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Wijesurendra RS, Sardell R, Jayaram R, Samuel N, Chen Z, Staplin N, Collins R, Zheng Z, Haynes R, Hill M, Emberson J, Casadei B. Mechanisms of rosuvastatin-related acute kidney injury following cardiac surgery: the STICS trial. Eur Heart J 2024; 45:629-631. [PMID: 37793132 PMCID: PMC10881091 DOI: 10.1093/eurheartj/ehad640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/01/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Rohan S Wijesurendra
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rebecca Sardell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Raja Jayaram
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, UK
| | - Nathan Samuel
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Natalie Staplin
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhe Zheng
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Richard Haynes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Hill
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, UK
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Gajendragadkar PR, Martin CA, Wijesurendra RS. Making the Right Diagnosis: Slowly but Surely. Circulation 2023; 148:1814-1818. [PMID: 38011246 PMCID: PMC10664777 DOI: 10.1161/circulationaha.123.067074] [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: 11/29/2023]
Affiliation(s)
- Parag R. Gajendragadkar
- Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom (P.R.G., C.A.M.)
- Nuffield Department of Population Health, University of Oxford, United Kingdom (P.R.G., R.S.W.)
| | - Claire A. Martin
- Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom (P.R.G., C.A.M.)
- Division of Medicine, University of Cambridge, United Kingdom (C.A.M.)
| | - Rohan S. Wijesurendra
- Nuffield Department of Population Health, University of Oxford, United Kingdom (P.R.G., R.S.W.)
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom (R.S.W.)
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3
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Spartera M, Stracquadanio A, Pessoa-Amorim G, Harston G, Mazzucco S, Young V, Von Ende A, Hess AT, Ferreira VM, Kennedy J, Neubauer S, Casadei B, Wijesurendra RS. Reduced Left Atrial Rotational Flow Is Independently Associated With Embolic Brain Infarcts. JACC Cardiovasc Imaging 2023; 16:1149-1159. [PMID: 37204381 DOI: 10.1016/j.jcmg.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/22/2023] [Accepted: 03/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Up to 25% of embolic strokes occur in individuals without atrial fibrillation (AF) or other identifiable mechanisms. OBJECTIVES This study aims to assess whether left atrial (LA) blood flow characteristics are associated with embolic brain infarcts, independently of AF. METHODS The authors recruited 134 patients: 44 with a history of ischemic stroke and 90 with no history of stroke but CHA2DS2VASc score ≥1. Cardiac magnetic resonance (CMR) evaluated cardiac function and LA 4-dimensional flow parameters, including velocity and vorticity (a measure of rotational flow), and brain magnetic resonance imaging (MRI) was performed to detect large noncortical or cortical infarcts (LNCCIs) (likely embolic), or nonembolic lacunar infarcts. RESULTS Patients (41% female; age 70 ± 9 years) had moderate stroke risk (median CHA2DS2VASc = 3, Q1-Q3: 2-4). Sixty-eight (51%) had diagnosed AF, of whom 58 (43%) were in AF during CMR. Thirty-nine (29%) had ≥1 LNCCI, 20 (15%) had ≥1 lacunar infarct without LNCCI, and 75 (56%) had no infarct. Lower LA vorticity was significantly associated with prevalent LNCCIs after adjustment for AF during CMR, history of AF, CHA2DS2VASc score, LA emptying fraction, LA indexed maximum volume, left ventricular ejection fraction, and indexed left ventricular mass (OR: 2.06 [95% CI: 1.08-3.92 per SD]; P = 0.027). By contrast, LA flow peak velocity was not significantly associated with LNCCIs (P = 0.21). No LA parameter was associated with lacunar infarcts (all P > 0.05). CONCLUSIONS Reduced LA flow vorticity is significantly and independently associated with embolic brain infarcts. Imaging LA flow characteristics may aid identification of individuals who would benefit from anticoagulation for embolic stroke prevention, regardless of heart rhythm.
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Affiliation(s)
- Marco Spartera
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom.
| | - Antonio Stracquadanio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Guilherme Pessoa-Amorim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - George Harston
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Sara Mazzucco
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, Oxford, United Kingdom
| | - Victoria Young
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Adam Von Ende
- CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Aaron T Hess
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - James Kennedy
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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4
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Dasí A, Pope MT, Wijesurendra RS, Betts TR, Sachetto R, Bueno‐Orovio A, Rodriguez B. What determines the optimal pharmacological treatment of atrial fibrillation? Insights from in silico trials in 800 virtual atria. J Physiol 2023; 601:4013-4032. [PMID: 37475475 PMCID: PMC10952228 DOI: 10.1113/jp284730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
The best pharmacological treatment for each atrial fibrillation (AF) patient is unclear. We aim to exploit AF simulations in 800 virtual atria to identify key patient characteristics that guide the optimal selection of anti-arrhythmic drugs. The virtual cohort considered variability in electrophysiology and low voltage areas (LVA) and was developed and validated against experimental and clinical data from ionic currents to ECG. AF sustained in 494 (62%) atria, with large inward rectifier K+ current (IK1 ) and Na+ /K+ pump (INaK ) densities (IK1 0.11 ± 0.03 vs. 0.07 ± 0.03 S mF-1 ; INaK 0.68 ± 0.15 vs. 0.38 ± 26 S mF-1 ; sustained vs. un-sustained AF). In severely remodelled left atrium, with LVA extensions of more than 40% in the posterior wall, higher IK1 (median density 0.12 ± 0.02 S mF-1 ) was required for AF maintenance, and rotors localized in healthy right atrium. For lower LVA extensions, rotors could also anchor to LVA, in atria presenting short refractoriness (median L-type Ca2+ current, ICaL , density 0.08 ± 0.03 S mF-1 ). This atrial refractoriness, modulated by ICaL and fast Na+ current (INa ), determined pharmacological treatment success for both small and large LVA. Vernakalant was effective in atria presenting long refractoriness (median ICaL density 0.13 ± 0.05 S mF-1 ). For short refractoriness, atria with high INa (median density 8.92 ± 2.59 S mF-1 ) responded more favourably to amiodarone than flecainide, and the opposite was found in atria with low INa (median density 5.33 ± 1.41 S mF-1 ). In silico drug trials in 800 human atria identify inward currents as critical for optimal stratification of AF patient to pharmacological treatment and, together with the left atrial LVA extension, for accurately phenotyping AF dynamics. KEY POINTS: Atrial fibrillation (AF) maintenance is facilitated by small L-type Ca2+ current (ICaL ) and large inward rectifier K+ current (IK1 ) and Na+ /K+ pump. In severely remodelled left atrium, with low voltage areas (LVA) covering more than 40% of the posterior wall, sustained AF requires higher IK1 and rotors localize in healthy right atrium. For lower LVA extensions, rotors can also anchor to LVA, if the atria present short refractoriness (low ICaL ) Vernakalant is effective in atria presenting long refractoriness (high ICaL ). For short refractoriness, atria with fast Na+ current (INa ) up-regulation respond more favourably to amiodarone than flecainide, and the opposite is found in atria with low INa . The inward currents (ICaL and INa ) are critical for optimal stratification of AF patient to pharmacological treatment and, together with the left atrial LVA extension, for accurately phenotyping AF dynamics.
