MR-augmented cardiopulmonary exercise testing. All exercises were performed on an MR-compatible ergometer, and oxygen uptake was continuously acquired using a modified metabolic cart. Simultaneous cardiac output was measured using a real-time MR flow sequence and combined with oxygen uptake to calculate arteriovenous oxygen content difference. Peak oxygen uptake was significantly lower in the PAH group (12.6±1.31 mL/kg per minute;
P
=0.01) and trended toward lower in the tetralogy of Fallot group (13.5±1.29 mL/kg per minute;
P
=0.06) compared with controls (16.7±1.37 mL/kg per minute). Although tetralogy of Fallot patients had the largest increase in cardiac output, they had lower resting (3±1.2 L/min per m
2
) and peak (5.3±1.2 L/min per m
2
) values compared with controls (resting 4.3±1.2 L/min per m
2
and peak 6.6±1.2 L/min per m
2
) and PAH patients (resting 4.5±1.1 L/min per m
2
and peak 5.9±1.1 L/min per m
2
). Both the PAH and tetralogy of Fallot patients had blunted exercise–induced increases in arteriovenous oxygen content difference. However, only the PAH patients had significantly reduced peak values (6.9±1.3 mlO2/100 mL) compared with controls (8.4±1.4 mlO2/100 mL;
P
=0.005).
Conclusions—
MR-augmented cardiopulmonary exercise testing is feasible in both healthy children and children with cardiac disease. Using this novel technique, we have demonstrated abnormal exercise patterns in oxygen uptake, cardiac output, and arteriovenous oxygen content difference.
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Affiliation(s)
- Nathaniel J. Barber
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (N.J.B., E.O.A., G.T.K., M.H.C., J.A.S., V.M.); Great Ormond Street Hospital, London, United Kingdom (N.J.B., G.T.K., M.H.C., J.A.S., S.M., V.M.); and Bart’s Heart Centre, London, United Kingdom (E.O.A., B.P.)
| | - Emmanuel O. Ako
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (N.J.B., E.O.A., G.T.K., M.H.C., J.A.S., V.M.); Great Ormond Street Hospital, London, United Kingdom (N.J.B., G.T.K., M.H.C., J.A.S., S.M., V.M.); and Bart’s Heart Centre, London, United Kingdom (E.O.A., B.P.)
| | - Gregorz T. Kowalik
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (N.J.B., E.O.A., G.T.K., M.H.C., J.A.S., V.M.); Great Ormond Street Hospital, London, United Kingdom (N.J.B., G.T.K., M.H.C., J.A.S., S.M., V.M.); and Bart’s Heart Centre, London, United Kingdom (E.O.A., B.P.)
| | - Mun H. Cheang
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (N.J.B., E.O.A., G.T.K., M.H.C., J.A.S., V.M.); Great Ormond Street Hospital, London, United Kingdom (N.J.B., G.T.K., M.H.C., J.A.S., S.M., V.M.); and Bart’s Heart Centre, London, United Kingdom (E.O.A., B.P.)
| | - Bejal Pandya
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (N.J.B., E.O.A., G.T.K., M.H.C., J.A.S., V.M.); Great Ormond Street Hospital, London, United Kingdom (N.J.B., G.T.K., M.H.C., J.A.S., S.M., V.M.); and Bart’s Heart Centre, London, United Kingdom (E.O.A., B.P.)
| | - Jennifer A. Steeden
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (N.J.B., E.O.A., G.T.K., M.H.C., J.A.S., V.M.); Great Ormond Street Hospital, London, United Kingdom (N.J.B., G.T.K., M.H.C., J.A.S., S.M., V.M.); and Bart’s Heart Centre, London, United Kingdom (E.O.A., B.P.)
| | - Shahin Moledina
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (N.J.B., E.O.A., G.T.K., M.H.C., J.A.S., V.M.); Great Ormond Street Hospital, London, United Kingdom (N.J.B., G.T.K., M.H.C., J.A.S., S.M., V.M.); and Bart’s Heart Centre, London, United Kingdom (E.O.A., B.P.)
| | - Vivek Muthurangu
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (N.J.B., E.O.A., G.T.K., M.H.C., J.A.S., V.M.); Great Ormond Street Hospital, London, United Kingdom (N.J.B., G.T.K., M.H.C., J.A.S., S.M., V.M.); and Bart’s Heart Centre, London, United Kingdom (E.O.A., B.P.)
