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Akhtar W, Peterzan MA, Banya W, Olwell B, Aghouee FV, Brookes P, Dunning J, Dar O. Donor specific antibodies association with survival and adverse events after heart transplantation: A single center retrospective study between 2006 and 2021. Clin Transplant 2023; 37:e14914. [PMID: 36630276 DOI: 10.1111/ctr.14914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/23/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Newly detected donor HLA-specific antibodies (DSA) are historically known to be associated with reduced survival in heart transplant patients. Our objective is to clarify the modern incidence of DSA and determine its relationship with survival and MACE. METHODS This retrospective study included all patients undergoing orthotopic heart transplantation at Harefield Hospital, London between January 1, 2006 and May 31, 2021. We identified patients who developed DSA at any point post heart transplantation and its effect on survival and MACE (defined as rejection, coronary event, stroke, and arrhythmia. RESULTS In total of 232 patients were included with a median follow up time of 4.7 years post heart transplantation. 23.7% of patients included developed DSA post heart transplantation. There was a significantly increased risk of death in patients developing DSA versus not (sub distribution hazard ratio [SHR] 1.83, 95% confidence interval 1.03-3.24, p = .04). At the time of detection of DSA, 38.2% of the cohort had rejection necessitating treatment. A MACE event had occurred in 48.1% by 2 years and 53.7% by 3 years in the DSA cohort. There was a significantly increased risk of MACE in patients developing DSA versus not (SHR 2.48 [1.58-3.89, p < .0001]). CONCLUSIONS This study showed an increased risk of death and MACE in patients developing DSA post heart transplantation. Further research is required into the optimal management of these patients.
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Affiliation(s)
- Waqas Akhtar
- Department of Advanced Heart Failure, Transplantation and Mechanical Support, Harefield Hospital, Harefield, UK
| | - Mark A Peterzan
- Department of Advanced Heart Failure, Transplantation and Mechanical Support, Harefield Hospital, Harefield, UK
| | - Winston Banya
- Department of Advanced Heart Failure, Transplantation and Mechanical Support, Harefield Hospital, Harefield, UK
| | - Brian Olwell
- Department of Advanced Heart Failure, Transplantation and Mechanical Support, Harefield Hospital, Harefield, UK
| | - Farveh Vakilian Aghouee
- Department of Advanced Heart Failure, Transplantation and Mechanical Support, Harefield Hospital, Harefield, UK
| | - Paul Brookes
- Department of Advanced Heart Failure, Transplantation and Mechanical Support, Harefield Hospital, Harefield, UK
| | - John Dunning
- Department of Advanced Heart Failure, Transplantation and Mechanical Support, Harefield Hospital, Harefield, UK
| | - Owais Dar
- Department of Advanced Heart Failure, Transplantation and Mechanical Support, Harefield Hospital, Harefield, UK
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Henry JA, Levelt E, Rayner JJ, Hundertmark MJ, Peterzan MA, Green PG, Watson W, Burrage MK, Arvidsson P, Lewis AJM, Chamley R, Neubauer S, Valkovic L, Rider OJ. Investigating myocardial energetic deficit across the spectrum of cardiac disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The phosphocreatine-to-adenosine triphosphate ratio (PCr/ATP) is a sensitive marker of the energetic state of the heart and can be reliably measured non-invasively using 31Phosphorus magnetic resonance spectroscopy (31P-MRS). Derangements in cardiac energetics are a distinctive feature in the pathophysiology of several cardiac diseases, and thus potential therapeutic targets.
Purpose
We sought to compare cardiac PCr/ATP across a range of cardiac pathologies.
Methods
Using a 3D chemical shift 31P spectral acquisition we recorded PCr/ATP in 515 participants: athletes (n=17), healthy controls with normal weight (n=148), overweight (n=67) and with obesity (n=73), diabetes (n=23), heart failure with preserved ejection fraction (HFpEF) (n=33), heart failure with reduced ejection fraction (HFrEF) (n=63), amyloid (n=9), severe aortic stenosis (AS) (n=29), severe mitral regurgitation (MR) (n=18), and hypertrophic cardiomyopathy (HCM) (n=35).
Results
A spectrum of myocardial PCr/ATP exists ranging from normal in athletes (2.23±0.28) and those with normal weight (2.05±0.38) to severely impaired in severe MR (1.56±0.32) and cardiac amyloid (1.34±0.19, Figure 1). Despite normal systolic function (all LVEF >57%) those living with obesity and diabetes have lower PCr/ATP than normal (all p<0.001). In all groups with HF, regardless of aetiology, myocardial energetics were impaired (all p<0.001). Across the whole cohort PCr/ATP was negatively correlated with body mass index (r −0.28, p<0.001), age (r −0.34, p<0.001) and LV mass (r −0.1, p<0.001). PCr/ATP was not related to systolic or diastolic blood pressure in these cohorts.
Conclusions
We demonstrate a spectrum of energetic deficit in cardiac disease and this is affected by not only myocardial pathology but also by obesity and age. Derangements in myocardial energetics are present in myocardial pathologies independent of underlying aetiology.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): We acknowledge support from the British Heart Foundation Oxford Center of Research Excellence.