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Affiliation(s)
- Albert Dasí
- Department of Computer ScienceUniversity of OxfordOxfordUK
| | - Michael T.B. Pope
- Department of CardiologyOxford University Hospitals NHS Foundation TrustOxfordUK
- Department for Human Development and HealthUniversity of SouthamptonSouthamptonUK
| | - Rohan S. Wijesurendra
- Department of CardiologyOxford University Hospitals NHS Foundation TrustOxfordUK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Tim R. Betts
- Department of CardiologyOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Rafael Sachetto
- Departamento de Ciência da ComputaçãoUniversidade Federal de São João del‐ReiSão João del‐ReiBrazil
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5
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Liu A, Wijesurendra RS, Ariga R, Mahmod M, Levelt E, Greiser A, Petrou M, Krasopoulos G, Forfar JC, Kharbanda RK, Channon KM, Neubauer S, Piechnik SK, Ferreira VM. Editorial Expression of Concern: Splenic T1-mapping: a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:27. [PMID: 37231467 PMCID: PMC10210525 DOI: 10.1186/s12968-023-00935-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rohan S Wijesurendra
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rina Ariga
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Masliza Mahmod
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Eylem Levelt
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Mario Petrou
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK
| | - John C Forfar
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | - Rajesh K Kharbanda
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
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Deal O, Rayner J, Stracquadanio A, Wijesurendra RS, Neubauer S, Rider O, Spartera M. Effect of Weight Loss on Early Left Atrial Myopathy in People With Obesity But No Established Cardiovascular Disease. J Am Heart Assoc 2022; 11:e026023. [PMID: 36346054 PMCID: PMC9750071 DOI: 10.1161/jaha.122.026023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Obesity is associated with left atrial (LA) remodeling (ie, dilatation and dysfunction) which is an independent determinant of future cardiovascular events. We aimed to assess whether LA remodeling is present in obesity even in individuals without established cardiovascular disease and whether it can be improved by intentional weight loss. Methods and Results Forty-five individuals with severe obesity without established cardiovascular disease (age, 45±11 years; body mass index; 39.1±6.7 kg/m2; excess body weight, 51±18 kg) underwent cardiac magnetic resonance for quantification of LA and left ventricular size and function before and at a median of 373 days following either a low glycemic index diet (n=28) or bariatric surgery (n=17). Results were compared with those obtained in 27 normal-weight controls with similar age and sex. At baseline, individuals with obesity displayed reduced LA reservoir function (a marker of atrial distensibility), and a higher mass and LA maximum volume (all P<0.05 controls) but normal LA emptying fraction. On average, weight loss led to a significant reduction of LA maximum volume and left ventricular mass (both P<0.01); however, significant improvement of the LA reservoir function was only observed in those at the upper tertile of weight loss (≥47% excess body weight loss). Following weight loss, we found an average residual increase in left ventricular mass compared with controls but no residual significant differences in LA maximum volume and strain function (all P>0.05). Conclusions Obesity is linked to subtle LA myopathy in the absence of overt cardiovascular disease. Only larger volumes of weight loss can completely reverse the LA myopathic phenotype.
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Affiliation(s)
- Oscar Deal
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
| | - Jennifer Rayner
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Antonio Stracquadanio
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Rohan S. Wijesurendra
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
| | - Oliver Rider
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Marco Spartera
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
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7
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Tang PT, Davies M, Bashir Y, Betts TR, Pedersen M, Rajappan K, Ginks MR, Wijesurendra RS. Efficacy and safety of same-day discharge after atrial fibrillation ablation compared with post-procedural overnight stay: a systematic review and meta-analysis. Europace 2022; 24:1569-1584. [PMID: 35640891 DOI: 10.1093/europace/euac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/10/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Catheter ablation for atrial fibrillation (AF) has historically required inpatient admission post-procedure, but same-day discharge (SDD) has recently been reported. We aimed to assess the efficacy and safety of SDD compared with overnight stay (OS) post-ablation. METHODS AND RESULTS We performed a systematic search of the PubMed database. Random-effects meta-analysis was performed to assess the efficacy (successful SDD) and safety (24 h complications, 30-day complications, 30-day re-admissions, and 30-day mortality) of a SDD AF ablation strategy. Fourteen non-randomized observational studies met criteria for inclusion, encompassing 26488 patients undergoing AF ablation, of whom 9766 were SDD. The mean age of participants was 61.9 years, and 67.9% were male. Around 61.7% underwent ablation for paroxysmal AF. The pooled success rate of SDD was 83.2% [95% confidence intervals (CIs): 61.5-97.0%, I2 100%]. The risk of bias was severe for all effect estimates due to confounding, as most cohorts were retrospectively identified without appropriately matched comparators. There was no significant difference in 30-day complications [odds ratio (OR): 0.95, 95% CI: 0.65-1.40, I2 53%] or 30-day re-admission (OR 0.96, 95% CI: 0.49-1.89, I2 82%) between groups. There were insufficient data for meta-analysis of 24 h complications and 30-day mortality. Where reported, no re-admissions occurred due to 24 h complications after SDD. Two deaths (0.04%) were reported in both SDD and OS groups. CONCLUSION Same-day discharge after AF ablation appears to be an effective and safe strategy in selected patients. However, the available evidence is of low quality, and more robust prospective studies comparing SDD to OS are needed.