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22
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Jones A, Pruessner JC, McMillan MR, Jones RW, Kowalik GT, Steeden JA, Williams B, Taylor AM, Muthurangu V. Physiological adaptations to chronic stress in healthy humans - why might the sexes have evolved different energy utilisation strategies? J Physiol 2016; 594:4297-307. [PMID: 27027401 DOI: 10.1113/jp272021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/23/2016] [Indexed: 01/08/2023] Open
Abstract
KEY POINTS The human stress response activates the autonomic nervous system and endocrine systems to increase performance during environmental challenges. This response is usually beneficial, improving the chance of overcoming environmental challenges, but costs resources such as energy. Humans and other animals are known to adapt their responses to acute stress when they are stimulated chronically, presumably to optimise resource utilisation. Characterisation of these adaptations has been limited. Using advanced imaging techniques, we show that cardiovascular and endocrine physiology, reflective of energy utilisation during acute stress, and energy storage (fat) differ between the sexes when they are exposed to chronic stress. We examine possible evolutionary explanations for these differences, related to energy use, and point out how these physiological differences could underpin known disparities between the sexes in their risk of important cardiometabolic disorders such as obesity and cardiovascular disease. ABSTRACT Obesity and associated diseases, such as cardiovascular disease, are the dominant human health problems in the modern era. Humans develop these conditions partly because they consume excess energy and exercise too little. Stress might be one of the factors contributing to these disease-promoting behaviours. We postulate that sex-specific primordial energy optimisation strategies exist, which developed to help cope with chronic stress but have become maladaptive in modern societies, worsening health. To demonstrate the existence of these energy optimisation strategies, we recruited 88 healthy adults with varying adiposity and chronic stress exposure. Cardiovascular physiology at rest and during acute stress (Montreal Imaging Stress Task), and body fat distribution were measured using advanced magnetic resonance imaging methods, together with endocrine function, cardiovascular energy use and cognitive performance. Potential confounders such as lifestyle, social class and employment were accounted for. We found that women exposed to chronic stress had lower adiposity, greater acute stress cardiovascular responses and better cognitive performance. Conversely, chronic stress-exposed men had greater adiposity and lower cardiovascular responses to acute stress. These results provide initial support for our hypothesis that differing sex-specific energy conservation strategies exist. We propose that these strategies have initially evolved to benefit humans but are now maladaptive and increase the risk of disorders such as obesity, especially in men exposed to chronic stress.
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Affiliation(s)
- Alexander Jones
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Jens C Pruessner
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, Canada
| | - Merlin R McMillan
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Russell W Jones
- Chorleywood Health Centre, Chorleywood, UK.,Department of Information Systems and Computing, Brunel University, Uxbridge, UK
| | - Grzegorz T Kowalik
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | | | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
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Hauser JA, Muthurangu V, Steeden JA, Taylor AM, Jones A. Comprehensive assessment of the global and regional vascular responses to food ingestion in humans using novel rapid MRI. Am J Physiol Regul Integr Comp Physiol 2016; 310:R541-5. [DOI: 10.1152/ajpregu.00454.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/10/2016] [Indexed: 11/22/2022]
Abstract
Ingestion of food is known to increase mesenteric blood flow. It is not clear whether this increased flow demand is compensated by a rise in cardiac output (CO) alone or by redistribution of blood flow from other organs. We used a new comprehensive imaging method to assess the human cardiovascular response to food ingestion. Following a 12-h fast, blood flow in segments of the aorta and in organ-specific arteries, and ventricular volumes were assessed in 20 healthy adults using MRI at rest and following ingestion of a high-energy liquid meal. Systemic vascular resistance (SVR) fell substantially and CO rose significantly. Blood pressure remained stable. These changes were predominantly driven by a rapid fall in mesenteric vascular resistance, resulting in over four times more intestinal blood flow. Renal vascular resistance also declined but less dramatically. No changes in blood flow to the celiac territory, the brain, or the limbs were observed. In conclusion, this is the first study to fully characterize systemic and regional changes in vascular resistance after food ingestion in humans. Our findings show that the postprandial drop in SVR is fully compensated for by increased CO and not by redistribution of blood from other organs. With the exception of a modest increase in renal blood flow, there was no evidence of altered blood flow to nondigestive organs. The proposed oral food challenge protocol can be applied safely in an MRI environment and may be useful for studying the involvement of the gut in systemic or cardiovascular disease.
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Affiliation(s)
- Jakob A. Hauser
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
| | - Vivek Muthurangu
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
| | - Jennifer A. Steeden
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
| | - Andrew M. Taylor
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
| | - Alexander Jones
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
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Kowalik GT, Muthurangu V, Khushnood A, Steeden JA. Rapid breath-hold assessment of myocardial velocities using spiral UNFOLD-ed SENSE tissue phase mapping. J Magn Reson Imaging 2016; 44:1003-9. [PMID: 26929195 DOI: 10.1002/jmri.25218] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To develop and validate a rapid breath-hold tissue phase mapping (TPM) sequence. MATERIALS AND METHODS The sequence was based on an efficient uniform density spiral acquisition, combined with data acceleration. A novel acquisition and reconstruction strategy enabled combination of UNFOLD (2×) and SENSE (3×): UNFOLD-ed SENSE. The sequence was retrospectively cardiac-gated, and a graphics processing unit (GPU) was used for rapid "online" reconstruction. The optimal UNFOLD parameters for the data were calculated using an in silico model. The technique was validated on a 1.5T MR scanner in 15 patients with known aortic valve disease, against a respiratory self-navigated free-breathing TPM technique. Quantitative image quality measures (velocity-to-noise and edge sharpness) were made as well as calculation of longitudinal, radial, and tangential myocardial velocities in the left ventricle. RESULTS The proposed breath-hold TPM data took eight heartbeats to acquire. The breath-hold TPM images had significantly higher edge sharpness (P = 0.0014) than the self-navigated TPM images, but with significantly lower velocity-to-noise ratio (P < 0.0001). There was excellent agreement (r > 0.94) in the longitudinal, radial, and tangential velocities between the self-navigated data and the proposed breath-hold TPM sequence. CONCLUSION We demonstrate the feasibility of using spiral UNFOLD-ed SENSE to measure myocardial velocities using a rapid breath-hold spiral TPM sequence. This novel technique might enable accurate measurement of myocardial velocities, in a short scan time, which is especially important in a busy clinical workflow. J. MAGN. RESON. IMAGING 2016;44:1003-1009.
