1
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Lalayiannis AD, Crabtree NJ, Ferro CJ, Wheeler DC, Duncan ND, Smith C, Popoola J, Varvara A, Mitsioni A, Kaur A, Sinha MD, Biassoni L, McGuirk SP, Mortensen KH, Milford DV, Long J, Leonard MD, Fewtrell M, Shroff R. Bone Mineral Density and Vascular Calcification in Children and Young Adults With CKD 4 to 5 or on Dialysis. Kidney Int Rep 2022; 8:265-273. [PMID: 36815116 PMCID: PMC9939315 DOI: 10.1016/j.ekir.2022.10.023] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Older adults with chronic kidney disease (CKD) can have low bone mineral density (BMD) with concurrent vascular calcification. Mineral accrual by the growing skeleton may protect young people with CKD from extraosseous calcification. Our hypothesis was that children and young adults with increasing BMD do not develop vascular calcification. Methods This was a multicenter longitudinal study in children and young people (5-30 years) with CKD stages 4 to 5 or on dialysis. BMD was assessed by tibial peripheral quantitative computed tomography (pQCT) and lumbar spine dual-energy X-ray absorptiometry (DXA). The following cardiovascular imaging tests were undertaken: cardiac computed tomography for coronary artery calcification (CAC), ultrasound for carotid intima media thickness z-score (cIMTz), pulse wave velocity z-score (PWVz), and carotid distensibility for arterial stiffness. All measures are presented as age-adjusted and sex-adjusted z-scores. Results One hundred participants (median age 13.82 years) were assessed at baseline and 57 followed up after a median of 1.45 years. Trabecular BMD z-score (TrabBMDz) decreased (P = 0.01), and there was a nonsignificant decrease in cortical BMD z-score (CortBMDz) (P = 0.09). Median cIMTz and PWVz showed nonsignificant increase (P = 0.23 and P = 0.19, respectively). The annualized increase in TrabBMDz (ΔTrabBMDz) was an independent predictor of cIMTz increase (R 2 = 0.48, β = 0.40, P = 0.03). Young people who demonstrated statural growth (n = 33) had lower ΔTrabBMDz and also attenuated vascular changes compared with those with static growth (n = 24). Conclusion This hypothesis-generating study suggests that children and young adults with CKD or on dialysis may develop vascular calcification even as their BMD increases. A presumed buffering capacity of the growing skeleton may offer some protection against extraosseous calcification.
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Affiliation(s)
- Alexander D. Lalayiannis
- Pediatric Nephrology, Birmingham Women’s and Children’s Hospitals, National Health Service Foundation Trust, Birmingham, UK; University College London Great Ormond Street Hospital Institute of Child Health, London, UK
- Nephrology, Birmingham Children’s Hospital, Birmingham, UK
- Correspondence: Alexander D. Lalayiannis, Nephrology Department, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Nicola J. Crabtree
- Densitometry Department, Birmingham Women’s and Children’s Hospitals National Health Service, Foundation Trust, Birmingham, UK
| | | | - David C. Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Neill D. Duncan
- Imperial College Healthcare National Health Service Trust, Renal and Transplant Center, London, UK
| | - Colette Smith
- Institute of Global Helath, University College London, London, UK
| | - Joyce Popoola
- St. George’s University Hospital National Health Service Foundation Trust, London, UK
| | - Askiti Varvara
- Department of Pediatric Nephrology, “P & A Kyriakou” Children’s Hospital, Athens, Greece
| | - Andromachi Mitsioni
- Department of Pediatric Nephrology, “P & A Kyriakou” Children’s Hospital, Athens, Greece
| | - Amrit Kaur
- Pediatric Nephrology, Manchester University National Health Service Foundation Trust, Manchester, UK
| | - Manish D. Sinha
- Pediatric Nephrology, Evelina Children’s Hospital, London, UK
| | - Lorenzo Biassoni
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Simon P. McGuirk
- Radiology Department, Birmingham Women’s and Children’s Hospitals National Health Service Foundation Trust, Birmingham, UK
| | - Kristian H. Mortensen
- Department of Cardiac Imaging, University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | | | - Jin Long
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Mary D. Leonard
- Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mary Fewtrell
- University College London Great Ormond Street Institute of Child Health, Population Policy and Practice, Childhood Nutrition Research Center, London, UK
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
- Great Ormond Street Hospital, London, UK
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2
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Lalayiannis AD, Ferro CJ, Wheeler DC, Duncan ND, Smith C, Popoola J, Askiti V, Mitsioni A, Kaur A, Sinha MD, McGuirk SP, Mortensen KH, Milford DV, Shroff R. The burden of subclinical cardiovascular disease in children and young adults with chronic kidney disease and on dialysis. Clin Kidney J 2022; 15:287-294. [PMID: 35145643 PMCID: PMC8824782 DOI: 10.1093/ckj/sfab168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a common cause of morbidity and mortality even in young
people with chronic kidney disease (CKD). We examined structural and functional CV
changes in patients ˂30 years of age with CKD Stages 4 and 5 and on dialysis. Methods A total of 79 children and 21 young adults underwent cardiac computed tomography for
coronary artery calcification (CAC), ultrasound for carotid intima-media thickness
(cIMT), carotid–femoral pulse wave velocity (cfPWV) and echocardiography. Differences in
structural (CAC, cIMT z-score, left ventricular mass index) and
functional (carotid distensibility z-score and cfPWV
z-score) measures were examined between CKD Stages 4 and 5 and dialysis
patients. Results Overall, the cIMT z-score was elevated [median 2.17 (interquartile
range 1.14–2.86)] and 10 (10%) had CAC. A total of 16/23 (69.5%) patients with CKD
Stages 4 and 5 and 68/77 (88.3%) on dialysis had at least one structural or functional
CV abnormality. There was no difference in the prevalence of structural abnormalities in
CKD or dialysis cohorts, but functional abnormalities were more prevalent in patients on
dialysis (P < 0.05). The presence of more than one structural abnormality was
associated with a 4.5-fold increased odds of more than one functional abnormality (95%
confidence interval 1.3–16.6; P < 0.05). Patients with structural and functional
abnormalities [cIMT z-score >2 standard deviation (SD) or
distensibility <−2 SD) had less carotid dilatation (lumen:wall cross-sectional area
ratio) compared with those with normal cIMT and distensibility. Conclusions There is a high burden of subclinical CVD in young CKD patients, with a greater
prevalence of functional abnormalities in dialysis compared with CKD patients.
Longitudinal studies are required to test these hypothesis-generating data and define
the trajectory of CV changes in CKD.