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Affiliation(s)
- Pok-Tin Tang
- Royal Berkshire Hospital, Royal Berkshire Hospitals NHS Foundation Trust, RG1 5AN Reading, UK
| | - Mark Davies
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Yaver Bashir
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Timothy R Betts
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK.,Oxford Biomedical Research Centre, Oxford University Hospitals, OX3 9DU Oxford, UK.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, OX3 9DU University of Oxford, UK
| | - Michala Pedersen
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Kim Rajappan
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Matthew R Ginks
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Rohan S Wijesurendra
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK.,Oxford Biomedical Research Centre, Oxford University Hospitals, OX3 9DU Oxford, UK.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, OX3 9DU University of Oxford, UK
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8
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Spartera M, Stracquadanio A, Pessoa-Amorim G, Von Ende A, Fletcher A, Manley P, Ferreira VM, Hess AT, Hopewell JC, Neubauer S, Wijesurendra RS, Casadei B. The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics. Eur Heart J Cardiovasc Imaging 2021; 23:115-123. [PMID: 34687541 PMCID: PMC8685601 DOI: 10.1093/ehjci/jeab213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/06/2021] [Indexed: 12/03/2022] Open
Abstract
AIMS Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR). METHODS AND RESULTS We investigated 95 individuals: 37 patients with persistent AF, who were studied before and after cardioversion [Group 1; median CHA2DS2-VASc = 2.0 (1.5-3.5)]; 35 individuals with no history of AF but similar stroke risk to Group 1 [Group 2; median CHA2DS2-VASc = 3.0 (2.0-4.0)]; and 23 low-risk individuals in SR [Group 3; median CHA2DS2-VASc = 0.0 (0.0-0.0)]. Cardiac function and LA flow characteristics were evaluated using cardiac magnetic resonance. Before cardioversion, Group 1 displayed impaired left ventricular (LV) and LA function, reduced LA flow velocities and vorticity, and a higher normalized vortex volume (all P < 0.001 vs. Groups 2 and 3). After restoration of SR at ≥4-week post-cardioversion, LV systolic function and LA flow parameters improved significantly (all P < 0.001 vs. pre-cardioversion) and were no longer different from those in Group 2. However, in the presence of SR, LA flow peak and mean velocity, and vorticity were lower in Groups 1 and 2 vs. Group 3 (all P < 0.01), and were associated with impaired LA emptying fraction (LAEF) and LV diastolic dysfunction. CONCLUSION Patients at moderate-to-high stroke risk display altered LA flow characteristics in SR in association with an LA myopathic phenotype and LV diastolic dysfunction, regardless of a history of AF.
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Affiliation(s)
- Marco Spartera
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Antonio Stracquadanio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Guilherme Pessoa-Amorim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Adam Von Ende
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alison Fletcher
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Peter Manley
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Aaron T Hess
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Jemma C Hopewell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
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9
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Spartera M, Pessoa-Amorim G, Stracquadanio A, Von Ende A, Fletcher A, Manley P, Neubauer S, Ferreira VM, Casadei B, Hess AT, Wijesurendra RS. Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation. J Cardiovasc Magn Reson 2021; 23:29. [PMID: 33745457 PMCID: PMC7983287 DOI: 10.1186/s12968-021-00729-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 06/11/2020] [Accepted: 02/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows sophisticated quantification of left atrial (LA) blood flow, and could yield novel biomarkers of propensity for intra-cardiac thrombus formation and embolic stroke. As reproducibility is critically important to diagnostic performance, we systematically investigated technical and temporal variation of LA 4D flow in atrial fibrillation (AF) and sinus rhythm (SR). METHODS Eighty-six subjects (SR, n = 64; AF, n = 22) with wide-ranging stroke risk (CHA2DS2VASc 0-6) underwent LA 4D flow assessment of peak and mean velocity, vorticity, vortex volume, and stasis. Eighty-five (99%) underwent a second acquisition within the same session, and 74 (86%) also returned at 30 (27-35) days for an interval scan. We assessed variability attributable to manual contouring (intra- and inter-observer), and subject repositioning and reacquisition of data, both within the same session (same-day scan-rescan), and over time (interval scan). Within-subject coefficients of variation (CV) and bootstrapped 95% CIs were calculated and compared. RESULTS Same-day scan-rescan CVs were 6% for peak velocity, 5% for mean velocity, 7% for vorticity, 9% for vortex volume, and 10% for stasis, and were similar between SR and AF subjects (all p > 0.05). Interval-scan variability was similar to same-day scan-rescan variability for peak velocity, vorticity, and vortex volume (all p > 0.05), and higher for stasis and mean velocity (interval scan CVs of 14% and 8%, respectively, both p < 0.05). Longitudinal changes in heart rate and blood pressure at the interval scan in the same subjects were associated with significantly higher variability for LA stasis (p = 0.024), but not for the remaining flow parameters (all p > 0.05). SR subjects showed significantly greater interval-scan variability than AF patients for mean velocity, vortex volume, and stasis (all p < 0.05), but not peak velocity or vorticity (both p > 0.05). CONCLUSIONS LA peak velocity and vorticity are the most reproducible and temporally stable novel LA 4D flow biomarkers, and are robust to changes in heart rate, blood pressure, and differences in heart rhythm.
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Affiliation(s)
- Marco Spartera
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK.
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK.