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Affiliation(s)
- Grzegorz T Kowalik
- UCL Centre for Cardiovascular Imaging, University College London, London, UK
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, University College London, London, UK.
| | - Abbas Khushnood
- UCL Centre for Cardiovascular Imaging, University College London, London, UK
| | - Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, University College London, London, UK
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Knight DS, Steeden JA, Moledina S, Jones A, Coghlan JG, Muthurangu V. Left ventricular diastolic dysfunction in pulmonary hypertension predicts functional capacity and clinical worsening: a tissue phase mapping study. J Cardiovasc Magn Reson 2015; 17:116. [PMID: 26715551 PMCID: PMC4696235 DOI: 10.1186/s12968-015-0220-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/15/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The function of the right and left ventricles is intimately related through a shared septum and pericardium. Therefore, right ventricular (RV) disease in pulmonary hypertension (PH) can result in abnormal left ventricular (LV) myocardial mechanics. To assess this, we implemented novel cardiovascular magnetic resonance (CMR) tissue phase mapping (TPM) to assess radial, longitudinal and tangential LV myocardial velocities in patients with PH. METHODS Respiratory self-gated TPM was performed using a rotating golden-angle spiral acquisition with retrospective cardiac gating. TPM of a mid ventricular slice was acquired in 40 PH patients and 20 age- and sex-matched healthy controls. Endocardial and epicardial LV borders were manually defined, and myocardial velocities calculated using in-house software. Patients without proximal CTEPH (chronic thromboembolic PH) and not receiving intravenous prostacyclin therapy (n = 34) were followed up until the primary outcome of disease progression (death, transplantation, or progression to intravenous therapy) or the end of the study. Physicians who determined disease progression were blinded to CMR data. Conventional ventricular volumetric indices and novel TPM metrics were analyzed for prediction of 6-min walk distance (6MWD) and disease progression. RESULTS Peak longitudinal (p < 0.0001) and radial (p = 0.001) early diastolic (E) wave velocities were significantly lower in PH patients compared with healthy volunteers. Reversal of tangential E waves was observed in all patients and was highly discriminative for the presence of PH (p < 0.0001). The global radial E wave (β = 0.41, p = 0.017) and lateral wall radial systolic (S) wave velocities (β = 0.33, p = 0.028) were the only independent predictors of 6MWD in a model including RV ejection fraction (RVEF) and LV stroke volume. Over a median follow-up period of 20 months (IQR 7.9 months), 8 patients commenced intravenous therapy and 1 died. Global longitudinal E wave was the only independent predictor of clinical worsening (6.3× increased risk, p = 0.009) in a model including RVEF and septal curvature. CONCLUSIONS TPM metrics of LV diastolic function are significantly abnormal in PH. More importantly, abnormal LV E wave velocities are the only independent predictors of functional capacity and clinical worsening in a model that includes conventional metrics of biventricular function.
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MESH Headings
- Adult
- Biomechanical Phenomena
- Case-Control Studies
- Diastole
- Disease Progression
- Feasibility Studies
- Female
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/mortality
- Hypertension, Pulmonary/physiopathology
- Hypertension, Pulmonary/therapy
- Image Interpretation, Computer-Assisted/methods
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/mortality
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Daniel S Knight
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
| | | | - Shahin Moledina
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
| | - Alexander Jones
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
| | - J Gerry Coghlan
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
| | - Vivek Muthurangu
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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26
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Steeden JA, Pandya B, Tann O, Muthurangu V. Free breathing contrast-enhanced time-resolved magnetic resonance angiography in congenital heart disease. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328261 DOI: 10.1186/1532-429x-17-s1-o65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mortensen KH, Jones A, Steeden JA, Taylor AM, Muthurangu V. Isometric stress in cardiovascular magnetic resonance-a simple and easily replicable method of assessing cardiovascular differences not apparent at rest. Eur Radiol 2015. [PMID: 26205639 DOI: 10.1007/s00330-015-3920-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Isometric exercise may unmask cardiovascular disease not evident at rest, and cardiovascular magnetic resonance (CMR) imaging is proven for comprehensive resting assessment. This study devised a simple isometric exercise CMR methodology and assessed the hemodynamic response evoked by isometric exercise. METHODS A biceps isometric exercise technique was devised for CMR, and 75 healthy volunteers were assessed at rest, after 3-minute biceps exercise, and 5-minute of recovery using: 1) blood pressure (BP) and 2) CMR measured aortic flow and left ventricular function. Total peripheral resistance (SVR) and arterial compliance (TAC), cardiac output (CO), left ventricular volumes and function (ejection fraction, stroke volume, power output), blood pressure (BP), heart rate (HR), and rate pressure product were assessed at all time points. RESULTS Image quality was preserved during stress. During exercise there were increases in CO (+14.9 %), HR (+17.0 %), SVR (+9.8 %), systolic BP (+22.4 %), diastolic BP (+25.4 %) and mean BP (+23.2 %). In addition, there were decreases in TAC (-22.0 %) and left ventricular ejection fraction (-6.3 %). Age and body mass index modified the evoked response, even when resting measures were similar. CONCLUSIONS Isometric exercise technique evokes a significant cardiovascular response in CMR, unmasking physiological differences that are not apparent at rest. KEY POINTS • Isometric exercise unmasks cardiovascular differences not evident at rest. • CMR is the reference standard for non-invasive cardiovascular assessment at rest. • A new easily replicable method combines isometric exercise with CMR. • Significant haemodynamic changes occur and differences are unmasked. • The physiological, isometric CMR stressor can be easily replicated.