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Affiliation(s)
- J A Henry
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - E Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - P G Green
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - W Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - M K Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - P Arvidsson
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - A J M Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - R Chamley
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - L Valkovic
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
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Rayner JJ, Peterzan MA, Clarke WT, Rodgers CT, Neubauer S, Rider OJ. Obesity modifies the energetic phenotype of dilated cardiomyopathy. Eur Heart J 2021; 43:ehab663. [PMID: 34542592 PMCID: PMC8885325 DOI: 10.1093/eurheartj/ehab663] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/13/2021] [Accepted: 09/13/2021] [Indexed: 01/05/2023] Open
Abstract
AIMS We sought to determine if myocardial energetics could distinguish obesity cardiomyopathy as a distinct entity from dilated cardiomyopathy. METHODS AND RESULTS Sixteen normal weight participants with dilated cardiomyopathy (DCMNW), and 27 with DCM and obesity (DCMOB), were compared to 26 normal weight controls (CTLNW). All underwent cardiac magnetic resonance imaging and 31P spectroscopy to assess function and energetics. Nineteen DCMOB underwent repeat assessment after a dietary weight loss intervention. Adenosine triphosphate (ATP) delivery through creatine kinase (CK flux) was 55% lower in DCMNW than in CTLNW (P = 0.004), correlating with left ventricular ejection fraction (LVEF, r = 0.4, P = 0.015). In contrast, despite similar LVEF (DCMOB 41 ± 7%, DCMNW 38 ± 6%, P = 0.14), CK flux was two-fold higher in DCMOB (P < 0.001), due to higher rate through CK [median kf 0.21 (0.14) vs. 0.11 (0.12) s-1, P = 0.002]. During increased workload, the CTLNW heart increased CK flux by 97% (P < 0.001). In contrast, CK flux was unchanged in DCMNW and fell in DCMOB (by >50%, P < 0.001). Intentional weight loss was associated with positive left ventricular remodelling, with reduced left ventricular end-diastolic volume (by 8%, P < 0.001) and a change in LVEF (40 ± 9% vs. 45 ± 10%, P = 0.002). This occurred alongside a fall in ATP delivery rate with weight loss (by 7%, P = 0.049). CONCLUSIONS In normal weight, DCM is associated with reduced resting ATP delivery. In obese DCM, ATP demand through CK is greater, suggesting reduced efficiency of energy utilization. Dietary weight loss is associated with significant improvement in myocardial contractility, and a fall in ATP delivery, suggesting improved metabolic efficiency. This highlights distinct energetic pathways in obesity cardiomyopathy, which are both different from dilated cardiomyopathy, and may be reversible with weight loss.
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Affiliation(s)
- Jennifer J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Mark A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - William T Clarke
- Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Christopher T Rodgers
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Box 65, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Peterzan MA, Neubauer S, Rodgers CT, Rider OJ. Response by Peterzan et al to Letter Regarding Article, "Cardiac Energetics in Patients With Aortic Stenosis and Preserved Versus Reduced Ejection Fraction". Circulation 2020; 142:e377-e378. [PMID: 33253000 DOI: 10.1161/circulationaha.120.050848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, University of Oxford, UK (M.A.P., S.N., O.J.R.)
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, University of Oxford, UK (M.A.P., S.N., O.J.R.)
| | | | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, University of Oxford, UK (M.A.P., S.N., O.J.R.)
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Peterzan MA, Lewis AJM, Neubauer S, Rider OJ. Non-invasive investigation of myocardial energetics in cardiac disease using 31P magnetic resonance spectroscopy. Cardiovasc Diagn Ther 2020; 10:625-635. [PMID: 32695642 DOI: 10.21037/cdt-20-275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiac metabolism and function are intrinsically linked. High-energy phosphates occupy a central and obligate position in cardiac metabolism, coupling oxygen and substrate fuel delivery to the myocardium with external work. This insight underlies the widespread clinical use of ischaemia testing. However, other deficits in high-energy phosphate metabolism (not secondary to supply-demand mismatch of oxygen and substrate fuels) may also be documented, and are of particular interest when found in the context of structural heart disease. This review introduces the scope of deficits in high-energy phosphate metabolism that may be observed in the myocardium, how to assess for them, and how they might be interpreted.
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Affiliation(s)
- Mark A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew J M Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Peterzan MA, Clarke WT, Lygate CA, Lake HA, Lau JYC, Miller JJ, Johnson E, Rayner JJ, Hundertmark MJ, Sayeed R, Petrou M, Krasopoulos G, Srivastava V, Neubauer S, Rodgers CT, Rider OJ. Cardiac Energetics in Patients With Aortic Stenosis and Preserved Versus Reduced Ejection Fraction. Circulation 2020; 141:1971-1985. [PMID: 32438845 PMCID: PMC7294745 DOI: 10.1161/circulationaha.119.043450] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Supplemental Digital Content is available in the text. Why some but not all patients with severe aortic stenosis (SevAS) develop otherwise unexplained reduced systolic function is unclear. We investigate the hypothesis that reduced creatine kinase (CK) capacity and flux is associated with this transition.