| | - Guilherme Pessoa-Amorim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Antonio Stracquadanio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Adam Von Ende
- Department of Population Health, CTSU Nuffield University of Oxford, Oxford, UK
| | - Alison Fletcher
- The University of Oxford Acute Vascular Imaging Centre (AVIC), Oxford, UK
| | - Peter Manley
- The University of Oxford Acute Vascular Imaging Centre (AVIC), Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
| | - Aaron T Hess
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
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10
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Liu A, Wijesurendra RS, Liu JM, Greiser A, Jerosch-Herold M, Forfar JC, Channon KM, Piechnik SK, Neubauer S, Kharbanda RK, Ferreira VM. Retraction notice to Gadolinium-Free Cardiac MR Stress T1-Mapping to Distinguish Epicardial From Microvascular Coronary Disease: J Am Coll Cardiol 71 (2018) 957-968. J Am Coll Cardiol 2020; 76:1915. [PMID: 33059839 PMCID: PMC8055537 DOI: 10.1016/j.jacc.2020.08.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/02/2022]
Affiliation(s)
- Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rohan S Wijesurendra
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Joanna M Liu
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Andreas Greiser
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Michael Jerosch-Herold
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - John C Forfar
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Keith M Channon
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rajesh K Kharbanda
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Siemens Healthcare GmbH, Erlangen, Germany; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Liu A, Wijesurendra RS, Liu JM, Forfar JC, Channon KM, Jerosch-Herold M, Piechnik SK, Neubauer S, Kharbanda RK, Ferreira VM. Retraction notice to Diagnosis of Microvascular Angina Using Cardiac Magnetic Resonance: J Am Coll Cardiol 71 (2018) 969-979. J Am Coll Cardiol 2020; 76:1916. [PMID: 33059840 PMCID: PMC8055540 DOI: 10.1016/j.jacc.2020.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/18/2022]
Affiliation(s)
- Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
| | - Rohan S Wijesurendra
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
| | - Joanna M Liu
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
| | - John C Forfar
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
| | - Keith M Channon
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
| | - Michael Jerosch-Herold
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
| | - Rajesh K Kharbanda
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts
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Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia, currently affecting over 33 million individuals worldwide, and its prevalence is expected to more than double over the next 40 years. AF is associated with a twofold increase in premature mortality, and important major adverse cardiovascular events such as heart failure, severe stroke and myocardial infarction. Significant effort has been made over a number of years to define the underlying cellular, molecular and electrophysiological changes that predispose to the induction and maintenance of AF in patients. Progress has been limited by the realisation that AF is a complex arrhythmia that can be the end result of various different pathophysiological processes, with significant heterogeneity between individual patients (and between species). In this focused Review article, we aim to succinctly summarise for the non-specialist the current state of knowledge regarding the mechanisms of AF. We address all aspects of pathophysiology, including the basic electrophysiological and structural changes within the left atrium, the genetics of AF and the links to comorbidities and wider systemic and metabolic perturbations that may be upstream contributors to development of AF. Finally, we outline the translational implications for current and future rhythm control strategies in patients with AF.
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Affiliation(s)
| | - Barbara Casadei
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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13
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Liu A, Wijesurendra RS, Liu JM, Greiser A, Jerosch-Herold M, Forfar JC, Channon KM, Piechnik SK, Neubauer S, Kharbanda RK, Ferreira VM. Gadolinium-Free Cardiac MR Stress T1-Mapping to Distinguish Epicardial From Microvascular Coronary Disease. J Am Coll Cardiol 2019; 71:957-968. [PMID: 29495995 PMCID: PMC5835225 DOI: 10.1016/j.jacc.2017.11.071] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Novel cardiac magnetic resonance (CMR) stress T1 mapping can detect ischemia and myocardial blood volume changes without contrast agents and may be a more comprehensive ischemia biomarker than myocardial blood flow. OBJECTIVES This study describes the performance of the first prospective validation of stress T1 mapping against invasive coronary measurements for detecting obstructive epicardial coronary artery disease (CAD), defined by fractional flow reserve (FFR <0.8), and coronary microvascular dysfunction, defined by FFR ≥0.8 and the index of microcirculatory resistance (IMR ≥25 U), compared with first-pass perfusion imaging. METHODS Ninety subjects (60 patients with angina; 30 healthy control subjects) underwent CMR (1.5- and 3-T) to assess left ventricular function (cine), ischemia (adenosine stress/rest T1 mapping and perfusion), and infarction (late gadolinium enhancement). FFR and IMR were assessed ≤7 days post-CMR. Stress and rest images were analyzed blinded to other information. RESULTS Normal myocardial T1 reactivity (ΔT1) was 6.2 ± 0.4% (1.5-T) and 6.2 ± 1.3% (3-T). Ischemic viable myocardium downstream of obstructive CAD showed near-abolished T1 reactivity (ΔT1 = 0.7 ± 0.7%). Myocardium downstream of nonobstructive coronary arteries with microvascular dysfunction showed less-blunted T1 reactivity (ΔT1 = 3.0 ± 0.9%). Stress T1 mapping significantly outperformed gadolinium-based first-pass perfusion, including absolute quantification of myocardial blood flow, for detecting obstructive CAD (area under the receiver-operating characteristic curve: 0.97 ± 0.02 vs. 0.91 ± 0.03, respectively; p < 0.001). A ΔT1 of 1.5% accurately detected obstructive CAD (sensitivity: 93%; specificity: 95%; p < 0.001), whereas a less-blunted ΔT1 of 4.0% accurately detected microvascular dysfunction (area under the receiver-operating characteristic curve: 0.95 ± 0.03; sensitivity: 94%; specificity: 94%: p < 0.001). CONCLUSIONS CMR stress T1 mapping accurately detected and differentiated between obstructive epicardial CAD and microvascular dysfunction, without contrast agents or radiation.
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Affiliation(s)
- Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rohan S Wijesurendra
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Joanna M Liu
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - John C Forfar
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rajesh K Kharbanda
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vanessa M Ferreira
- 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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14
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Nikolaidou C, Wijesurendra RS, Baker C, Myerson SG. P584An unusual cause of pericarditic chest pain. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez108.020] [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)
- C Nikolaidou
- John Radcliffe Hospital - Oxford University Hospitals, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - R S Wijesurendra
- John Radcliffe Hospital - Oxford University Hospitals, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - C Baker
- John Radcliffe Hospital - Oxford University Hospitals, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S G Myerson
- John Radcliffe Hospital - Oxford University Hospitals, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
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Affiliation(s)
| | - Barbara Casadei
- From Division of Cardiovascular Medicine, University of Oxford, UK.
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16
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Rigolli M, Sivalokanathan S, Bull S, Wijesurendra RS, Ariga R, Loudon M, Francis JM, Karamitsos TD, Neubauer S, Mahmod M, Myerson SG. A Hyperdynamic RV Is an Early Marker of Clinical Decompensation and Cardiac Recovery in Aortic Stenosis With Normal LV Ejection Fraction. JACC Cardiovasc Imaging 2019; 12:214-216. [DOI: 10.1016/j.jcmg.2018.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 12/31/2022]
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Affiliation(s)
- Rohan S Wijesurendra
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (R.S.W., M.G., K.R.).,Division of Cardiovascular Medicine, University of Oxford, United Kingdom (R.S.W.)
| | - Matthew Ginks
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (R.S.W., M.G., K.R.)
| | - Kim Rajappan
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (R.S.W., M.G., K.R.)
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18
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Affiliation(s)
- Rohan S Wijesurendra
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom
| | - Oliver J Rider
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom
| | - Stefan Neubauer
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom.