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Affiliation(s)
- Alexander D Lalayiannis
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Charles J Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Neill D Duncan
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Colette Smith
- Institute of Global Health, University College London, London, UK
| | - Joyce Popoola
- Department of Nephrology and Transplantation, St. George's University Hospital NHS Foundation Trust, London, UK
| | | | | | - Amrit Kaur
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Manish D Sinha
- Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Simon P McGuirk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Kristian H Mortensen
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - David V Milford
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
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3
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Milano EG, Kostolny M, Pajaziti E, Marek J, Regan W, Caputo M, Luciani GB, Mortensen KH, Cook AC, Schievano S, Capelli C. Enhanced 3D visualization for planning biventricular repair of double outlet right ventricle: a pilot study on the advantages of virtual reality. Eur Heart J Digit Health 2021; 2:667-675. [PMID: 36713107 PMCID: PMC9707861 DOI: 10.1093/ehjdh/ztab087] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/27/2021] [Indexed: 02/01/2023]
Abstract
Aims We aim to determine any additional benefit of virtual reality (VR) experience if compared to conventional cross-sectional imaging and standard three-dimensional (3D) modelling when deciding on surgical strategy in patients with complex double outlet right ventricle (DORV). Methods and results We retrospectively selected 10 consecutive patients with DORV and complex interventricular communications, who underwent biventricular repair. An arterial switch operation (ASO) was part of the repair in three of those. Computed tomography (CT) or cardiac magnetic resonance imaging images were used to reconstruct patient-specific 3D anatomies, which were then presented using different visualization modalities: 3D pdf, 3D printed models, and VR models. Two experienced paediatric cardiac surgeons, blinded to repair performed, reviewed each case evaluating the suitability of repair following assessment of each visualization modalities. In addition, they had to identify those who had ASO as part of the procedure. Answers of the two surgeons were compared to the actual operations performed. There was no mortality during the follow-up (mean = 2.5 years). Two patients required reoperations. After review of CT/cardiac magnetic resonance images, the evaluators identified the surgical strategy in accordance with the actual surgical plan in 75% of the cases. When using 3D pdf this reached only 70%. Accordance improved to 85% after revision of 3D printed models and to 95% after VR. Use of 3D printed models and VR facilitated the identification of patients who required ASO. Conclusion Virtual reality can enhance understanding of suitability for biventricular repair in patients with complex DORV if compared to cross-sectional images and other 3D modelling techniques.
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Affiliation(s)
- Elena Giulia Milano
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK.,Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Martin Kostolny
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK.,Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - Endrit Pajaziti
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - Jan Marek
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - William Regan
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Westminster Bridge Rd, SE1 7EH, London, UK
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, Bristol Medical School, University of Bristol, St Michael's Hill, BS2 8DZ, Bristol, UK
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Kristian H Mortensen
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - Andrew C Cook
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - Silvia Schievano
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - Claudio Capelli
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
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Riley JYJ, Leong K, Mortensen KH, Ariff B, Gopalan D. Native aorto-ostial coronary lesions on CT coronary angiogram. Br J Radiol 2021; 94:20210211. [PMID: 33989055 PMCID: PMC8248224 DOI: 10.1259/bjr.20210211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aorto-ostial coronary lesions (AOLs) are important to detect due to the high risk of catastrophic consequences. Unfortunately, due to the complexities of these lesions, they may be missed on invasive coronary angiography. Computed tomography coronary angiogram (CTCA) is highly sensitive and specific in detecting AOLs, and has the additional advantage of demonstrating the surrounding anatomy. CTCA is particularly useful when assessing for AOL aetiologies in addition to atherosclerotic disease, e.g.Congenital anomalies, extrinsic Compression, Iatrogenic, Arteritis and Other, such as Thrombus, Embolism, Dissection and Spasm. This gives rise to “CIAO (TEDS)” as a proposed aide-mémoire and will form the structure of this pictorial review.
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Affiliation(s)
- Jan Y J Riley
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom.,Department of Diagnostic Imaging, Monash Health, Melbourne, Australia
| | - Kai'En Leong
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Kristian H Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Ben Ariff
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom.,Department of Radiology, Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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5
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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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6
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Funck KL, Budde RPJ, Viuff MH, Wen J, Jensen JM, Nørgaard BL, Bons LR, Duijnhouwer AL, Dey D, Mortensen KH, Andersen NH, Roos-Hesselink JW, Gravholt CH. Coronary plaque burden in Turner syndrome a coronary computed tomography angiography study. Heart Vessels 2020; 36:14-23. [PMID: 32613319 DOI: 10.1007/s00380-020-01660-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/26/2020] [Indexed: 11/25/2022]
Abstract
Turner syndrome (TS) is associated with coronary artery disease (CAD), an important cause of premature death in TS. However, the determinants of CAD in women with TS remain unknown. In a cross-sectional study design, 168 women without clinical evidence of CAD (115 with TS and 53 without TS) were assessed for the presence and volume of subclinical CAD using coronary CT angiography. Karyotype, the presence of congenital heart defects and conventional cardiovascular risk factors were also registered. Comparative analyses were performed (1) between women with and without TS and (2) in the TS group, between women with and without subclinical CAD. The prevalence of CAD, in crude and adjusted analyses, was not increased for women with TS (crude prevalence: 40 [35%] in TS vs. 25 [47%] in controls, p = 0.12). The volume of atherosclerosis was not higher in women with TS compared with controls (median and interquartile range 0 [0-92] in TS vs. 0 [0-81]mm3 in controls, p = 0.29). Among women with TS, women with subclinical CAD were older (46 ± 13 vs. 37 ± 11 years, p < 0.001), had higher blood pressure (systolic blood pressure 129 ± 16 vs. 121 ± 16 mmHg, p < 0.05) and were more frequently diagnosed with type 2 diabetes (5 [13%] vs. 2 [3%], p < 0.05). Karyotype or congenital heart defects were not associated with subclinical CAD. Some women with TS show early signs of CAD, however overall, not more than women without TS. Conventional cardiovascular risk factors were the principal determinants of CAD also in TS, and CAD prevention strategies should be observed.ClinicalTrial.gov Identifier: NCT01678261 ( https://clinicaltrials.gov/ct2/show/NCT01678261 ).
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Affiliation(s)
- Kristian L Funck
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark. .,Diagnostic Center, Regional Hospital Central Jutland, Silkeborg, Denmark.
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
| | - Mette H Viuff
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
| | - Jan Wen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Århus, Denmark
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Århus, Denmark
| | - Lidia R Bons
- Department of Cardiology, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | | | - Damini Dey
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Kristian H Mortensen
- Centre for Cardiovascular Imaging Department, Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Niels H Andersen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Århus, Denmark
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7
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Brun S, Berglund A, Mortensen KH, Hjerrild BE, Hansen KW, Andersen NH, Gravholt CH. Blood pressure, sympathovagal tone, exercise capacity and metabolic status are linked in Turner syndrome. Clin Endocrinol (Oxf) 2019; 91:148-155. [PMID: 30954026 DOI: 10.1111/cen.13983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/30/2019] [Accepted: 03/31/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES We studied cardiac autonomic changes in relation to metabolic factors, body composition and 24-hour ambulatory blood pressure measurements in Turner syndrome patients without known hypertension. DESIGN Cross sectional. PATIENTS Participants were 48 TS women and 24 healthy female controls aged over 18 years. METHODS Short-term power spectral analysis was obtained in supine-standing-supine position. Bedside tests included three conventional cardiovascular reflex tests of heart rate response to standing up, heart rate response to deep breathing and blood pressure response to standing up. Mean heart rate during the last 2 minutes of work was used to calculate the maximal aerobic power (VO2max ). RESULTS We found a significantly higher mean reciprocal of the heart rate per second (RR) in TS. Testing for interaction between position and status (TS or control), there were highly significant differences between TS and controls in high-frequency (HF) power, the coefficient of component variation (square root of HF power/mean RR) and low-frequency (LF): HF ratio, with a dampened decline in vagal activity among TS during standing. Bedside test showed TS had a significantly higher diastolic BP in the supine position compared to controls, and the adaptive rise in BP, when changing to upright position was reduced. VO2max and self-reported level of physical activity were significantly correlated to systolic ambulatory blood pressure both 24-hour and night diastolic ambulatory blood pressure. CONCLUSION Vagal tone and modulation of the sympathovagal balance during alteration in body position are impaired in TS. These changes can be risk factors for cardiovascular disease.