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Affiliation(s)
- Mark A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - William T Clarke
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences (W.T.C.), University of Oxford, United Kingdom
| | | | - Hannah A Lake
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.A.L.), University of Oxford, United Kingdom
| | - Justin Y C Lau
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - Jack J Miller
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - Errin Johnson
- Dunn School of Pathology (E.J.), University of Oxford, United Kingdom
| | - Jennifer J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - Moritz J Hundertmark
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - Rana Sayeed
- Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, United Kingdom (R.S., G.K., V.S.)
| | - Mario Petrou
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom (M.P.)
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, United Kingdom (R.S., G.K., V.S.)
| | - Vivek Srivastava
- Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, United Kingdom (R.S., G.K., V.S.)
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | | | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
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Rider OJ, Apps A, Miller JJJJ, Lau JYC, Lewis AJM, Peterzan MA, Dodd MS, Lau AZ, Trumper C, Gallagher FA, Grist JT, Brindle KM, Neubauer S, Tyler DJ. Noninvasive In Vivo Assessment of Cardiac Metabolism in the Healthy and Diabetic Human Heart Using Hyperpolarized 13C MRI. Circ Res 2020; 126:725-736. [PMID: 32078413 PMCID: PMC7077975 DOI: 10.1161/circresaha.119.316260] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 01/04/2023]
Abstract
RATIONALE The recent development of hyperpolarized 13C magnetic resonance spectroscopy has made it possible to measure cellular metabolism in vivo, in real time. OBJECTIVE By comparing participants with and without type 2 diabetes mellitus (T2DM), we report the first case-control study to use this technique to record changes in cardiac metabolism in the healthy and diseased human heart. METHODS AND RESULTS Thirteen people with T2DM (glycated hemoglobin, 6.9±1.0%) and 12 age-matched healthy controls underwent assessment of cardiac systolic and diastolic function, myocardial energetics (31P-magnetic resonance spectroscopy), and lipid content (1H-magnetic resonance spectroscopy) in the fasted state. In a subset (5 T2DM, 5 control), hyperpolarized [1-13C]pyruvate magnetic resonance spectra were also acquired and in 5 of these participants (3 T2DM, 2 controls), this was successfully repeated 45 minutes after a 75 g oral glucose challenge. Downstream metabolism of [1-13C]pyruvate via PDH (pyruvate dehydrogenase, [13C]bicarbonate), lactate dehydrogenase ([1-13C]lactate), and alanine transaminase ([1-13C]alanine) was assessed. Metabolic flux through cardiac PDH was significantly reduced in the people with T2DM (Fasted: 0.0084±0.0067 [Control] versus 0.0016±0.0014 [T2DM], Fed: 0.0184±0.0109 versus 0.0053±0.0041; P=0.013). In addition, a significant increase in metabolic flux through PDH was observed after the oral glucose challenge (P<0.001). As is characteristic of diabetes mellitus, impaired myocardial energetics, myocardial lipid content, and diastolic function were also demonstrated in the wider study cohort. CONCLUSIONS This work represents the first demonstration of the ability of hyperpolarized 13C magnetic resonance spectroscopy to noninvasively assess physiological and pathological changes in cardiac metabolism in the human heart. In doing so, we highlight the potential of the technique to detect and quantify metabolic alterations in the setting of cardiovascular disease.
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Affiliation(s)
- Oliver J Rider
- From the Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (O.J.R., A.A., J.J.J.J.M., J.Y.C.L., A.J.M.L., M.A.P., C.T., S.N., D.J.T.), University of Oxford, United Kingdom
| | - Andrew Apps
- From the Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (O.J.R., A.A., J.J.J.J.M., J.Y.C.L., A.J.M.L., M.A.P., C.T., S.N., D.J.T.), University of Oxford, United Kingdom
| | - Jack J J J Miller
- From the Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (O.J.R., A.A., J.J.J.J.M., J.Y.C.L., A.J.M.L., M.A.P., C.T., S.N., D.J.T.), University of Oxford, United Kingdom
- Department of Physiology, Anatomy and Genetics (J.J.J.J.M., J.Y.C.L., D.J.T.), University of Oxford, United Kingdom
- Department of Physics (J.J.J.J.M.), University of Oxford, United Kingdom
| | - Justin Y C Lau
- From the Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (O.J.R., A.A., J.J.J.J.M., J.Y.C.L., A.J.M.L., M.A.P., C.T., S.N., D.J.T.), University of Oxford, United Kingdom
- Department of Physiology, Anatomy and Genetics (J.J.J.J.M., J.Y.C.L., D.J.T.), University of Oxford, United Kingdom
| | - Andrew J M Lewis
- From the Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (O.J.R., A.A., J.J.J.J.M., J.Y.C.L., A.J.M.L., M.A.P., C.T., S.N., D.J.T.), University of Oxford, United Kingdom
| | - Mark A Peterzan
- From the Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (O.J.R., A.A., J.J.J.J.M., J.Y.C.L., A.J.M.L., M.A.P., C.T., S.N., D.J.T.), University of Oxford, United Kingdom
| | - Michael S Dodd
- School of Life Sciences, Coventry University, United Kingdom (M.S.D.)
| | - Angus Z Lau
- Sunnybrook Research Institute, Toronto, Canada (A.Z.L.)