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Affiliation(s)
- Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Department of Cardiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - Katharine A Sheppard
- Department of Pathology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - Stephen Westaby
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - Oliver Ormerod
- Department of Cardiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - Saul G Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Department of Cardiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
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20
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Wijesurendra RS, Liu A, Notaristefano F, Ntusi NAB, Karamitsos TD, Bashir Y, Ginks M, Rajappan K, Betts TR, Jerosch‐Herold M, Ferreira VM, Neubauer S, Casadei B. Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation. J Am Heart Assoc 2018; 7:e009218. [PMID: 30371239 PMCID: PMC6201472 DOI: 10.1161/jaha.118.009218] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
Abstract
Background Atrial fibrillation ( AF ) is associated with myocardial infarction, and patients with AF and no obstructive coronary artery disease can present with symptoms and evidence of cardiac ischemia. We hypothesized that microvascular coronary dysfunction underlies these observations. Methods and Results Myocardial blood flow ( MBF ) at baseline and during adenosine stress and left ventricular and left atrial function were evaluated by magnetic resonance in 49 patients with AF (25 paroxysmal, 24 persistent) with no history of epicardial coronary artery disease or diabetes mellitus, before and 6 to 9 months after ablation. Findings were compared with those obtained in matched controls in sinus rhythm (n=25). Before ablation, patients with AF had impaired left atrial function and left ventricular ejection fraction and strain indices (all P<0.05 versus controls). MBF was impaired in patients both under baseline conditions (1.21±0.24 mL/min per g·[mm Hg·bpm/104]-1 versus 1.34±0.28 mL/min per g·[mm Hg·bpm/104]-1 in controls, P=0.044) and during adenosine stress (2.29±0.48 mL/min per g versus 2.73±0.37 mL/min per g in controls, P<0.001). Under baseline conditions, MBF correlated with left ventricular strain and left atrial function (all P≤0.001), so that cardiac function was most impaired in patients with the lowest MBF . Baseline and stress MBF remained unchanged postablation (both P=ns), and baseline MBF showed similar correlations with functional indices to those present preablation (all P≤0.001). Conclusions Baseline and stress MBF are significantly impaired in patients with AF but no epicardial coronary artery disease. Reduction in MBF is proportional to severity of left ventricular and left atrial dysfunction, even after successful ablation. Coronary microvascular dysfunction may be a relevant pathophysiological mechanism in patients with a history of AF .
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Affiliation(s)
- Rohan S. Wijesurendra
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Alexander Liu
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Francesco Notaristefano
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Ntobeko A. B. Ntusi
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Theodoros D. Karamitsos
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Yaver Bashir
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Matthew Ginks
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Kim Rajappan
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Tim R. Betts
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | | | - Vanessa M. Ferreira
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Barbara Casadei
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
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Liu A, Wijesurendra RS, Liu JM, Forfar JC, Channon KM, Jerosch-Herold M, Piechnik SK, Neubauer S, Kharbanda RK, Ferreira VM. Diagnosis of Microvascular Angina Using Cardiac Magnetic Resonance. J Am Coll Cardiol 2018; 71:969-979. [PMID: 29495996 PMCID: PMC5835222 DOI: 10.1016/j.jacc.2017.12.046] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [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: 09/18/2017] [Revised: 12/01/2017] [Accepted: 12/26/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND In patients with angina and nonobstructive coronary artery disease (NOCAD), confirming symptoms due to coronary microvascular dysfunction (CMD) remains challenging. Cardiac magnetic resonance (CMR) assesses myocardial perfusion with high spatial resolution and is widely used for diagnosing obstructive coronary artery disease (CAD). OBJECTIVES The goal of this study was to validate CMR for diagnosing microvascular angina in patients with NOCAD, compared with patients with obstructive CAD and correlated to the index of microcirculatory resistance (IMR) during invasive coronary angiography. METHODS Fifty patients with angina (65 ± 9 years of age) and 20 age-matched healthy control subjects underwent adenosine stress CMR (1.5- and 3-T) to assess left ventricular function, inducible ischemia (myocardial perfusion reserve index [MPRI]; myocardial blood flow [MBF]), and infarction (late gadolinium enhancement). During subsequent angiography within 7 days, 28 patients had obstructive CAD (fractional flow reserve [FFR] ≤0.8) and 22 patients had NOCAD (FFR >0.8) who underwent 3-vessel IMR measurements. RESULTS In patients with NOCAD, myocardium with IMR <25 U had normal MPRI (1.9 ± 0.4 vs. controls 2.0 ± 0.3; p = 0.49); myocardium with IMR ≥25 U had significantly impaired MPRI, similar to ischemic myocardium downstream of obstructive CAD (1.2 ± 0.3 vs. 1.2 ± 0.4; p = 0.61). An MPRI of 1.4 accurately detected impaired perfusion related to CMD (IMR ≥25 U; FFR >0.8) (area under the curve: 0.90; specificity: 95%; sensitivity: 89%; p < 0.001). Impaired MPRI in patients with NOCAD was driven by impaired augmentation of MBF during stress, with normal resting MBF. Myocardium with FFR >0.8 and normal IMR (<25 U) still had blunted stress MBF, suggesting mild CMD, which was distinguishable from control subjects by using a stress MBF threshold of 2.3 ml/min/g with 100% positive predictive value. CONCLUSIONS In angina patients with NOCAD, CMR can objectively and noninvasively assess microvascular angina. A CMR-based combined diagnostic pathway for both epicardial and microvascular CAD deserves further clinical validation.
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Affiliation(s)
- Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rohan S Wijesurendra
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Joanna M Liu
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - John C Forfar
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rajesh K Kharbanda
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vanessa M Ferreira
- 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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Levelt E, Piechnik SK, Liu A, Wijesurendra RS, Mahmod M, Ariga R, Francis JM, Greiser A, Clarke K, Neubauer S, Ferreira VM, Karamitsos TD. Correction to: Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease. J Cardiovasc Magn Reson 2017; 19:99. [PMID: 29212500 PMCID: PMC5719930 DOI: 10.1186/s12968-017-0406-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
In the original publication of this article [1] Fig. 1 was incorrect due to the use of a colour bar with wrong range in error.
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Affiliation(s)
- Eylem Levelt
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Stefan K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alexander Liu
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rohan S Wijesurendra
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Masliza Mahmod
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rina Ariga
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jane M Francis
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Theodoros D Karamitsos
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital St. Kyriakidi 1, 54636, Thessaloniki, Greece.