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Affiliation(s)
- Sara Brun
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Agnethe Berglund
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kristian H Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Britta E Hjerrild
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Klavs W Hansen
- Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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8
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Affiliation(s)
- Elena Giulia Milano
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Endrit Pajaziti
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Emilie Sauvage
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Andrew Cook
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Silvia Schievano
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Kristian H Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Andrew M Taylor
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Jan Marek
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Martin Kostolny
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK (M.K.)
- Slovak Medical University, Bratislava, Slovakia (M.K.)
| | - Claudio Capelli
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
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Mortensen KH, Wen J, Erlandsen M, Trolle C, Ringgaard S, Gutmark EJ, Gutmark-Little I, Andersen NH, Gravholt CH. Aortic growth rates are not increased in Turner syndrome—a prospective CMR study. Eur Heart J Cardiovasc Imaging 2019; 20:1164-1170. [DOI: 10.1093/ehjci/jez065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/15/2019] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
Aortic disease is a key determinant of outcomes in Turner syndrome (TS). The present study characterized aortic growth rates and outcomes over nearly a decade in adult women with TS.
Methods and results
Prospective observational study assessing aortic diameters twice with cardiovascular magnetic resonance imaging in women with TS [N = 91; mean follow-up 8.8 ± 3.3 (range 1.6–12.6) years] and healthy age-matched female controls [N = 37; mean follow-up 6.7 ± 0.5 (range 5.9–8.1) years]. Follow-up also included aortic outcomes and mortality, antihypertensive treatment and ambulatory blood pressure. Aortic growth rates were similar or smaller in TS, but the variation was larger. The proximal aorta in TS grew by 0.20 ± 0.26 (mid-ascending) to 0.32 ± 0.36 (sinuses) mm/year. This compared to 0.26 ± 0.14 (mid-ascending) and 0.32 ± 0.17 (sinuses) mm/year in the controls. During 799 years at risk, 7 suffered an aortic outcome (1 aortic death, 2 aortic dissections, 2 aortic interventions, 2 surgical aortic listings) with further 2 aortic valve replacements. At baseline, two women were excluded. One died during subacute aortic surgery (severe dilatation) and one had a previously undetected type A dissection. The combined aortic outcome rate was 1126 per 100 000 observation years. The aortic and all-cause mortality rates were 1 per 799 years (125 deaths per 100 000 observation years) and 9 per 799 years (1126 deaths per 100 000 observation years). Aortic growth patterns were particularly perturbed in bicuspid aortic valves (BAV) and aortic coarctation (CoA).
Conclusion
Aortic growth rates in TS are not increased. BAVs and CoA are major factors that impact aortic growth. Aortic outcomes remain a concern.
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Affiliation(s)
- Kristian H Mortensen
- Department of Endocrinology and Internal Medicine, and Medical Research Laboratories, Aarhus University Hospital, Aarhus N, Denmark
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jan Wen
- Department of Endocrinology and Internal Medicine, and Medical Research Laboratories, Aarhus University Hospital, Aarhus N, Denmark
| | - Mogens Erlandsen
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Christian Trolle
- Department of Endocrinology and Internal Medicine, and Medical Research Laboratories, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Ephraim J Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH, USA
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, and Medical Research Laboratories, Aarhus University Hospital, Aarhus N, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
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Wen J, Trolle C, Viuff MH, Ringgaard S, Laugesen E, Gutmark EJ, Subramaniam DR, Backeljauw P, Gutmark-Little I, Andersen NH, Mortensen KH, Gravholt CH. Impaired aortic distensibility and elevated central blood pressure in Turner Syndrome: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2018; 20:80. [PMID: 30541571 PMCID: PMC6292015 DOI: 10.1186/s12968-018-0497-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 09/28/2017] [Accepted: 10/23/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Women with Turner Syndrome have an increased risk for aortic dissection. Arterial stiffening is a risk factor for aortic dilatation and dissection. Here we investigate if arterial stiffening can be observed in Turner Syndrome patients and is an initial step in the development of aortic dilatation and subsequent dissection. METHODS Fifty-seven women with Turner Syndrome (48 years [29-66]) and thirty-six age- and sex-matched controls (49 years [26-68]) were included. Distensibility, blood pressure, carotid-femoral pulse wave velocity (PWV), the augmentation index (Aix) and central blood pressure were determined using cardiovascular magnetic resonance, a 24-h blood pressure measurement and applanation tonometry. Aortic distensibility was determined at three locations: ascending aorta, transverse aortic arch, and descending aorta. RESULTS Mean aortic distensibility in the descending aorta was significantly lower in Turner Syndrome compared to healthy controls (P = 0.02), however, this was due to a much lower distensibility among Turner Syndrome with coarctation, while Turner Syndrome without coarctation had similar distensibility as controls. Both the mean heart rate adjusted Aix (31.4% vs. 24.4%; P = 0.02) and central diastolic blood pressure (78.8 mmHg vs. 73.7 mmHg; P = 0.02) were higher in Turner Syndrome compared to controls, and these indices correlated significantly with ambulatory night-time diastolic blood pressure. The presence of aortic coarctation (r = - 0.44, P = 0.005) and a higher central systolic blood pressure (r = - 0.34, P = 0.03), age and presence of diabetes were inversely correlated with aortic distensibility in TS. CONCLUSION Aortic wall function in the descending aorta is impaired in Turner Syndrome with lower distensibility among those with coarctation of the aorta, and among all Turner Syndrome higher Aix, and elevated central diastolic blood pressure when compared to sex- and age-matched controls. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov ( #NCT01678274 ) on September 3, 2012.