| | - Claire Trumper
- From the Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (O.J.R., A.A., J.J.J.J.M., J.Y.C.L., A.J.M.L., M.A.P., C.T., S.N., D.J.T.), University of Oxford, United Kingdom
| | - Ferdia A Gallagher
- Department of Radiology (F.A.G., J.T.G.), University of Cambridge, United Kingdom
| | - James T Grist
- Department of Radiology (F.A.G., J.T.G.), University of Cambridge, United Kingdom
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute (K.M.B.), University of Cambridge, United Kingdom
| | - Stefan Neubauer
- From the Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (O.J.R., A.A., J.J.J.J.M., J.Y.C.L., A.J.M.L., M.A.P., C.T., S.N., D.J.T.), University of Oxford, United Kingdom
| | - Damian J Tyler
- From the Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (O.J.R., A.A., J.J.J.J.M., J.Y.C.L., A.J.M.L., M.A.P., C.T., S.N., D.J.T.), University of Oxford, United Kingdom
- Department of Physiology, Anatomy and Genetics (J.J.J.J.M., J.Y.C.L., D.J.T.), University of Oxford, United Kingdom
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Rayner JJ, Peterzan MA, Watson WD, Clarke WT, Neubauer S, Rodgers CT, Rider OJ. Myocardial Energetics in Obesity: Enhanced ATP Delivery Through Creatine Kinase With Blunted Stress Response. Circulation 2020; 141:1152-1163. [PMID: 32138541 PMCID: PMC7144750 DOI: 10.1161/circulationaha.119.042770] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity is strongly associated with exercise intolerance and the development of heart failure. Whereas myocardial energetics and diastolic function are impaired in obesity, systolic function is usually preserved. This suggests that the rate of ATP delivery is maintained, but this has never been explored in human obesity. We hypothesized that ATP transfer rate through creatine kinase (CK) (kfCKrest) would be increased, compensating for depleted energy stores (phosphocreatine/ATP), but potentially limiting greater ATP delivery during increased workload. We hypothesized that these changes would normalize with weight loss. METHODS We recruited 80 volunteers (35 controls [body mass index 24±3 kg/m2], 45 obese [body mass index 35±5 kg/m2]) without coexisting cardiovascular disease. Participants underwent body composition analysis, magnetic resonance imaging of abdominal, liver, and myocardial fat content, left ventricular function, and 31P magnetic resonance spectroscopy to assess phosphocreatine/ATP and CK kinetics, at rest and during dobutamine stress. Obese volunteers were assigned to a dietary weight loss intervention, before reexamination. RESULTS At rest, although myocardial phosphocreatine/ATP was 14% lower in obesity (1.9±0.3 versus 2.2±0.2, P<0.001), kfCkrest was 33% higher (0.23±0.07 s-1 versus 0.16±0.08 s-1, P=0.002), yielding no difference in overall resting ATP delivery (obese 2.5±0.9 µmol·g-1·s-1 versus control 2.2±1.1 µmol·g-1·s-1, P=0.232). In controls, increasing cardiac workload led to an increase in both kfCK (+86%, P<0.001) and ATP delivery (+80%, P<0.001). However, in obesity, similar stress led to no significant increase in either kfCK (P=0.117) or ATP delivery (P=0.608). This was accompanied by reduced systolic augmentation (absolute increase in left ventricular ejection fraction, obese +16±7% versus control +21±4%, P=0.031). Successful weight loss (-11±5% body weight) was associated with improvement of these energetic changes such that there was no significant difference in comparison with controls. CONCLUSIONS In the obese resting heart, the myocardial CK reaction rate is increased, maintaining ATP delivery despite reduced phosphocreatine/ATP. During increased workload, although the nonobese heart increases ATP delivery through CK, the obese heart does not; this is associated with reduced systolic augmentation and exercise tolerance. Weight loss reverses these energetic changes. This highlights myocardial energy delivery through CK as a potential therapeutic target to improve symptoms in obesity-related heart disease, and a fascinating modifiable pathway involved in the progression to heart failure, as well.
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Affiliation(s)
- Jennifer J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - Mark A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - William D Watson
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - William T Clarke
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain (W.T.C.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - Christopher T Rodgers
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus, United Kingdom (C.T.R.)
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
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Peterzan MA, Clarke WT, Lygate CA, Lake HA, Lau JYC, Johnson E, Rayner JJ, Hundertmark MJ, Sayeed RA, Petrou M, Krasopoulos G, Srivastava V, Neubauer S, Rodgers CT, Rider OJ. P2272Determinants of left ventricular ATP availability measured in vivo and ex vivo in patients with severe aortic stenosis: correlation of creatine kinase activity with LVEF and ATP diffusion distance. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The transition to systolic failure in severe aortic stenosis (AS) increases mortality. There are currently no reliable markers of transition, and the guideline LVEF <50% threshold for intervention in asymptomatic severe AS does not capture all subjects at increased risk. In animal models, reduced ATP delivery capacity through creatine kinase (CK) is important, with modest increases in CK capacity conferring cardioprotection. ATP may also diffuse (independent of CK) from mitochondria to the contractile site. We have performed the first human study to test whether ATP diffusion distance relates to CK activity and whether CK activity is reduced in low LVEF severe AS.