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Levelt E, Piechnik SK, Liu A, Wijesurendra RS, Mahmod M, Ariga R, Francis JM, Greiser A, Clarke K, Neubauer S, Ferreira VM, Karamitsos TD. Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease. J Cardiovasc Magn Reson 2017; 19:81. [PMID: 29070069 PMCID: PMC5655826 DOI: 10.1186/s12968-017-0397-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/12/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with coronary microvascular dysfunction in the absence of obstructive coronary artery disease (CAD). Cardiovascular magnetic resonance (CMR) T1-mapping at rest and during adenosine stress can assess coronary vascular reactivity. We hypothesised that the non-contrast T1 response to vasodilator stress will be altered in patients with T2DM without CAD compared to controls due to coronary microvascular dysfunction. METHODS Thirty-one patients with T2DM and sixteen matched healthy controls underwent CMR (3 T) for cine, rest and adenosine stress non-contrast T1-mapping (ShMOLLI), first-pass perfusion and late gadolinium enhancement (LGE) imaging. Significant CAD (>50% coronary luminal stenosis) was excluded in all patients by coronary computed tomographic angiography. RESULTS All subjects had normal left ventricular (LV) ejection and LV mass index, with no LGE. Myocardial perfusion reserve index (MPRI) was lower in T2DM than in controls (1.60 ± 0.44 vs 2.01 ± 0.42; p = 0.008). There was no difference in rest native T1 values (p = 0.59). During adenosine stress, T1 values increased significantly in both T2DM patients (from 1196 ± 32 ms to 1244 ± 44 ms, p < 0.001) and controls (from 1194 ± 26 ms to 1273 ± 44 ms, p < 0.001). T2DM patients showed blunted relative stress non-contrast T1 response (T2DM: ΔT1 = 4.1 ± 2.9% vs. CONTROLS ΔT1 = 6.6 ± 2.6%, p = 0.007) due to a blunted maximal T1 during adenosine stress (T2DM 1244 ± 44 ms vs. controls 1273 ± 44 ms, p = 0.045). CONCLUSIONS Patients with well controlled T2DM, even in the absence of arterial hypertension and significant CAD, exhibit blunted maximal non-contrast T1 response during adenosine vasodilatory stress, likely reflecting coronary microvascular dysfunction. Adenosine stress and rest T1 mapping can detect subclinical abnormalities of the coronary microvasculature, without the need for gadolinium contrast agents. CMR may identify early features of the diabetic heart phenotype and subclinical cardiac risk markers in patients with T2DM, providing an opportunity for early therapeutic intervention.
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Affiliation(s)
- Eylem Levelt
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Stefan K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alexander Liu
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rohan S Wijesurendra
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Masliza Mahmod
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rina Ariga
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jane M Francis
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Theodoros D Karamitsos
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital St. Kyriakidi 1, 54636, Thessaloniki, Greece.
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Wijesurendra RS, Liu A, Ferreira VM, Neubauer S, Casadei B. Histopathological and Immunological Characteristics of Tachycardia-Induced Cardiomyopathy. J Am Coll Cardiol 2017; 70:1686. [DOI: 10.1016/j.jacc.2017.05.083] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/23/2017] [Indexed: 12/01/2022]
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Liu A, Wijesurendra RS, Liu JM, Forfar JC, Channon KM, Piechnik SK, Neubauer S, Kharbanda RK, Ferreira VM. 022 Novel perfusion CMR reference standard for the objective diagnosis of microcirculatory dysfunction – validation against prognostic invasive markers of coronary physiology. Heart 2017. [DOI: 10.1136/heartjnl-2017-311399.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Liu A, Wijesurendra RS, Ariga R, Mahmod M, Levelt E, Greiser A, Petrou M, Krasopoulos G, Forfar JC, Kharbanda RK, Channon KM, Neubauer S, Piechnik SK, Ferreira VM. Splenic T1-mapping: a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:1. [PMID: 28081721 PMCID: PMC5234250 DOI: 10.1186/s12968-016-0318-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Perfusion cardiovascular magnetic resonance (CMR) performed with inadequate adenosine stress leads to false-negative results and suboptimal clinical management. The recently proposed marker of adequate stress, the "splenic switch-off" sign, detects splenic blood flow attenuation during stress perfusion (spleen appears dark), but can only be assessed after gadolinium first-pass, when it is too late to optimize the stress response. Reduction in splenic blood volume during adenosine stress is expected to shorten native splenic T1, which may predict splenic switch-off without the need for gadolinium. METHODS Two-hundred and twelve subjects underwent adenosine stress CMR: 1.5 T (n = 104; 75 patients, 29 healthy controls); 3 T (n = 108; 86 patients, 22 healthy controls). Native T1spleen was assessed using heart-rate-independent ShMOLLI prototype sequence at rest and during adenosine stress (140 μg/kg/min, 4 min, IV) in 3 short-axis slices (basal, mid-ventricular, apical). This was compared with changes in peak splenic perfusion signal intensity (ΔSIspleen) and the "splenic switch-off" sign on conventional stress/rest gadolinium perfusion imaging. T1spleen values were obtained blinded to perfusion ΔSIspleen, both were derived using regions of interest carefully placed to avoid artefacts and partial-volume effects. RESULTS Normal resting splenic T1 values were 1102 ± 66 ms (1.5 T) and 1352 ± 114 ms (3 T), slightly higher than in patients (1083 ± 59 ms, p = 0.04; 1295 ± 105 ms, p = 0.01, respectively). T1spleen decreased significantly during adenosine stress (mean ΔT1spleen ~ -40 ms), independent of field strength, age, gender, and cardiovascular diseases. While ΔT1spleen correlated strongly with ΔSIspleen (rho = 0.70, p < 0.0001); neither indices showed significant correlations with conventional hemodynamic markers (rate pressure product) during stress. By ROC analysis, a ΔT1spleen threshold of ≥ -30 ms during stress predicted the "splenic switch-off" sign (AUC 0.90, p < 0.0001) with sensitivity (90%), specificity (88%), accuracy (90%), PPV (98%), NPV (42%). CONCLUSIONS Adenosine stress and rest splenic T1-mapping is a novel method for assessing stress responses, independent of conventional hemodynamic parameters. It enables prediction of the visual "splenic switch-off" sign without the need for gadolinium, and correlates well to changes in splenic signal intensity during stress/rest perfusion imaging. ΔT1spleen holds promise to facilitate optimization of stress responses before gadolinium first-pass perfusion CMR.