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Affiliation(s)
- Kristian H Mortensen
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Alexander Jones
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Jennifer A Steeden
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Andrew M Taylor
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Steeden JA, Pandya B, Tann O, Muthurangu V. Free breathing contrast-enhanced time-resolved magnetic resonance angiography in pediatric and adult congenital heart disease. J Cardiovasc Magn Reson 2015; 17:38. [PMID: 25997552 PMCID: PMC4490694 DOI: 10.1186/s12968-015-0138-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/30/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Contrast enhanced magnetic resonance angiography (MRA) is generally performed during a long breath-hold (BH), limiting its utility in infants and small children. This study proposes a free-breathing (FB) time resolved MRA (TRA) technique for use in pediatric and adult congenital heart disease (CHD). METHODS A TRA sequence was developed by combining spiral trajectories with sensitivity encoding (SENSE, x4 kx-ky and x2 kz) and partial Fourier (75% in kz). As no temporal data sharing is used, an independent 3D data set was acquired every ~1.3s, with acceptable spatial resolution (~2.3x2.3x2.3 mm). The technique was tested during FB over 50 consecutive volumes. Conventional BH-MRA and FB-TRA data was acquired in 45 adults and children with CHD. We calculated quantitative image quality for both sequences. Diagnostic accuracy was assessed in all patients from both sequences. Additionally, vessel measurements were made at the sinotubular junction (N = 43), proximal descending aorta (N = 43), descending aorta at the level of the diaphragm (N = 43), main pulmonary artery (N = 35), left pulmonary artery (N = 35) and the right pulmonary artery (N = 35). Intra and inter observer variability was assessed in a subset of 10 patients. RESULTS BH-MRA had significantly higher homogeneity in non-contrast enhancing tissue (coefficient of variance, P <0.0001), signal-to-noise ratio (P <0.0001), contrast-to-noise ratio (P <0.0001) and relative contrast (P = 0.02) compared to the FB-TRA images. However, homogeneity in the vessels was similar in both techniques (P = 0.52) and edge sharpness was significantly (P <0.0001) higher in FB-TRA compared to BH-MRA. BH-MRA provided overall diagnostic accuracy of 82%, and FB-TRA of 87%, with no statistical difference between the two sequences (P = 0.77). Vessel diameter measurements showed excellent agreement between the two techniques (r = 0.98, P <0.05), with no bias (0.0 mm, P = 0.71), and clinically acceptable limits of agreement (-2.7 to +2.8 mm). Inter and intra observer reproducibility showed good agreement of vessel diameters (r>0.988, P<0.0001), with negligible biases (between -0.2 and +0.1mm) and small limits of agreement (between -2.4 and +2.5mm). CONCLUSIONS We have described a FB-TRA technique that is shown to enable accurate diagnosis and vessel measures compared to conventional BH-MRA. This simplifies the MRA technique and will enable angiography to be performed in children and adults whom find breath-holding difficult.
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Affiliation(s)
- Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
| | - Bejal Pandya
- UCL Centre for Cardiovascular Imaging, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
- The Heart Hospital, University College London Hospital Foundation Trust, London, W1G 8PH, UK.
| | - Oliver Tann
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
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Barber NJ, Ako EO, Kowalik GT, Steeden JA, Pandya B, Muthurangu V. MR augmented cardiopulmonary exercise testing—a novel approach to assessing cardiovascular function. Physiol Meas 2015; 36:N85-94. [DOI: 10.1088/0967-3334/36/5/n85] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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30
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Quail MA, Knight DS, Steeden JA, Taelman L, Moledina S, Taylor AM, Segers P, Coghlan GJ, Muthurangu V. Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension. Am J Physiol Heart Circ Physiol 2015; 308:H1603-11. [PMID: 25659483 PMCID: PMC4469876 DOI: 10.1152/ajpheart.00480.2014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/02/2015] [Indexed: 01/09/2023]
Abstract
Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35% CTEPH and 75% female) and 10 healthy controls (60% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls (P = 6e−8). The area under the BCW was associated with a sensitivity of 100% [95% confidence interval (CI) 63–100%] and specificity of 91% (95% CI 75–98%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH.