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Affiliation(s)
- Jan Wen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Christian Trolle
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Mette H. Viuff
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Steffen Ringgaard
- Department of Clinical Medicine, MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Ephraim J. Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH USA
- UC Department of Otolaryngology – Head and Neck Surgery, Cincinnati, OH USA
| | | | - Philippe Backeljauw
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Niels H. Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian H. Mortensen
- Cardiovascular Imaging Department, Cardio-respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH UK
| | - Claus H. Gravholt
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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11
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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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Silberbach M, Roos-Hesselink JW, Andersen NH, Braverman AC, Brown N, Collins RT, De Backer J, Eagle KA, Hiratzka LF, Johnson WH, Kadian-Dodov D, Lopez L, Mortensen KH, Prakash SK, Ratchford EV, Saidi A, van Hagen I, Young LT. Cardiovascular Health in Turner Syndrome: A Scientific Statement From the American Heart Association. Circ: Genomic and Precision Medicine 2018; 11:e000048. [DOI: 10.1161/hcg.0000000000000048] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Mortensen KH, Young L, De Backer J, Silberbach M, Collins RT, Duijnhouwer AL, Pandya B, Gravholt CH, Lopez L, Roos-Hesselink JW. Cardiovascular imaging in Turner syndrome: state-of-the-art practice across the lifespan. Heart 2018; 104:1823-1831. [DOI: 10.1136/heartjnl-2017-312658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/29/2018] [Accepted: 06/29/2018] [Indexed: 01/15/2023] Open
Abstract
Cardiovascular imaging is essential to providing excellent clinical care for girls and women with Turner syndrome (TS). Congenital and acquired cardiovascular diseases are leading causes of the lifelong increased risk of premature death in TS. Non-invasive cardiovascular imaging is crucial for timely diagnosis and treatment planning, and a systematic and targeted imaging approach should combine echocardiography, cardiovascular magnetic resonance and, in select cases, cardiac CT. In recent decades, evidence has mounted for the need to perform cardiovascular imaging in all females with TS irrespective of karyotype and phenotype. This is due to the high incidence of outcome-determining lesions that often remain subclinical and occur in patterns specific to TS. This review provides an overview of state-of-the-art cardiovascular imaging practice in TS, by means of a review of the most recent literature, in the context of a recent consensus statement that has highlighted the role of cardiovascular diseases in these females.
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Abstract
Cardiovascular CT (CCT) is an important imaging modality in congenital and acquired paediatric heart disease. Technological advances have resulted in marked improvements in spatial and temporal resolution of CCT with a concomitant increase in speed of data acquisition and a decrease in radiation dose. This has elevated CCT from being sparingly used to an essential diagnostic tool in the daily multimodality imaging practice alongside echocardiography, cardiovascular MR and invasive angiography. The application of CCT in paediatric congenital and acquired heart disease can be both technically and diagnostically challenging. This review highlights important considerations for current state of the art CCT across the spectrum of heart disease encountered in children.
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Affiliation(s)
- Kristian H Mortensen
- 1 Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Oliver Tann
- 1 Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
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15
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Mohammad AJ, Mortensen KH, Babar J, Smith R, Jones RB, Nakagomi D, Sivasothy P, Jayne DRW. Pulmonary Involvement in Antineutrophil Cytoplasmic Antibodies (ANCA)-associated Vasculitis: The Influence of ANCA Subtype. J Rheumatol 2017; 44:1458-1467. [PMID: 28765242 DOI: 10.3899/jrheum.161224] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe pulmonary involvement at time of diagnosis in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV), as defined by computed tomography (CT). METHODS Patients with thoracic CT performed on or after the onset of AAV (n = 140; 75 women; granulomatosis with polyangiitis, n = 79; microscopic polyangiitis MPA, n = 61) followed at a tertiary referral center vasculitis clinic were studied. Radiological patterns of pulmonary involvement were evaluated from the CT studies using a predefined protocol, and compared to proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA specificity. RESULTS Of the patients, 77% had an abnormal thoracic CT study. The most common abnormality was nodular disease (24%), of which the majority were peribronchial nodules, followed by bronchiectasis and pleural effusion (19%, each), pulmonary hemorrhage and lymph node enlargement (14%, each), emphysema (13%), and cavitating lesions (11%). Central airways disease and a nodular pattern of pulmonary involvement were more common in PR3-ANCA-positive patients (p < 0.05). Usual interstitial pneumonitis (UIP) and bronchiectasis were more prevalent in MPO-ANCA-positive patients (p < 0.05). Alveolar hemorrhage, pleural effusion, lymph node enlargement, and pulmonary venous congestion were more frequent in MPO-ANCA-positive patients. CONCLUSION Pulmonary involvement is frequent and among 140 patients with AAV who underwent a thoracic CT study, almost 80% have pulmonary abnormalities on thoracic CT. Central airway disease occurs exclusively among patients with PR3-ANCA while UIP were mainly seen in those with MPO-ANCA. These findings may have important implications for the investigation, management, and pathogenesis of AAV.
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Affiliation(s)
- Aladdin J Mohammad
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK. .,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital.
| | - Kristian H Mortensen
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Judith Babar
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Rona Smith
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Rachel B Jones
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Daiki Nakagomi
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Pasupathy Sivasothy
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - David R W Jayne
- From the Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, and Department of Radiology, and Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK.,A.J. Mohammad, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; K.H. Mortensen, MD, PhD, Department of Radiology, Addenbrooke's Hospital; J. Babar, MBChB, MRCP, FRCR, Department of Radiology, Addenbrooke's Hospital; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; R.B. Jones, MD, MRCP, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; D. Nakagomi, MD, PhD, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; P. Sivasothy, MBBS, PhD, Department of Respiratory Medicine, Addenbrooke's Hospital; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
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Subramaniam DR, Stoddard WA, Mortensen KH, Ringgaard S, Trolle C, Gravholt CH, Gutmark EJ, Mylavarapu G, Backeljauw PF, Gutmark-Little I. Continuous measurement of aortic dimensions in Turner syndrome: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2017; 19:20. [PMID: 28231838 PMCID: PMC5324249 DOI: 10.1186/s12968-017-0336-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/21/2017] [Accepted: 02/02/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Severity of thoracic aortic disease in Turner syndrome (TS) patients is currently described through measures of aorta size and geometry at discrete locations. The objective of this study is to develop an improved measurement tool that quantifies changes in size and geometry over time, continuously along the length of the thoracic aorta. METHODS Cardiovascular magnetic resonance (CMR) scans for 15 TS patients [41 ± 9 years (mean age ± standard deviation (SD))] were acquired over a 10-year period and compared with ten healthy gender and age-matched controls. Three-dimensional aortic geometries were reconstructed, smoothed and clipped, which was followed by identification of centerlines and planes normal to the centerlines. Geometric variables, including maximum diameter and cross-sectional area, were evaluated continuously along the thoracic aorta. Distance maps were computed for TS and compared to the corresponding maps for controls, to highlight any asymmetry and dimensional differences between diseased and normal aortae. Furthermore, a registration scheme was proposed to estimate localized changes in aorta geometry between visits. The estimated maximum diameter from the continuous method was then compared with corresponding manual measurements at 7 discrete locations for each visit and for changes between visits. RESULTS Manual measures at the seven positions and the corresponding continuous measurements of maximum diameter for all visits considered, correlated highly (R-value = 0.77, P < 0.01). There was good agreement between manual and continuous measurement methods for visit-to-visit changes in maximum diameter. The continuous method was less sensitive to inter-user variability [0.2 ± 2.3 mm (mean difference in diameters ± SD)] and choice of smoothing software [0.3 ± 1.3 mm]. Aortic diameters were larger in TS than controls in the ascending [TS: 13.4 ± 2.1 mm (mean distance ± SD), Controls: 12.6 ± 1 mm] and descending [TS: 10.2 ± 1.3 mm (mean distance ± SD), Controls: 9.5 ± 0.9 mm] thoracic aorta as observed from the distance maps. CONCLUSIONS An automated methodology is presented that enables rapid and precise three-dimensional measurement of thoracic aortic geometry, which can serve as an improved tool to define disease severity and monitor disease progression. TRIAL REGISTRATION ClinicalTrials.gov Identifier - NCT01678274 . Registered - 08.30.2012.