Methods
19 patients with severe AS, LVEF ≥55% (AS-pEF, mean±SD LVEF 63±5%, mean gradient 48±14 mmHg) and 10 with severe AS, LVEF <55% (AS-rEF, LVEF 42±8%, mean gradient 32±11) underwent 31P-MRS for CK rate constant (kf) and phosphocreatine/ATP (PCr/ATP) ratio, and MRI for LV volumes. LV biopsies were taken during AVR and analysed for CK total activity, CK isoforms, total creatine, and citrate synthase (CS) activity. 9 biopsies also underwent serial block face scanning electron microscopy and mitochondria-sarcomere 3D distance distributions were plotted. Results were compared to 24 controls (LVEF 61±4%), of which 4 had LV biopsy (3 severe MS, 1 LA myxoma, MS-pEF). Surgical patients had flow-limiting atheroma excluded with invasive angiography and prior myocardial infarction excluded with late gadolinium enhancement MRI.
Results
When compared to controls, both CK total activity and CS activity were lower in AS-pEF (by 27% and 23% respectively, both p<0.05, Panels A-B). Although PCr/ATP reduced in AS-pEF (by 20%, p<0.001, panel C), kf (panel D) and CK flux estimated by kf × total creatine were not different. CK-MB expression reduced in AS-pEF (19 vs 27% of total CK, p=0.003), reflecting compensatory increases in CK-MM (p=0.26) and CK-BB (p=0.18) in the face of reduced CK activity.
AS-rEF was associated with further reduction in both CK and CS activities (by 32% and 22% respectively, both p<0.05, Panels A-B), but no differences in PCr/ATP, CK kf or relative CK isozyme expression were seen. There were no significant between-group differences in total creatine (Panel E). Overall this suggests that CK reserve and oxidative capacity potentially reduce in pressure overload, with further falls commensurate with systolic dysfunction.
When median mitochondria-sarcomere ATP diffusion distances were plotted against CK total activity a strong positive correlation was observed (r=0.86, p=0.003, Panel F). This suggests a compensatory reduction in diffusion distance develops when CK activity falls.
Conclusions
Transition to failure in severe AS is associated with lower oxidative capacity and maximal ATP delivery capacity through CK. Despite compensatory falls in ATP diffusion distance and altered CK isozyme expression, these changes may underlie susceptibility to EF decline in AS.
Acknowledgement/Funding
British Heart Foundation Clinical Research Training Fellowship (FS/15/80/31803) and Programme Grant (RG/18/12/34040).
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Affiliation(s)
- M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - W T Clarke
- University of Oxford, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Oxford, United Kingdom
| | - H A Lake
- University of Oxford, Oxford, United Kingdom
| | - J Y C Lau
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - E Johnson
- University of Oxford, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - R A Sayeed
- John Radcliffe Hospital, Oxford, United Kingdom
| | - M Petrou
- John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C T Rodgers
- University of Cambridge, Wolfson Brain Imaging Centre, Cambridge, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Peterzan MA, Clarke WT, Lygate CA, Lake HA, Rayner JJ, Hundertmark MJ, Apps AP, Sayeed RA, Petrou M, Krasopoulos G, Srivastava V, Neubauer S, Rodgers CT, Rider OJ. P1611Non-invasive predictors of LV biopsy-obtained creatine kinase activity in patients with non-failing and failing myocardial hypertrophy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Myocardial creatine kinase (CK) activity represents an important metabolic reserve: it correlates closely with contractile reserve and post-ischaemic function, keeps cytosolic [ADP] low, and optimises the free energy for ATP hydrolysis. It may also contribute to the transition to failure in the heart hypertrophied by chronic haemodynamic overload; modest up-regulation has been shown to be cardio-protective.
Total CK activity measurement requires chemical freeze-and-extract methods, which destroy tissue, precluding repeated measures. To date, non-invasive assessments of human myocardial CK flux (calculated as kf × [PCr], where kf is the pseudo-first-order forward rate constant measured by 31P-magnetic resonance spectroscopy (MRS) have not assessed creatine content or total CK activity. Thus we aimed to validate kf measurement against total CK activity and investigate predictors of CK activity.
Methods
39 subjects (median age 71, range 43–84) undergoing clinically indicated cardiac surgery had CK total activity measured from LV biopsy. 31 had severe AS (10 with impaired LVEF); 2 had severe primary MR; 5 had severe mitral stenosis (2 with impaired LVEF) and 1 had an LA mass. 35 of 39 contributed triplicate datasets: CK total activity, kf (31P-MRS TRiST sequence at 3T) and LV volumes (cine-MRI, 3T Siemens). 27 had severe AS (8 with impaired LVEF); other groups were the same. Exclusion criteria were prior myocardial infarction and flow-limiting coronary disease. Flash-frozen LV biopsies obtained within 15 min of cardiopulmonary bypass were analysed for CK total activity, total creatine, and citrate synthase (CS) activity (a marker of oxidative phosphorylation capacity).
Results
Multiple, novel correlations were observed between CK total activity (IU/mg protein) and CS activity (r=0.87, p=9e-13), total creatine (r=0.59, p=8e-5), kf (r=0.42, p=0.013), total creatine × kf (r=0.64, p=4e-5), LVESVi (r=−0.52, p=8e-4), LVEF (r=0.48, p=0.002) and LVMi (r=−0.42, p=0.009) (Panels A-E) (LVEDVi and non-indexed counterparts were also significant correlates.) The most predictive linear regression model incorporating elements of the CK rate equation included total creatine (nmol/mg protein), kf (/s), and kf × LVESVi (ml/m2) (adjusted R2=0.56, beta=0.426, 0.618, −1.968 and p=0.001, 5e-5, 0.003 respectively, Panel F).