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Affiliation(s)
- Michael A Quail
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Daniel S Knight
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom; Department of Cardiology, Royal Free London National Health Services Foundation Trust, London, United Kingdom; and
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Liesbeth Taelman
- IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium
| | - Shahin Moledina
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Patrick Segers
- IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium
| | - Gerry J Coghlan
- Department of Cardiology, Royal Free London National Health Services Foundation Trust, London, United Kingdom; and
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom;
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31
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Biglino G, Cosentino D, Steeden JA, De Nova L, Castelli M, Ntsinjana H, Pennati G, Taylor AM, Schievano S. Using 4D Cardiovascular Magnetic Resonance Imaging to Validate Computational Fluid Dynamics: A Case Study. Front Pediatr 2015; 3:107. [PMID: 26697416 PMCID: PMC4677094 DOI: 10.3389/fped.2015.00107] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 05/07/2015] [Accepted: 11/25/2015] [Indexed: 11/30/2022] Open
Abstract
Computational fluid dynamics (CFD) can have a complementary predictive role alongside the exquisite visualization capabilities of 4D cardiovascular magnetic resonance (CMR) imaging. In order to exploit these capabilities (e.g., for decision-making), it is necessary to validate computational models against real world data. In this study, we sought to acquire 4D CMR flow data in a controllable, experimental setup and use these data to validate a corresponding computational model. We applied this paradigm to a case of congenital heart disease, namely, transposition of the great arteries (TGA) repaired with arterial switch operation. For this purpose, a mock circulatory loop compatible with the CMR environment was constructed and two detailed aortic 3D models (i.e., one TGA case and one normal aortic anatomy) were tested under realistic hemodynamic conditions, acquiring 4D CMR flow. The same 3D domains were used for multi-scale CFD simulations, whereby the remainder of the mock circulatory system was appropriately summarized with a lumped parameter network. Boundary conditions of the simulations mirrored those measured in vitro. Results showed a very good quantitative agreement between experimental and computational models in terms of pressure (overall maximum % error = 4.4% aortic pressure in the control anatomy) and flow distribution data (overall maximum % error = 3.6% at the subclavian artery outlet of the TGA model). Very good qualitative agreement could also be appreciated in terms of streamlines, throughout the cardiac cycle. Additionally, velocity vectors in the ascending aorta revealed less symmetrical flow in the TGA model, which also exhibited higher wall shear stress in the anterior ascending aorta.
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Affiliation(s)
- Giovanni Biglino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Daria Cosentino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Lorenzo De Nova
- Laboratory of Biological Structures Mechanics (LAbS), Politecnico di Milano , Milan , Italy
| | - Matteo Castelli
- Laboratory of Biological Structures Mechanics (LAbS), Politecnico di Milano , Milan , Italy
| | - Hopewell Ntsinjana
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Giancarlo Pennati
- Laboratory of Biological Structures Mechanics (LAbS), Politecnico di Milano , Milan , Italy
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
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Pandya B, Quail MA, Steeden JA, McKee A, Odille F, Taylor AM, Schulze-Neick I, Derrick G, Moledina S, Muthurangu V. Real-Time Magnetic Resonance Assessment of Septal Curvature Accurately Tracks Acute Hemodynamic Changes in Pediatric Pulmonary Hypertension. Circ Cardiovasc Imaging 2014; 7:706-13. [DOI: 10.1161/circimaging.113.001156] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Bejal Pandya
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Michael A. Quail
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Jennifer A. Steeden
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Andrea McKee
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Freddy Odille
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Andrew M. Taylor
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Ingram Schulze-Neick
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Graham Derrick
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Shahin Moledina
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Vivek Muthurangu
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
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Steeden JA, Muthurangu V. Investigating the limitations of single breath-hold renal artery blood flow measurements using spiral phase contrast MR with R-R interval averaging. J Magn Reson Imaging 2014; 41:1143-9. [PMID: 24723271 DOI: 10.1002/jmri.24638] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 02/04/2014] [Accepted: 03/26/2014] [Indexed: 11/05/2022] Open
Abstract
PURPOSE 1) To validate an R-R interval averaged golden angle spiral phase contrast magnetic resonance (RAGS PCMR) sequence against conventional cine PCMR for assessment of renal blood flow (RBF) in normal volunteers; and 2) To investigate the effects of motion and heart rate on the accuracy of flow measurements using an in silico simulation. MATERIALS AND METHODS In 20 healthy volunteers RAGS (∼6 sec breath-hold) and respiratory-navigated cine (∼5 min) PCMR were performed in both renal arteries to assess RBF. A simulation of RAGS PCMR was used to assess the effect of heart rate (30-105 bpm), vessel expandability (0-150%) and translational motion (x1.0-4.0) on the accuracy of RBF measurements. RESULTS There was good agreement between RAGS and cine PCMR in the volunteer study (bias: 0.01 L/min, limits of agreement: -0.04 to +0.06 L/min, P = 0.0001). The simulation demonstrated a positive linear relationship between heart rate and error (r = 0.9894, P < 0.0001), a negative linear relationship between vessel expansion and error (r = -0.9484, P < 0.0001), and a nonlinear, heart rate-dependent relationship between vessel translation and error. CONCLUSION We have demonstrated that RAGS PCMR accurately measures RBF in vivo. However, the simulation reveals limitations in this technique at extreme heart rates (<40 bpm, >100 bpm), or when there is significant motion (vessel expandability: >80%, vessel translation: >x2.2).