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Affiliation(s)
| | - William A. Stoddard
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH USA
| | - Kristian H. Mortensen
- Cardio-respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Steffen Ringgaard
- Institute for Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Christian Trolle
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Claus H. Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Ephraim J. Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH USA
- UC Department of Otolaryngology, Head and Neck Surgery, Cincinnati, OH USA
| | - Goutham Mylavarapu
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Philippe F. Backeljauw
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 USA
| | - Iris Gutmark-Little
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 USA
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Viuff MH, Trolle C, Wen J, Jensen JM, Nørgaard BL, Gutmark EJ, Gutmark-Little I, Mortensen KH, Gravholt CH, Andersen NH. Coronary artery anomalies in Turner Syndrome. J Cardiovasc Comput Tomogr 2016; 10:480-484. [DOI: 10.1016/j.jcct.2016.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 07/30/2016] [Accepted: 08/03/2016] [Indexed: 01/15/2023]
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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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Mortensen KH, Babar JL, Balan A. Multidetector CT of pulmonary cavitation: filling in the holes. Clin Radiol 2015; 70:446-56. [PMID: 25623513 DOI: 10.1016/j.crad.2014.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/03/2014] [Accepted: 12/11/2014] [Indexed: 12/17/2022]
Abstract
Pulmonary cavitation causes significant morbidity and mortality. Early diagnosis of the presence and aetiology of a cavity is therefore crucial in order to avoid further demise in both the localized pulmonary and systemic disorders that may manifest with pulmonary cavity formation. Multidetector CT has become the principal diagnostic technique for detecting pulmonary cavitation and its complications. This review provides an overview of the aetiologies and their imaging findings using this technique. Combining a literature review with case illustration, a synopsis of the different imaging features and constellations is provided, which may suggest a particular cause and aid the differentiation from diseases with similar findings.
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Affiliation(s)
- K H Mortensen
- University Department of Radiology, Cambridge University, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
| | - J L Babar
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - A Balan
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
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Trolle C, Mortensen KH, Pedersen LN, Berglund A, Jensen HK, Andersen NH, Gravholt CH. Long QT interval in Turner syndrome--a high prevalence of LQTS gene mutations. PLoS One 2013; 8:e69614. [PMID: 23936059 PMCID: PMC3723856 DOI: 10.1371/journal.pone.0069614] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/07/2013] [Indexed: 01/15/2023] Open
Abstract
Objectives QT-interval prolongation of unknown aetiology is common in Turner syndrome. This study set out to explore the presence of known long QT mutations in Turner syndrome and to examine the corrected QT-interval (QTc) over time and relate the findings to the Turner syndrome phenotype. Methods Adult women with Turner syndrome (n = 88) were examined thrice and 68 age-matched healthy controls were examined once. QTc was measured by one blinded reader (intra-reader variability: 0.7%), and adjusted for influence of heart rate by Bazett’s (bQTc) and Hodges’s formula (hQTc). The prevalence of mutations in genes related to Long QT syndrome was determined in women with Turner syndrome and a QTc >432.0 milliseconds (ms). Echocardiographic assessment of aortic valve morphology, 24-hour blood pressures and blood samples were done. Results The mean hQTc in women with Turner syndrome (414.0±25.5 ms) compared to controls (390.4±17.8 ms) was prolonged (p<0.001) and did not change over time (416.9±22.6 vs. 415.6±25.5 ms; p = 0.4). 45,X karyotype was associated with increased hQTc prolongation compared to other Turner syndrome karyotypes (418.2±24.8 vs. 407.6±25.5 ms; p = 0.055). In women with Turner syndrome and a bQTc >432 ms, 7 had mutations in major Long QT syndrome genes (SCN5A and KCNH2) and one in a minor Long QT syndrome gene (KCNE2). Conclusion There is a high prevalence of mutations in the major LQTS genes in women with TS and prolonged QTc. It remains to be settled, whether these findings are related to the unexplained excess mortality in Turner women. Clinical Trial Registration NCT00624949. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol/sid/S0001FLI/selectaction/View/ts/3/uid/U000099E.
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Affiliation(s)
- Christian Trolle
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Kristian H. Mortensen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- Department of Radiology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Lisbeth N. Pedersen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Agnethe Berglund
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik K. Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels H. Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus H. Gravholt
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
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Mortensen KH, Erlandsen M, Andersen NH, Gravholt CH. Prediction of aortic dilation in Turner syndrome--the use of serial cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2013; 15:47. [PMID: 23742092 PMCID: PMC3702474 DOI: 10.1186/1532-429x-15-47] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 05/22/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Identification of the subset females with Turner syndrome who face especially high risk of aortic dissection is difficult, and more optimal risk assessment is pivotal in order to improve outcomes. This study aimed to provide comprehensive, dynamic mathematical models of aortic disease in Turner syndrome by use of cardiovascular magnetic resonance (CMR). METHODS A prospective framework of long-term aortic follow-up was used, which comprised diameters of the thoracic aorta prospectively assessed at nine positions by CMR at the three points in time (baseline [n = 102, age 38 ± 11 years], follow-up [after 2.4 ± 0.4 years, n = 80] and end-of-study [after 4.8 ± 0.5 years, n = 78]). Mathematical models were created that cohesively integrated all measurements at all positions, from all visits and for all participants, and using these models cohesive risk factor analyses were conducted based on which predictive modeling was performed on which predictive modelling was performed. RESULTS The cohesive models showed that the variables with effect on aortic diameter were aortic coarctation (P < 0.0001), bicuspid aortic valves (P < 0.0001), age (P < 0.0001), diastolic blood pressure (P = 0.0008), body surface area (P = 0.015) and antihypertensive treatment (P = 0.005). Oestrogen replacement therapy had an effect of borderline significance (P = 0.08). From these data, mathematical models were created that enabled preemption of aortic dilation from CMR derived aortic diameters in scenarios both with and without known risk factors. The fit of the models to the actual data was good. CONCLUSION The presented cohesive model for prediction of aortic diameter in Turner syndrome could help identifying females with rapid growth of aortic diameter, and may enhance clinical decision-making based on serial CMR.
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Moledina S, Pandya B, Bartsota M, Mortensen KH, McMillan M, Quyam S, Taylor AM, Haworth SG, Schulze-Neick I, Muthurangu V. Prognostic Significance of Cardiac Magnetic Resonance Imaging in Children With Pulmonary Hypertension. Circ Cardiovasc Imaging 2013; 6:407-14. [DOI: 10.1161/circimaging.112.000082] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
There are very few validated prognostic markers in pediatric pulmonary hypertension. Cardiac MRI is a useful, noninvasive method for determining prognosis in adults. The present study is the first to assess its prognostic value in children.