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Affiliation(s)
- Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rohan S. Wijesurendra
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rina Ariga
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Masliza Mahmod
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Eylem Levelt
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Mario Petrou
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK
| | - John C. Forfar
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | - Rajesh K. Kharbanda
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Keith M. Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Levelt E, Rodgers CT, Clarke WT, Mahmod M, Ariga R, Francis JM, Liu A, Wijesurendra RS, Dass S, Sabharwal N, Robson MD, Holloway CJ, Rider OJ, Clarke K, Karamitsos TD, Neubauer S. Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus. Eur Heart J 2016; 37:3461-3469. [PMID: 26392437 PMCID: PMC5201143 DOI: 10.1093/eurheartj/ehv442] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/27/2015] [Accepted: 08/12/2015] [Indexed: 12/12/2022] Open
Abstract
AIMS Patients with type 2 diabetes mellitus (T2DM) are known to have impaired resting myocardial energetics and impaired myocardial perfusion reserve, even in the absence of obstructive epicardial coronary artery disease (CAD). Whether or not the pre-existing energetic deficit is exacerbated by exercise, and whether the impaired myocardial perfusion causes deoxygenation and further energetic derangement during exercise stress, is uncertain. METHODS AND RESULTS Thirty-one T2DM patients, on oral antidiabetic therapies with a mean HBA1c of 7.4 ± 1.3%, and 17 matched controls underwent adenosine stress cardiovascular magnetic resonance for assessment of perfusion [myocardial perfusion reserve index (MPRI)] and oxygenation [blood-oxygen level-dependent (BOLD) signal intensity change (SIΔ)]. Cardiac phosphorus-MR spectroscopy was performed at rest and during leg exercise. Significant CAD (>50% coronary stenosis) was excluded in all patients by coronary computed tomographic angiography. Resting phosphocreatine to ATP (PCr/ATP) was reduced by 17% in patients (1.74 ± 0.26, P = 0.001), compared with controls (2.07 ± 0.35); during exercise, there was a further 12% reduction in PCr/ATP (P = 0.005) in T2DM patients, but no change in controls. Myocardial perfusion and oxygenation were decreased in T2DM (MPRI 1.61 ± 0.43 vs. 2.11 ± 0.68 in controls, P = 0.002; BOLD SIΔ 7.3 ± 7.8 vs. 17.1 ± 7.2% in controls, P < 0.001). Exercise PCr/ATP correlated with MPRI (r = 0.50, P = 0.001) and BOLD SIΔ (r = 0.32, P = 0.025), but there were no correlations between rest PCr/ATP and MPRI or BOLD SIΔ. CONCLUSION The pre-existing energetic deficit in diabetic cardiomyopathy is exacerbated by exercise; stress PCr/ATP correlates with impaired perfusion and oxygenation. Our findings suggest that, in diabetes, coronary microvascular dysfunction exacerbates derangement of cardiac energetics under conditions of increased workload.
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Affiliation(s)
- Eylem Levelt
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Christopher T Rodgers
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - William T Clarke
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Rina Ariga
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Jane M Francis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Alexander Liu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Saira Dass
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | | | - Matthew D Robson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Cameron J Holloway
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
- St. Vincent's Hospital, Sydney, Australia
| | - Oliver J Rider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Kieran Clarke
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Theodoros D Karamitsos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University, Thessaloniki, Greece
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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Wijesurendra RS, Rider OJ. Atrial remodeling in obesity and hypertension-What can we learn from the ECG? Obesity (Silver Spring) 2016; 24:2448. [PMID: 27813267 DOI: 10.1002/oby.21689] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Rohan S Wijesurendra
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, OCMR, John Radcliffe Hospital, Oxford, UK
| | - Oliver J Rider
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, OCMR, John Radcliffe Hospital, Oxford, UK
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Wijesurendra RS, Liu A, Eichhorn C, Ariga R, Levelt E, Clarke WT, Rodgers CT, Karamitsos TD, Bashir Y, Ginks M, Rajappan K, Betts T, Ferreira VM, Neubauer S, Casadei B. Lone Atrial Fibrillation Is Associated With Impaired Left Ventricular Energetics That Persists Despite Successful Catheter Ablation. Circulation 2016; 134:1068-1081. [PMID: 27630135 PMCID: PMC5054971 DOI: 10.1161/circulationaha.116.022931] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/23/2016] [Indexed: 01/15/2023]
Abstract
Supplemental Digital Content is available in the text. Lone atrial fibrillation (AF) may reflect a subclinical cardiomyopathy that persists after sinus rhythm (SR) restoration, providing a substrate for AF recurrence. To test this hypothesis, we investigated the effect of restoring SR by catheter ablation on left ventricular (LV) function and energetics in patients with AF but no significant comorbidities.
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Affiliation(s)
- Rohan S Wijesurendra
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Alexander Liu
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Christian Eichhorn
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Rina Ariga
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Eylem Levelt
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - William T Clarke
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Christopher T Rodgers
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Theodoros D Karamitsos
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Yaver Bashir
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Matthew Ginks
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Kim Rajappan
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Tim Betts
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Vanessa M Ferreira
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Stefan Neubauer
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.)
| | - Barbara Casadei
- From Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N., B.C.); University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK (R.S.W., A.L., C.E., R.A., E.L., W.T.C., C.T.R., T.D.K., V.M.F., S.N.); and Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.B., M.G., K.R., T.B.).