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Affiliation(s)
- Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, University College London, London, UK
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Kowalik GT, Knight DS, Steeden JA, Tann O, Odille F, Atkinson D, Taylor A, Muthurangu V. Assessment of cardiac time intervals using high temporal resolution real-time spiral phase contrast with UNFOLDed-SENSE. Magn Reson Med 2014; 73:749-56. [DOI: 10.1002/mrm.25183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/21/2014] [Accepted: 01/26/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Grzegorz T. Kowalik
- UCL Institute of Cardiovascular Science; Centre for Cardiovascular Imaging; London United Kingdom
| | - Daniel S. Knight
- UCL Institute of Cardiovascular Science; Centre for Cardiovascular Imaging; London United Kingdom
- Division of Medicine; University College London; Royal Free Campus, Rowland Hill Street London United Kingdom
| | - Jennifer A. Steeden
- UCL Institute of Cardiovascular Science; Centre for Cardiovascular Imaging; London United Kingdom
| | - Oliver Tann
- UCL Institute of Cardiovascular Science; Centre for Cardiovascular Imaging; London United Kingdom
- Cardiorespiratory Unit; Great Ormond Street Hospital for Children; London United Kingdom
| | - Freddy Odille
- IADI; INSERM U947 Nancy France
- Université de Lorraine; Nancy France
| | - David Atkinson
- Centre for Medical Imaging; UCL Division of Medicine; London United Kingdom
| | - Andrew Taylor
- UCL Institute of Cardiovascular Science; Centre for Cardiovascular Imaging; London United Kingdom
- Cardiorespiratory Unit; Great Ormond Street Hospital for Children; London United Kingdom
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science; Centre for Cardiovascular Imaging; London United Kingdom
- Cardiorespiratory Unit; Great Ormond Street Hospital for Children; London United Kingdom
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Knight DS, Steeden JA, Coghlan JG, Taylor A, Muthurangu V. Abnormal systolic and diastolic LV motion by novel tissue phase mapping accounts for functional capacity in pulmonary hypertension. J Cardiovasc Magn Reson 2014. [PMCID: PMC4043762 DOI: 10.1186/1532-429x-16-s1-p253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kowalik GT, Knight DS, Steeden JA, Tann O, Odille F, Atkinson D, Taylor A, Muthurangu V. Assessment of cardiac time intervals using high temporal resolution real-time spiral phase contrast with UNFOLD-SENSE. J Cardiovasc Magn Reson 2014. [PMCID: PMC4045129 DOI: 10.1186/1532-429x-16-s1-w15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Quail MA, Steeden JA, Knight D, Segers P, Taylor AM, Muthurangu V. Development and validation of a novel method to derive central aortic systolic pressure from the MR aortic distension curve. J Magn Reson Imaging 2013; 40:1064-70. [DOI: 10.1002/jmri.24471] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/21/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Michael A. Quail
- Center for Cardiovascular Imaging; Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children; London United Kingdom
| | - Jennifer A. Steeden
- Center for Cardiovascular Imaging; Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children; London United Kingdom
| | - Daniel Knight
- Center for Cardiovascular Imaging; Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children; London United Kingdom
| | | | - Andrew M. Taylor
- Center for Cardiovascular Imaging; Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children; London United Kingdom
| | - Vivek Muthurangu
- Center for Cardiovascular Imaging; Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children; London United Kingdom
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Jones A, McMillan MR, Jones RW, Kowalik GT, Steeden JA, Pruessner JC, Taylor AM, Deanfield JE, Muthurangu V. Habitual alcohol consumption is associated with lower cardiovascular stress responses--a novel explanation for the known cardiovascular benefits of alcohol? Stress 2013; 16:369-76. [PMID: 23425242 DOI: 10.3109/10253890.2013.777833] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In contrast to heavy alcohol consumption, which is harmful, light to moderate drinking has been linked to reduced cardiovascular morbidity and mortality. Effects on lipid status or clotting do not fully explain these benefits. Exaggerated cardiovascular responses to mental stress are detrimental to cardiovascular health. We hypothesized that habitual alcohol consumption might reduce these responses, with potential benefits. Advanced magnetic resonance techniques were used to accurately measure cardiovascular responses to an acute mental stressor (Montreal Imaging Stress Task) in 88 healthy adults (∼1:1 male:female). Salivary cortisol and task performance measures were used to assess endocrine and cognitive responses. Habitual alcohol consumption and confounding factors were assessed by questionnaire. Alcohol consumption was inversely related to responses of heart rate (HR) (r = -0.31, p = 0.01), cardiac output (CO) (r = -0.32, p = 0.01), vascular resistance (r = 0.25, p = 0.04) and mean blood pressure (r = -0.31, p = 0.01) provoked by stress, but not to stroke volume (SV), or arterial compliance changes. However, high alcohol consumers had greater cortisol stress responses, compared to moderate consumers (3.5 versus 0.7 nmol/L, p = 0.04). Cognitive measures did not differ. Findings were not explained by variations in age, sex, social class, ethnicity, physical activity, adrenocortical activity, adiposity, smoking, menstrual phase and chronic stress. Habitual alcohol consumption is associated with reduced cardiac responsiveness during mental stress, which has been linked to lower risk of hypertension and vascular disease. Consistent with established evidence, our findings suggest a mechanism by which moderate alcohol consumption might reduce cardiovascular disease, but not high consumption, where effects such as greater cortisol stress responses may negate any benefits.
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Affiliation(s)
- Alexander Jones
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, UK.