Figure 1
Conclusions
These results are the first evidence of agreement between non-invasive estimates of human cardiac CK activity (kf) and freeze-extracted chemical methods. The key original finding is that it is feasible to attempt to predict CK capacity in vivo by using a combination of techniques (creatine by 1H MRS, CK kf by 31P-MRS and LVESVi by cine imaging). The key insight is that CK capacity is best estimated not simply from what the rate equation would predict (creatine and kf), but that other factors relating to failing contractility reduce CK activity independently from creatine content and enzyme kf.
Acknowledgement/Funding
British Heart Foundation Clinical Research Training Fellowship (FS/15/80/31803) and Programme Grant (RG/18/12/34040).
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Affiliation(s)
- M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - W T Clarke
- University of Oxford, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Oxford, United Kingdom
| | - H A Lake
- University of Oxford, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - A P Apps
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - R A Sayeed
- John Radcliffe Hospital, Oxford, United Kingdom
| | - M Petrou
- John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C T Rodgers
- University of Cambridge, Wolfson Brain Imaging Centre, Cambridge, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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11
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Rayner JJ, Banerjee R, Holloway CJ, Lewis AJM, Peterzan MA, Francis JM, Neubauer S, Rider OJ. Correction: The Relative Contribution of Metabolic and Structural Abnormalities to Diastolic Dysfunction in Obesity. Int J Obes (Lond) 2019; 43:1652. [PMID: 31227797 PMCID: PMC7608285 DOI: 10.1038/s41366-019-0404-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - R Banerjee
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - C J Holloway
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - A J M Lewis
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - M A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - J M Francis
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - S Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - O J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK.
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12
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Clarke WT, Peterzan MA, Rayner JJ, Sayeed RA, Petrou M, Krasopoulos G, Lake HA, Raman B, Watson WD, Cox P, Hundertmark MJ, Apps AP, Lygate CA, Neubauer S, Rider OJ, Rodgers CT. Localized rest and stress human cardiac creatine kinase reaction kinetics at 3 T. NMR Biomed 2019; 32:e4085. [PMID: 30920054 PMCID: PMC6542687 DOI: 10.1002/nbm.4085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 05/11/2023]
Abstract
Changes in the kinetics of the creatine kinase (CK) shuttle are sensitive markers of cardiac energetics but are typically measured at rest and in the prone position. This study aims to measure CK kinetics during pharmacological stress at 3 T, with measurement in the supine position. A shorter "stressed saturation transfer" (StreST) extension to the triple repetition time saturation transfer (TRiST) method is proposed. We assess scanning in a supine position and validate the MR measurement against biopsy assay of CK activity. We report normal ranges of stress CK forward rate (kfCK ) for healthy volunteers and obese patients. TRiST measures kfCK in 40 min at 3 T. StreST extends the previously developed TRiST to also make a further kfCK measurement during <20 min of dobutamine stress. We test our TRiST implementation in skeletal muscle and myocardium in both prone and supine positions. We evaluate StreST in the myocardium of six healthy volunteers and 34 obese subjects. We validated MR-measured kfCK against biopsy assays of CK activity. TRiST kfCK values matched literature values in skeletal muscle (kfCK = 0.25 ± 0.03 s-1 vs 0.27 ± 0.03 s-1 ) and myocardium when measured in the prone position (0.32 ± 0.15 s-1 ), but a significant difference was found for TRiST kfCK measured supine (0.24 ± 0.12 s-1 ). This difference was because of different respiratory- and cardiac-motion-induced B0 changes in the two positions. Using supine TRiST, cardiac kfCK values for normal-weight subjects were 0.15 ± 0.09 s-1 at rest and 0.17 ± 0.15 s-1 during stress. For obese subjects, kfCK was 0.16 ± 0.07 s-1 at rest and 0.17 ± 0.10 s-1 during stress. Rest myocardial kfCK and CK activity from LV biopsies of the same subjects correlated (R = 0.43, p = 0.03). We present an independent implementation of TRiST on the Siemens platform using a commercially available coil. Our extended StreST protocol enables cardiac kfCK to be measured during dobutamine-induced stress in the supine position.