Methods and Results—
A total of 100 children with pulmonary hypertension (median, 10.4 years; range, 0.5–17.6 years) were evaluated (idiopathic, n=60; repaired congenital heart disease, n=22; miscellaneous, n=18). In all patients, ventricular volumes and great vessel flow were measured. Volumetric data were obtained using retrospectively gated cine imaging (n=37) or real-time imaging (n=63), depending on the patient’s ability to hold his or her breath. During a median follow-up of 1.9 years, 11 patients died and 3 received lung transplantation. Of the cardiac MR parameters measured, right ventricular ejection fraction and left ventricular stroke volume index were most strongly predictive of survival on univariate analysis (2.6- and 2.5-fold increase in mortality for every 1-SD decrease, respectively;
P
<0.05). These results were reflected in good separation of tertile-based Kaplan-Meier survival curves for these variables.
Conclusions—
Cardiac MR measures correlate with clinical status and prognosis in children with pulmonary hypertension. Cardiac MR is feasible and may be useful in clinical decision making in pediatric pulmonary hypertension.
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Affiliation(s)
- Shahin Moledina
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Bejal Pandya
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Margarita Bartsota
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Kristian H. Mortensen
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Merlin McMillan
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Sadia Quyam
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Andrew M. Taylor
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Sheila G. Haworth
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Ingram Schulze-Neick
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Vivek Muthurangu
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
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Mortensen KH, Andersen NH, Hjerrild BE, Hørlyck A, Stochholm K, Højbjerg Gravholt C. Carotid intima-media thickness is increased in Turner syndrome: multifactorial pathogenesis depending on age, blood pressure, cholesterol and oestrogen treatment. Clin Endocrinol (Oxf) 2012; 77:844-51. [PMID: 22233516 DOI: 10.1111/j.1365-2265.2012.04337.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Carotid intima-media thickness (IMT) may potentially supplement cardiovascular risk assessment in Turner syndrome (TS), where cardiovascular risk is high and appropriate risk stratification difficult. Knowledge of IMT in TS is scarce, and this study aimed to enhance insight into the cardiovascular risk marker. DESIGN, PATIENTS AND MEASUREMENTS IMT was cross-sectionally assessed by ultrasonography of the common carotid artery (cIMT) and carotid bulb (bIMT) in TS (n = 69, age 40 ± 10 years) and age-matched, healthy female controls (n = 67). Additional prospective IMT assessment was performed in TS over 2·4 ± 0·3 years. Metabolic biomarkers and 24-h ambulatory blood pressure were also assessed. RESULTS cIMT and bIMT (body surface area indexed) were increased in TS (P < 0·05) with 17-18% having IMTs that exceeded the 95th percentile of the controls (P < 0·05). Blood pressure, heart rate, glycosylated haemoglobin A1c and high-density lipoprotein cholesterol were increased in TS, where 43% received antihypertensive treatment. cIMT decreased during follow-up, coinciding with intensified cardiovascular risk prophylaxis, whereas bIMT was unchanged. In multiple regression analyses (R = 0·52-0·69, P < 0·05), baseline IMT in TS increased with age, blood pressure and cholesterol as well as in the presence of diabetes whilst IMT was inversely associated with duration of oestrogen replacement. In an analogue analysis, the prospective changes in cIMT (R = 0·37, P < 0·05) were beneficially influenced by antihypertensive treatment and oestrogen therapy and adversely by the presence of diabetes. CONCLUSION Carotid IMT was abnormal in TS and negatively influenced by age, metabolic biomarkers, blood pressure and short duration of oestrogen treatment. Attention to common cardiovascular and endocrine risk markers over more than 2 years appeared to influence IMT beneficially.
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Affiliation(s)
- Kristian H Mortensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital Aarhus, Denmark.
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Abstract
Cardiovascular disease is emerging as a cardinal trait of Turner syndrome, being responsible for half of the 3-fold excess mortality. Turner syndrome has been proposed as an independent risk marker for cardiovascular disease that manifests as congenital heart disease, aortic dilation and dissection, valvular heart disease, hypertension, thromboembolism, myocardial infarction, and stroke. Risk stratification is unfortunately not straightforward because risk markers derived from the general population inadequately identify the subset of females with Turner syndrome who will suffer events. A high prevalence of endocrine disorders adds to the complexity, exacerbating cardiovascular prognosis. Mounting knowledge about the prevalence and interplay of cardiovascular and endocrine disease in Turner syndrome is paralleled by improved understanding of the genetics of the X-chromosome in both normal health and disease. At present in Turner syndrome, this is most advanced for the SHOX gene, which partly explains the growth deficit. This review provides an up-to-date condensation of current state-of-the-art knowledge in Turner syndrome, the main focus being cardiovascular morbidity and mortality. The aim is to provide insight into pathogenesis of Turner syndrome with perspectives to advances in the understanding of genetics of the X-chromosome. The review also incorporates important endocrine features, in order to comprehensively explain the cardiovascular phenotype and to highlight how raised attention to endocrinology and genetics is important in the identification and modification of cardiovascular risk.
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Affiliation(s)
- Kristian H Mortensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8000 Aarhus, Denmark
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Gravholt CH, Mortensen KH, Andersen NH, Ibsen L, Ingerslev J, Hjerrild BE. Coagulation and fibrinolytic disturbances are related to carotid intima thickness and arterial blood pressure in Turner syndrome. Clin Endocrinol (Oxf) 2012; 76:649-56. [PMID: 21848660 DOI: 10.1111/j.1365-2265.2011.04190.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Turner syndrome (TS) is characterized by growth retardation, hypogonadism and a high risk of cardiovascular complications and atherosclerosis; case reports suggest that thrombo-embolic complications may be present. DESIGN Cross-sectional study. PATIENTS Sixty women with TS. MEASUREMENTS We characterized the activities of the haemostatic system, elucidated by the assessment of a panel of clotting factors and thrombosis risk factors and related these findings to carotid intima thickness (CIMT) and blood pressure. RESULTS Most (81%) received hormone replacement therapy. The medians of all measured factors and inflammatory parameters were not different from normative data, but many cases displayed values of C-reactive protein (CRP) (40%), fibrinogen (15%), fibrin D-dimer (15%), factor VIII (25%), von Willebrand factor (vWF) (15%), cholesterol and liver parameters that were greater than normative limits. CRP, fibrinogen, vWF, factor VIII and liver parameters were highly and positively correlated. Haemostatic variables were positively related to both CIMT and blood pressure. The Factor V Leiden G1691A gene polymorphism heterozygosity was detected in 12·5%. CONCLUSION We describe a significant proportion of individual TS females having high levels of vWF, factor VIII, fibrinogen and CRP (15-40%) and an increased frequency of the Leiden mutation, with important associations with CIMT and blood pressure, suggesting that a subset of TS may have an unfavourable haemostatic balance, which may contribute to the increased risk of premature ischaemic heart disease and possibly increase the risk of deep venous and portal vein thrombosis.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus Hospital NBG, Aarhus University Hospital, Aarhus C, Demmark.