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Steeden JA, Knight DS, Bali S, Atkinson D, Taylor AM, Muthurangu V. Self-navigated tissue phase mapping using a golden-angle spiral acquisition-proof of concept in patients with pulmonary hypertension. Magn Reson Med 2013; 71:145-55. [PMID: 23412927 DOI: 10.1002/mrm.24646] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 09/02/2012] [Revised: 11/29/2012] [Accepted: 12/21/2012] [Indexed: 11/08/2022]
Abstract
PURPOSE To create a high temporal- and spatial-resolution retrospectively cardiac-gated, tissue phase mapping (TPM) sequence, using an image-based respiratory navigator calculated from the data itself. METHODS The sequence was based on a golden-angle spiral acquisition. Reconstruction of real-time images allowed creation of an image-based navigator. The expiratory spiral interleaves were then retrospectively cardiac-gated using data binning. TPM data were acquired in 20 healthy volunteers and 10 patients with pulmonary hypertension. Longitudinal and radial myocardial velocities were calculated in the left ventricle and right ventricle. RESULTS The image-based navigator was shown to correlate well with simultaneously acquired airflow data in 10 volunteers(r=0.93±0.04). The TPM navigated images had a significantly higher subjective image quality and edge sharpness (P<0.0001) than averaged spiral TPM. No significant differences in myocardial velocities were seen between conventional Cartesian TPM with navigator respiratory-gating and the proposed self-navigated TPM technique, in 10 volunteers. Significant differences in the velocities were seen between the volunteers and patients in the left ventricle at systole and end diastole and in the right ventricle at end diastole. CONCLUSION The feasibility of measuring myocardial motion using a golden-angle spiral TPM sequence was demonstrated, with an image-based respiratory navigator calculated from the TPM data itself.
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Affiliation(s)
- Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, UCL Institute for Cardiovascular Science, University College London, London, UK
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Knight DS, Steeden JA, Bali S, Taylor AM, Muthurangu V. Myocardial velocity mapping for the right ventricle in pulmonary arterial hypertension using a novel image-based respiratory self-navigation from a golden-angle spiral acquisition. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559960 DOI: 10.1186/1532-429x-15-s1-p43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Steeden JA, Atkinson D, Jones A, Muthurangu V. High resolution slice-selective Fourier Velocity Encoding using spiral SENSE with velocity unwrap. J Cardiovasc Magn Reson 2012. [PMCID: PMC3304774 DOI: 10.1186/1532-429x-14-s1-o40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Biglino G, Schievano S, Steeden JA, Ntsinjana H, Baker C, Khambadkone S, de Leval MR, Hsia TY, Taylor AM, Giardini A. Reduced ascending aorta distensibility relates to adverse ventricular mechanics in patients with hypoplastic left heart syndrome: noninvasive study using wave intensity analysis. J Thorac Cardiovasc Surg 2012; 144:1307-13; discussion 1313-4. [PMID: 23031685 DOI: 10.1016/j.jtcvs.2012.08.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 08/01/2012] [Accepted: 08/07/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the aortic arch elastic properties and ventriculoarterial coupling efficiency in patients with single ventricle physiology, with and without a surgically reconstructed arch. METHODS We studied 21 children with single ventricle physiology after bidirectional superior cavopulmonary surgery: 10 with hypoplastic left heart syndrome, who underwent surgical arch reconstruction, and 11 with other types of single ventricle physiology but without arch reconstruction. All children underwent pre-Fontan magnetic resonance imaging. No patient exhibited aortic recoarctation. Data on aortic wave speed, aortic distensibility and wave intensity profiles were all extracted from the magnetic resonance imaging studies using an in-house-written plug-in for the Digital Imaging and Communications in Medicine viewer OsiriX. RESULTS Children with hypoplastic left heart syndrome had significantly greater wave speed (P = .002), and both stiffer (P = .004) and larger (P < .0001) ascending aortas than the patients with a nonreconstructed arch. Aortic distensibility was not influenced by ventricular stroke volume but depended on a combination of increased aortic diameter and abnormal wall mechanical properties. Those with hypoplastic left heart syndrome had a lower peak wave intensity and reduced energy carried by the forward compression and the forward expansion waves, even after correction for stroke volume, suggesting an abnormal systolic and diastolic function. Lower wave energy was associated with an increased aortic diameter. CONCLUSIONS Using a novel, noninvasive technique based on image analysis, we have demonstrated that aortic arch reconstruction in children with hypoplastic left heart syndrome is associated with reduced aortic distensibility and unfavorable ventricular-vascular coupling compared with those with single ventricle physiology without aortic arch reconstruction.