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Affiliation(s)
- William T. Clarke
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
- Wellcome Centre for Integrative Neuroimaging, FMRIBUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Mark A. Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Jennifer J. Rayner
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Rana A. Sayeed
- Department of Cardiothoracic Surgery, John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Mario Petrou
- Department of Cardiothoracic Surgery, John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Hannah A. Lake
- Department of Cardiovascular MedicineUniversity of Oxford, Wellcome Trust Centre for Human GeneticsRoosevelt DriveOxfordUK
| | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - William D. Watson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Pete Cox
- Department of Physiology AnatomyUniversity of OxfordParks Road, Sherrington BuildingOxfordUK
| | - Moritz J. Hundertmark
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Andrew P. Apps
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Craig A. Lygate
- Department of Cardiovascular MedicineUniversity of Oxford, Wellcome Trust Centre for Human GeneticsRoosevelt DriveOxfordUK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Christopher T. Rodgers
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
- Wolfson Brain Imaging CentreUniversity of CambridgeBox 65, Cambridge Biomedical CampusCambridgeUK
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13
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Rayner JJ, Abdesselam I, Peterzan MA, Akoumianakis I, Akawi N, Antoniades C, Tomlinson JW, Neubauer S, Rider OJ. Very low calorie diets are associated with transient ventricular impairment before reversal of diastolic dysfunction in obesity. Int J Obes (Lond) 2018; 43:2536-2544. [PMID: 30464235 PMCID: PMC6892735 DOI: 10.1038/s41366-018-0263-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 01/06/2023]
Abstract
Objectives Very low calorie diets (VLCDs) are effective at clearing hepatic steatosis and improving insulin sensitivity. Whilst long-term weight loss is beneficial to the cardiovascular system, the acute elevation in fatty acids during caloric restriction is potentially detrimental to cardiac metabolism and function. We sought to investigate any cardiovascular changes occurring over the course of a modern VLCD regime, alongside the expected peripheral metabolic improvements. Methods 25 obese volunteers (BMI 36.8 ± 5.8 kg/m2) underwent magnetic resonance imaging, echocardiography, metabolic profiling, and bio-impedance analysis before 1 and 8 weeks following a VLCD (800 kcal/day). Results were compared to 15 age- and sex-matched controls. Results After 1 week of VLCD, despite only modest weight loss, significant drops occurred in liver fat and insulin resistance (HOMA-IR; by 14–50%, all p < 0.01). In contrast, myocardial triglyceride content (MTGC) increased (by 48%, p = 0.030), and was associated with deterioration in both systolic (LVEF by 4%, p = 0.041) and diastolic function (e/e′ 8.6 ± 1.4 to 9.4 ± 1.7, p = 0.019). Aortic stiffness also increased by 35% (p = 0.015). At 8 weeks, liver steatosis and visceral fat were lower than baseline (by 20–55%, p < 0.001), and peripheral metabolic improvements continued. MTGC also fell to below baseline (1.5 ± 0.6 vs 2.1 ± 1%, p = 0.05) with improved myocardial function (e/e′ 8.6 ± 1.4 to 7.5 ± 1.5, p = 0.003). Conclusions Whilst VLCDs result in dramatic improvements in insulin resistance, they are associated with transient but significant cardiovascular functional decline, which may have an impact on those with the coexisting cardiac disease. However, after 8 weeks, the diet was associated with normalisation of cardiac function, suggesting they may form a potential therapeutic intervention for diastolic dysfunction in obesity and diabetes.
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Affiliation(s)
- Jennifer J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
| | - Ines Abdesselam
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mark A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ioannis Akoumianakis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Nadia Akawi
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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14
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Rayner JJ, Abdesselam I, Peterzan MA, Tomlinson JW, Neubauer S, Rider OJ. 107Very low calorie diets lead to temporary and reversible left ventricular impairment. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - I Abdesselam
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - J W Tomlinson
- Oxford Centre for Diabetes, Oxford Centre for Diabetes, Endocrinology, and Metabolism (OCDEM), Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
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15
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Peterzan MA, Lygate CA, Lake HA, Rayner JJ, Hundertmark MJ, Apps AP, Neubauer S, Clarke WT, Rodgers CT, Rider OJ. P5449ATP delivery rate is maintained in severe aortic stenosis with preserved systolic function despite reduced PCr/ATP ratio. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Oxford, United Kingdom
| | - H A Lake
- University of Oxford, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - A P Apps
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - W T Clarke
- University of Oxford, Oxford, United Kingdom
| | - C T Rodgers
- University of Cambridge, Wolfson Brain Imaging Centre, Cambridge, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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16
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Watson WD, Rayner JJ, Peterzan MA, Neubauer S, Rider OJ. 5219Visceral fat is the strongest predictor of diastolic dysfunction in a preserved ejection fraction group. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- W D Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
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17
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Peterzan MA, Lygate CA, Lake HA, Rayner JJ, Hundertmark MJ, Apps AP, Sayeed RA, Petrou M, Krasopoulos G, Neubauer S, Clarke WT, Rodgers CT, Rider OJ. 6161Reduced myocardial ATP delivery in severe primary mitral regurgitation: a novel marker to guide timing of surgery? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Oxford, United Kingdom
| | - H A Lake
- University of Oxford, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - A P Apps
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - R A Sayeed
- John Radcliffe Hospital, Oxford, United Kingdom
| | - M Petrou
- John Radcliffe Hospital, Oxford, United Kingdom
| | | | - S Neubauer
- John Radcliffe Hospital, Oxford, United Kingdom
| | - W T Clarke
- University of Oxford, Oxford, United Kingdom
| | - C T Rodgers
- University of Cambridge, Wolfson Brain Imaging Centre, Cambridge, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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18
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Rayner JJ, Peterzan MA, Watson WD, Abdesselam I, Neubauer S, Rider OJ. 5220Intentional weight loss substantially improves left ventricular systolic function in obese patients with heart failure with reduced ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - W D Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - I Abdesselam
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
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19
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Abstract
The energy starvation hypothesis proposes that maladaptive metabolic remodeling antedates, initiates, and maintains adverse contractile dysfunction in heart failure (HF). Better understanding of the cardiac metabolic phenotype and metabolic signaling could help identify the role metabolic remodeling plays within HF and the conditions known to transition toward HF, including "pathological" hypertrophy. In this review, we discuss metabolic phenotype and metabolic signaling in the contexts of pathological hypertrophy and HF. We discuss the significance of alterations in energy supply (substrate utilization, oxidative capacity, and phosphotransfer) and energy sensing using observations from human and animal disease models and models of manipulated energy supply/sensing. We aim to provide ways of thinking about metabolic remodeling that center around metabolic flexibility, capacity (reserve), and efficiency rather than around particular substrate preferences or transcriptomic profiles. We show that maladaptive metabolic remodeling takes multiple forms across multiple energy-handling domains. We suggest that lack of metabolic flexibility and reserve (substrate, oxidative, and phosphotransfer) represents a final common denominator ultimately compromising efficiency and contractile reserve in stressful contexts.