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Abstract
The cardinal features of Turner syndrome (TS) are short stature, congenital abnormalities, infertility due to gonadal dysgenesis, with sex hormone insufficiency ensuing from premature ovarian failure, which is involved in lack of proper development of secondary sex characteristics and the frequent osteoporosis seen in Turner syndrome. But sex hormone insufficiency is also involved in the increased cardiovascular risk, state of physical fitness, insulin resistance, body composition, and may play a role in the increased incidence of autoimmunity. Severe morbidity and mortality affects females with Turner syndrome. Recent research emphasizes the need for proper sex hormone replacement therapy (HRT) during the entire lifespan of females with TS and new hypotheses concerning estrogen receptors, genetics and the timing of HRT offers valuable new information. In this review, we will discuss the effects of estrogen and androgen insufficiency as well as the effects of sex HRT on morbidity and mortality with special emphasis on evidence based research and areas needing further studies.
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Affiliation(s)
- Christian Trolle
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, 8000 Aarhus C, Denmark
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Mortensen KH, Steeden JA, Panzer J, Taylor AM, Muthurangu V. Isometric exercise in cardiac magnetic resonance imaging: an initial experience using fast imaging. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106644 DOI: 10.1186/1532-429x-13-s1-p386] [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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Mortensen KH, Hjerrild BE, Stochholm K, Andersen NH, Sørensen KE, Lundorf E, Hørlyck A, Pedersen EM, Christiansen JS, Gravholt CH. Dilation of the ascending aorta in Turner syndrome - a prospective cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2011; 13:24. [PMID: 21527014 PMCID: PMC3118376 DOI: 10.1186/1532-429x-13-24] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 04/28/2011] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The risk of aortic dissection is 100-fold increased in Turner syndrome (TS). Unfortunately, risk stratification is inadequate due to a lack of insight into the natural course of the syndrome-associated aortopathy. Therefore, this study aimed to prospectively assess aortic dimensions in TS. METHODS Eighty adult TS patients were examined twice with a mean follow-up of 2.4 ± 0.4 years, and 67 healthy age and gender-matched controls were examined once. Aortic dimensions were measured at nine predefined positions using 3D, non-contrast and free-breathing cardiovascular magnetic resonance. Transthoracic echocardiography and 24-hour ambulatory blood pressure were also performed. RESULTS At baseline, aortic diameters (body surface area indexed) were larger at all positions in TS. Aortic dilation was more prevalent at all positions excluding the distal transverse aortic arch. Aortic diameter increased in the aortic sinus, at the sinotubular junction and in the mid-ascending aorta with growth rates of 0.1 - 0.4 mm/year. Aortic diameters at all other positions were unchanged. The bicuspid aortic valve conferred higher aortic sinus growth rates (p < 0.05). No other predictors of aortic growth were identified. CONCLUSION A general aortopathy is present in TS with enlargement of the ascending aorta, which is accelerated in the presence of a bicuspid aortic valve.
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Affiliation(s)
- Kristian H Mortensen
- Department of Endocrinology and Internal Medicine (MEA) and Medical Research Laboratories, Aarhus Hospital NBG, Aarhus University Hospital, Aarhus, Denmark
| | - Britta E Hjerrild
- Department of Endocrinology and Internal Medicine (MEA) and Medical Research Laboratories, Aarhus Hospital NBG, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine (MEA) and Medical Research Laboratories, Aarhus Hospital NBG, Aarhus University Hospital, Aarhus, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | | | - Erik Lundorf
- The MR Centre, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Arne Hørlyck
- Department of Radiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Erik M Pedersen
- Department of Radiology, Aarhus Hospital NBG, Aarhus University Hospital, Aarhus, Denmark
| | - Jens S Christiansen
- Department of Endocrinology and Internal Medicine (MEA) and Medical Research Laboratories, Aarhus Hospital NBG, Aarhus University Hospital, Aarhus, Denmark
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine (MEA) and Medical Research Laboratories, Aarhus Hospital NBG, Aarhus University Hospital, Aarhus, Denmark
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Cleemann L, Mortensen KH, Holm K, Smedegaard H, Skouby SO, Wieslander SB, Leffers AM, Leth-Espensen P, Pedersen EM, Gravholt CH. Aortic dimensions in girls and young women with turner syndrome: a magnetic resonance imaging study. Pediatr Cardiol 2010; 31:497-504. [PMID: 20063160 DOI: 10.1007/s00246-009-9626-8] [Citation(s) in RCA: 37] [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: 07/11/2009] [Accepted: 12/15/2009] [Indexed: 01/15/2023]
Abstract
This study aimed to determine the dimensions of the thoracic aorta and the predictors of aortic dimensions in girls and young women with Turner syndrome (TS). A cross-sectional study was performed at a secondary care center. The study compared 41 TS patients with 50 healthy age-matched control subjects. The mean age of the patients was 17 +/- 3.3 years. Magnetic resonance imaging was performed for all the patients. The thoracic aortic diameters of the patients were measured at nine positions. Adjustment for body surface area (BSA) was performed. The outcome for the patients was measured in terms of absolute and BSA-adjusted aortic dilation. In TS, both the absolute and the BSA-adjusted mean aortic diameters were smaller than or comparable with those of the control subjects. However, individual aortic dilation at one to four positions was found in four TS patients according to the uncorrected data and in five TS patients after BSA-adjustment. The aortic diameters correlated with height, weight, body mass index (BMI), and BSA at all positions (R = 0.34-0.60; all p < 0.04). The diameters of the aortic arch and the descending aorta correlated with a history of aortic coarctation (R = 0.35-0.52; p < 0.03). The presence of bicuspid aortic valves correlated at the descending part of the aorta (R = 0.38; p < 0.03). The mean thoracic aortic dimensions were not enlarged in girls or young TS patients. The BSA predicted aortic size at all positions. The prevalence of aortic dilation and aneurysm was lower in this population of girls and younger women with TS than in older TS populations.
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Affiliation(s)
- Line Cleemann
- Department of Paediatrics, Hillerød Hospital, 3400 Hillerød, Denmark.
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Hjerrild BE, Mortensen KH, Sørensen KE, Pedersen EM, Andersen NH, Lundorf E, Hansen KW, Hørlyck A, Hager A, Christiansen JS, Gravholt CH. Thoracic aortopathy in Turner syndrome and the influence of bicuspid aortic valves and blood pressure: a CMR study. J Cardiovasc Magn Reson 2010; 12:12. [PMID: 20222980 PMCID: PMC2847561 DOI: 10.1186/1532-429x-12-12] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Accepted: 03/11/2010] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND To investigate aortic dimensions in women with Turner syndrome (TS) in relation to aortic valve morphology, blood pressure, karyotype, and clinical characteristics. METHODS AND RESULTS A cross sectional study of 102 women with TS (mean age 37.7; 18-62 years) examined by cardiovascular magnetic resonance (CMR- successful in 95), echocardiography, and 24-hour ambulatory blood pressure. Aortic diameters were measured by CMR at 8 positions along the thoracic aorta. Twenty-four healthy females were recruited as controls. In TS, aortic dilatation was present at one or more positions in 22 (23%). Aortic diameter in women with TS and bicuspid aortic valve was significantly larger than in TS with tricuspid valves in both the ascending (32.4 +/- 6.7 vs. 26.0 +/- 4.4 mm; p < 0.001) and descending (21.4 +/- 3.5 vs. 18.8 +/- 2.4 mm; p < 0.001) aorta. Aortic diameter correlated to age (R = 0.2 - 0.5; p < 0.01), blood pressure (R = 0.4; p < 0.05), a history of coarctation (R = 0.3; p = 0.01) and bicuspid aortic valve (R = 0.2-0.5; p < 0.05). Body surface area only correlated with descending aortic diameter (R = 0.23; p = 0.024). CONCLUSIONS Aortic dilatation was present in 23% of adult TS women, where aortic valve morphology, age and blood pressure were major determinants of the aortic diameter.