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Affiliation(s)
- Giovanni Biglino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom
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Kowalik GT, Steeden JA, Pandya B, Atkinson D, Taylor AM, Muthurangu V. Continuous assessment of cardiac output during exercise using real time flow with fast GPU reconstruction. J Cardiovasc Magn Reson 2012. [PMCID: PMC3305068 DOI: 10.1186/1532-429x-14-s1-p232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kowalik GT, Steeden JA, Pandya B, Atkinson D, Taylor AM, Muthurangu V. Real time flow with fast GPU reconstruction for continuous assessment of cardiac output. J Cardiovasc Magn Reson 2012. [PMCID: PMC3305721 DOI: 10.1186/1532-429x-14-s1-w63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ntsinjana H, Biglino G, Steeden JA, Schievano S, Taylor AM. Mechanical and morphological properties of the aortic root and arch late after arterial switch operation for transposition of the great arteries. J Cardiovasc Magn Reson 2012. [PMCID: PMC3304904 DOI: 10.1186/1532-429x-14-s1-p115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Biglino G, Steeden JA, Baker C, Schievano S, Hsia TY, Giardini A, Taylor AM. Non-invasive single slice estimate of aortic distensibility from phase-contrast MRI: application to hypoplastic left heart syndrome. J Cardiovasc Magn Reson 2012. [PMCID: PMC3305059 DOI: 10.1186/1532-429x-14-s1-p117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Biglino G, Steeden JA, Baker C, Schievano S, Taylor AM, Parker KH, Muthurangu V. A non-invasive clinical application of wave intensity analysis based on ultrahigh temporal resolution phase-contrast cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012; 14:57. [PMID: 22876747 PMCID: PMC3472227 DOI: 10.1186/1532-429x-14-57] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/19/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Wave intensity analysis, traditionally derived from pressure and velocity data, can be formulated using velocity and area. Flow-velocity and area can both be derived from high-resolution phase-contrast cardiovascular magnetic resonance (PC-CMR). In this study, very high temporal resolution PC-CMR data is processed using an integrated and semi-automatic technique to derive wave intensity. METHODS Wave intensity was derived in terms of area and velocity changes. These data were directly derived from PC-CMR using a breath-hold spiral sequence accelerated with sensitivity encoding (SENSE). Image processing was integrated in a plug-in for the DICOM viewer OsiriX, including calculations of wave speed and wave intensity. Ascending and descending aortic data from 15 healthy volunteers (30 ± 6 years) data were used to test the method for feasibility, and intra- and inter-observer variability. Ascending aortic data were also compared with results from 15 patients with coronary heart disease (61 ± 13 years) to assess the clinical usefulness of the method. RESULTS Rapid image acquisition (11 s breath-hold) and image processing was feasible in all volunteers. Wave speed was physiological (5.8 ± 1.3 m/s ascending aorta, 5.0 ± 0.7 m/s descending aorta) and the wave intensity pattern was consistent with traditionally formulated wave intensity. Wave speed, peak forward compression wave in early systole and peak forward expansion wave in late systole at both locations exhibited overall good intra- and inter-observer variability. Patients with coronary heart disease had higher wave speed (p <0.0001), and lower forward compression wave (p <0.0001) and forward expansion wave (p <0.0005) peaks. This difference is likely related to the older age of the patients' cohort, indicating stiffer aortas, as well as compromised ventricular function due to their underlying condition. CONCLUSION A non-invasive, semi-automated and reproducible method for performing wave intensity analysis is presented. Its application is facilitated by the use of a very high temporal resolution spiral sequence. A formulation of wave intensity based on area change has also been proposed, involving no assumptions about the cross-sectional shape of the vessel.
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Affiliation(s)
- Giovanni Biglino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Catriona Baker
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guildford Street, London, WC1N 1EH, UK
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Jones A, McMillan MR, Jones RW, Kowalik GT, Steeden JA, Deanfield JE, Pruessner JC, Taylor AM, Muthurangu V. Adiposity is associated with blunted cardiovascular, neuroendocrine and cognitive responses to acute mental stress. PLoS One 2012; 7:e39143. [PMID: 22745709 PMCID: PMC3380036 DOI: 10.1371/journal.pone.0039143] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/19/2012] [Indexed: 11/18/2022] Open
Abstract
Obesity and mental stress are potent risk factors for cardiovascular disease but their relationship with each other is unclear. Resilience to stress may differ according to adiposity. Early studies that addressed this are difficult to interpret due to conflicting findings and limited methods. Recent advances in assessment of cardiovascular stress responses and of fat distribution allow accurate assessment of associations between adiposity and stress responsiveness. We measured responses to the Montreal Imaging Stress Task in healthy men (N = 43) and women (N = 45) with a wide range of BMIs. Heart rate (HR) and blood pressure (BP) measures were used with novel magnetic resonance measures of stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and arterial compliance to assess cardiovascular responses. Salivary cortisol and the number and speed of answers to mathematics problems in the task were used to assess neuroendocrine and cognitive responses, respectively. Visceral and subcutaneous fat was measured using T2*-IDEAL. Greater BMI was associated with generalised blunting of cardiovascular (HR:β = −0.50 bpm.unit−1, P = 0.009; SV:β = −0.33 mL.unit−1, P = 0.01; CO:β = −61 mL.min−1.unit−1, P = 0.002; systolic BP:β = −0.41 mmHg.unit−1, P = 0.01; TPR:β = 0.11 WU.unit−1, P = 0.02), cognitive (correct answers: r = −0.28, P = 0.01; time to answer: r = 0.26, P = 0.02) and endocrine responses (cortisol: r = −0.25, P = 0.04) to stress. These associations were largely determined by visceral adiposity except for those related to cognitive performance, which were determined by both visceral and subcutaneous adiposity. Our findings suggest that adiposity is associated with centrally reduced stress responsiveness. Although this may mitigate some long-term health risks of stress responsiveness, reduced performance under stress may be a more immediate negative consequence.
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Affiliation(s)
- Alexander Jones
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom.
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