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Affiliation(s)
- Mark A Peterzan
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Craig A Lygate
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Oliver J Rider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
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20
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Abstract
Cardiovascular imaging is key for the assessment of patients with heart failure. Today, cardiovascular magnetic resonance imaging plays an established role in the assessment of patients with suspected and confirmed heart failure syndromes, in particular identifying aetiology. Its role in informing prognosis and guiding decisions around therapy are evolving. Key strengths include its accuracy; reproducibility; unrestricted field of view; lack of radiation; multiple abilities to characterise myocardial tissue, thrombus and scar; as well as unparalleled assessment of left and right ventricular volumes. T2* has an established role in the assessment and follow-up of iron overload cardiomyopathy and a role for T1 in specific therapies for cardiac amyloid and Anderson-Fabry disease is emerging.
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Affiliation(s)
- Mark A Peterzan
- Cardiology Clinical Academic GroupSt George's Hospital, London, UK.,University of Oxford Centre for Clinical Magnetic Resonance Research,John Radcliffe Hospital, Oxford, UK
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research,John Radcliffe Hospital, Oxford, UK
| | - Lisa J Anderson
- Cardiology Clinical Academic GroupSt George's Hospital, London, UK
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21
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Hughes AD, Peterzan MA, Chaturvedi N, Hardy R. Response to Potency of Office Blood Pressure From Hydrochlorothiazide and Chlorthalidone Fails to Explain Cardiovascular Events. Hypertension 2012. [DOI: 10.1161/hypertensionaha.112.200428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Nish Chaturvedi
- International Centre for Circulatory Health
National Heart and Lung Institute
Faculty of Medicine
Imperial College London and Imperial College Healthcare National Health Service Trust
London, United Kingdom (Hughes, Peterzan, Chaturvedi)
| | - Rebecca Hardy
- Medical Research Council Unit for Lifelong Health and Ageing
Medical Research Council National Survey for Health and Development
London, United Kingdom (Hardy)
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22
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Peterzan MA, Hardy R, Chaturvedi N, Hughes AD. Meta-analysis of dose-response relationships for hydrochlorothiazide, chlorthalidone, and bendroflumethiazide on blood pressure, serum potassium, and urate. Hypertension 2012; 59:1104-9. [PMID: 22547443 DOI: 10.1161/hypertensionaha.111.190637] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thiazide and thiazide-like diuretics are widely used in the management of hypertension, but recently the equivalence of hydrochlorothiazide and chlorthalidone for blood pressure (BP) lowering and prevention of cardiovascular disease has been questioned. We performed a meta-analysis to characterize the dose-response relationships for 3 commonly prescribed thiazide diuretics, hydrochlorothiazide, chlorthalidone, and bendroflumethiazide, on BP, serum potassium, and urate. Randomized, double-blind, parallel placebo-controlled trials meeting the following criteria, ≥ 2 different monotherapy dose arms, follow-up duration ≥ 4 weeks, and baseline washout of medication ≥ 2 weeks, were identified using Embase (1980-2010 week 50), Medline (1950-2010 November week 3), metaRegister of Controlled Trials, and Cochrane Central. A total of 26 trials examined hydrochlorothiazide, 3 examined chlorthalidone, and 1 examined bendroflumethiazide. Studies included a total of 4683 subjects in >53 comparison arms. Meta-regression of the effect of thiazides on systolic BP showed a log-linear relationship with a potency series: bendroflumethiazide>chlorthalidone>hydrochlorothiazide. The estimated dose of each drug predicted to reduce systolic BP by 10 mm Hg was 1.4, 8.6, and 26.4 mg, respectively, and there was no evidence of a difference in maximum reduction of systolic BP by high doses of different thiazides. Potency series for diastolic BP, serum potassium, and urate were similar to those seen for systolic BP. Hydrochlorothiazide, chlorthalidone, and bendroflumethiazide have markedly different potency. This may account for differences in the antihypertensive effect between hydrochlorothiazide and chlorthalidone using standard dose ranges.
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Affiliation(s)
- Mark A Peterzan
- International Centre for Circulatory Health, National Heart and Lung Institute, Faculty of Medicine, Imperial College London and Imperial College Healthcare National Health Service Trust, London, United Kingdom
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