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Affiliation(s)
- Britta E Hjerrild
- Medical Department M (Endocrinology and Diabetes) and Medical Research Laboratories, Aarhus Sygehus NBG, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
| | - Kristian H Mortensen
- Medical Department M (Endocrinology and Diabetes) and Medical Research Laboratories, Aarhus Sygehus NBG, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
| | - Keld E Sørensen
- Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Erik M Pedersen
- The MR Centre, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Niels H Andersen
- Medical Department M (Endocrinology and Diabetes) and Medical Research Laboratories, Aarhus Sygehus NBG, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
- Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Erik Lundorf
- The MR Centre, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Klavs W Hansen
- Department of Medicine, Silkeborg Centralsygehus, DK-8600 Silkeborg, Denmark
| | - Arne Hørlyck
- Department of Radiology, Skejby Sygehus, Århus University Hospital, DK-8200 Aarhus N, Denmark
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, D-80636 München, Germany
| | - Jens S Christiansen
- Medical Department M (Endocrinology and Diabetes) and Medical Research Laboratories, Aarhus Sygehus NBG, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
| | - Claus H Gravholt
- Medical Department M (Endocrinology and Diabetes) and Medical Research Laboratories, Aarhus Sygehus NBG, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
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Mortensen KH, Hjerrild BE, Andersen NH, Sorensen KE, Hoerlyck A, Lundorf E, Christiansen JS, Gravholt CH. Dilation of ascending aorta in Turner syndrome - short-term follow-up. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-o27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mortensen KH, Thuesen L, Kristensen IB, Christiansen EH. Spontaneous coronary artery dissection: a Western Denmark Heart Registry study. Catheter Cardiovasc Interv 2010; 74:710-7. [PMID: 19496145 DOI: 10.1002/ccd.22115] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) that associates with a high acute-phase mortality rate, whereas long-term outcome is less well described. OBJECTIVE To describe the incidence, predictors, and prognosis of SCAD. DESIGN Retrospective case-identification study from the Western Denmark Heart Registry and the database of the Forensic Institute at Aarhus University from 1999 through 2007. RESULTS SCAD was documented in 22 of 32,869 (0.7 per thousand) angiograms in the angiographic registry. The SCAD incidence among cases of ACS was 22 of 11,175 (2.0 per thousand). None was seen in the forensic database. The mean age was 48.7 +/- 8.9 years (range: 37-71 years). Females constituted 17 of 22 (77%) patients and all had undergone one or more pregnancies; two cases occurred in the postpartum period. The left descending artery (LAD) was the predominant site of entry. The age distribution, prevalence of the cardiovascular risk factors, presence of coronary atherosclerosis, and entry of the dissection were comparable among genders. Treatment was percutaneous coronary intervention in 13 of 22 (59%), coronary artery bypass operation in 2 of 22 (9%), and medical treatment in 7 of 22 (32%) patients. The mean follow-up period was 3.6 +/- 2.9 years. One patient suffered from recurrent SCAD; another patient died suddenly. The MACE- (cardiac death, nonfatal myocardial infarction, and new revascularization) free survival was 81% after 24 months. CONCLUSION SCAD is a rare disease that mainly affects younger women. Compared with earlier reports, the prognosis seems to be improved by early diagnosis and interventional treatment.
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Affiliation(s)
- K H Mortensen
- Medical Department M (Diabetes and Endocrinology) and Research Laboratories, Aarhus University Hospital, Aarhus Hospital NBG, Aarhus, Denmark.
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Mortensen KH, Taylor AM, Hughes ML. Optimising the accuracy and reproducibility of aortic root measurements from cardiac MRI data. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-o28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mortensen KH, Cleemann L, Hjerrild BE, Nexo E, Locht H, Jeppesen EM, Gravholt CH. Increased prevalence of autoimmunity in Turner syndrome--influence of age. Clin Exp Immunol 2009; 156:205-10. [PMID: 19298606 DOI: 10.1111/j.1365-2249.2009.03895.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Individuals with Turner syndrome (TS) are prone to develop autoimmune conditions such as coeliac disease (CD), thyroiditis and type 1 diabetes (T1DM). The objective of the present study was to examine TS of various karyotypes for autoantibodies and corresponding diseases. This was investigated in a prospective cross-sectional study of Danish TS patients (n = 107, median age 36.7 years, range: 6-60 years). A medical history was recorded and a blood sample was analysed for autoantibodies against gliadin, transglutaminase, adrenal cortex, intrinsic factor, anti-thyroid peroxidase (anti-TPO) and glutamic-acid-decarboxylase 65 (GAD-65). Autoantibodies were present in 58% (n = 61) of all patients, whereof 18% (11) had autoantibodies targeting more than one organ. Patients with autoantibodies were significantly older than those without (P = 0.001). Anti-TPO was present in 45% (48) of patients, of whom 33% (16) were hypothyroid. Overall, 18% (19) presented with CD autoantibodies, of whom 26% (five) had CD. Anti-TPO and CD autoantibodies co-existed in 9% (10). Immunoglobulin A deficiency was found in 3% (three) of patients, who all had CD autoantibodies without disease. Among four patients with anti-GAD-65 none had T1DM, but two were classified as having T2DM. One patient had adrenocortical autoantibodies but not adrenal failure. Autoantibodies against intrinsic factor were absent. Anti-GAD-65 was increased in isochromosomal karyotypes (3/23 versus 1/84, P = 0.008) with no other association found between autoantibodies and karyotype. In conclusion, TS girls and women face a high prevalence of autoimmunity and associated disease with a preponderance towards hypothyroidism and CD. Thus, health care providers dealing with this patient group should be observant and test liberally for these conditions even before clinical symptoms emerge.
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Affiliation(s)
- K H Mortensen
- Medical Department M (Endocrinology and Diabetes), Aarhus University Hospital, Aarhus C, Denmark.
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Mortensen KH, Hansen KW, Erlandsen M, Christiansen JS, Gravholt CH. Ambulatory Arterial Stiffness Index in Turner Syndrome: The Impact of Sex Hormone Replacement Therapy. Horm Res 2009; 72:184-9. [DOI: 10.1159/000232495] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 12/30/2008] [Indexed: 11/19/2022]
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