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Wijesurendra RS, Liu A, Eichhorn C, Levelt E, Ariga R, Bashir Y, Ginks M, Rajappan K, Betts TR, Ferreira VM, Casadei B, Neubauer S. Successful ablation of atrial fibrillation does not normalise left ventricular function, reverse impaired myocardial energetics or increase perfusion reserve: novel mechanistic insights with clinical implications. Journal of Cardiovascular Magnetic Resonance 2016. [PMCID: PMC5032795 DOI: 10.1186/1532-429x-18-s1-o35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liu A, Wijesurendra RS, Francis JM, Robson MD, Neubauer S, Piechnik SK, Ferreira VM. Adenosine Stress and Rest T1 Mapping Can Differentiate Between Ischemic, Infarcted, Remote, and Normal Myocardium Without the Need for Gadolinium Contrast Agents. JACC Cardiovasc Imaging 2015; 9:27-36. [PMID: 26684978 PMCID: PMC4708879 DOI: 10.1016/j.jcmg.2015.08.018] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 01/10/2023]
Abstract
Objectives The aim of this study was to evaluate the potential of T1 mapping at rest and during adenosine stress as a novel method for ischemia detection without the use of gadolinium contrast. Background In chronic coronary artery disease (CAD), accurate detection of ischemia is important because targeted revascularization improves clinical outcomes. Myocardial blood volume (MBV) may be a more comprehensive marker of ischemia than myocardial blood flow. T1 mapping using cardiac magnetic resonance (CMR) is highly sensitive to changes in myocardial water content, including MBV. We propose that T1 mapping at rest and during adenosine vasodilatory stress can detect MBV changes in normal and diseased myocardium in CAD. Methods Twenty normal controls (10 at 1.5-T; 10 at 3.0-T) and 10 CAD patients (1.5-T) underwent conventional CMR to assess for left ventricular function (cine), infarction (late gadolinium enhancement [LGE]) and ischemia (myocardial perfusion reserve index [MPRI] on first-pass perfusion imaging during adenosine stress). These were compared to novel pre-contrast stress/rest T1 mapping using the Shortened Modified Look-Locker Inversion recovery technique, which is heart rate independent. T1 values were derived for normal myocardium in controls and for infarcted, ischemic, and remote myocardium in CAD patients. Results Normal myocardium in controls (normal wall motion, MPRI, no LGE) showed normal resting T1 (954 ± 19 ms at 1.5-T; 1,189 ± 34 ms at 3.0-T) and significant positive T1 reactivity during adenosine stress compared to baseline (6.2 ± 0.5% at 1.5-T; 6.3 ± 1.1% at 3.0-T; all p < 0.0001). Infarcted myocardium showed the highest resting T1 of all tissue classes (1,442 ± 84 ms), without significant T1 reactivity (0.2 ± 1.5%). Ischemic myocardium showed elevated resting T1 compared to normal (987 ± 17 ms; p < 0.001) without significant T1 reactivity (0.2 ± 0.8%). Remote myocardium, although having comparable resting T1 to normal (955 ± 17 ms; p = 0.92), showed blunted T1 reactivity (3.9 ± 0.6%; p < 0.001). Conclusions T1 mapping at rest and during adenosine stress can differentiate between normal, infarcted, ischemic, and remote myocardium with distinctive T1 profiles. Stress/rest T1 mapping holds promise for ischemia detection without the need for gadolinium contrast.
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Affiliation(s)
- Alexander Liu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jane M Francis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Matthew D Robson
- 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
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
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Levelt E, Piechnik SK, Mahmod M, Ferreira VM, Ariga R, Francis JM, Liu A, Sellwood J, Wijesurendra RS, Robson MD, Clarke K, Neubauer S, Karamitsos TD. Adenosine stress native T1 mapping detects microvascular disease in diabetic cardiomyopathy, without the need for gadolinium-based contrast. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328981 DOI: 10.1186/1532-429x-17-s1-q55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Liu A, Wijesurendra RS, Francis JM, Robson MD, Neubauer S, Piechnik SK, Ferreira VM. Myocardial T1 responds to adenosine - normal values of stress T1 reactivity at 1.5T and 3T. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328684 DOI: 10.1186/1532-429x-17-s1-p107] [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: 11/29/2022] Open
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Ferreira VM, Wijesurendra RS, Liu A, Greiser A, Casadei B, Robson MD, Neubauer S, Piechnik SK. Systolic ShMOLLI myocardial T1-mapping for improved robustness to partial-volume effects and applications in tachyarrhythmias. J Cardiovasc Magn Reson 2015; 17:77. [PMID: 26315682 PMCID: PMC4552368 DOI: 10.1186/s12968-015-0182-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/13/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND T1-mapping using the Shortened Modified Look-Locker Inversion Recovery (ShMOLLI) technique enables non-invasive assessment of important myocardial tissue characteristics. However, tachyarrhythmia may cause mistriggering and inaccurate T1 estimation. We set out to test whether systolic T1-mapping might overcome this, and whether T1 values or data quality would be significantly different compared to conventional diastolic T1-mapping. METHODS Native T1 maps were acquired using ShMOLLI at 1.5 T (Magnetom Avanto, Siemens Healthcare) in 10 healthy volunteers (5 male) in sinus rhythm, at varying prescribed trigger delay (TD) times: 0, 50, 100 and 150 ms (all "systolic"), 340 ms (MOLLI TD 500 ms, the conventional TD for ShMOLLI) and also "end diastolic". T1 maps were also acquired using a shorter readout, to explore the effect of reducing image readout time and sensitivity to systolic motion. The feasibility and image quality of systolic T1-mapping was tested in 15 patients with tachyarrhythmia (n = 13 atrial fibrillation, n = 2 sinus tachycardia; mean HR range 93-121 bpm). RESULTS In healthy volunteers, systolic readout increased the thickness of myocardium compared to the diastolic readout. There was a small overall effect of TD on T1 values (p = 0.04), with slightly shorter T1 values in systole compared to diastole (maximum difference 10 ms). While there were apparent gender differences (with no effect of TD on T1 values in males, more marked differences in females, and exaggeration of this effect in thinner myocardial segments in females), dilatation and erosion of contours suggested that the effect of TD on T1 in females was almost entirely due to more partial-volume effects in diastole. All T1 maps were of excellent quality, but systolic TD and shorter readout were associated with less variability in segmental T1 values. In tachycardic patients, systolic acquisitions produced consistently excellent T1 maps (median R (2) = 0.993). CONCLUSIONS In healthy volunteers, systolic ShMOLLI T1-mapping reduces T1 variability and reports clinically equivalent T1 values to conventional diastolic readout; slightly shorter T1 values in systole are mostly explained by reduced partial-volume effects due to the increase in functional myocardial thickness. In patients with tachyarrhythmia, systolic ShMOLLI T1-mapping is feasible, circumvents mistriggering and produces excellent quality T1 maps. This extends its clinical applicability to challenging rhythms (such as rapid atrial fibrillation) and aids the investigation of thinner myocardial segments. With further validation, systolic T1-mapping may become a new and convenient standard for myocardial T1-mapping.
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Affiliation(s)
- Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK.
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK.
| | - Alexander Liu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK.
| | | | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK.
| | - Matthew D Robson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK.
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK.
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK.
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Abstract
Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with significant morbidity, mostly secondary to heart failure and stroke, and an estimated two-fold increase in premature death. Efforts to increase our understanding of AF and its complications have focused on unravelling the mechanisms of electrical and structural remodelling of the atrial myocardium. Yet, it is increasingly recognized that AF is more than an atrial disease, being associated with systemic inflammation, endothelial dysfunction, and adverse effects on the structure and function of the left ventricular myocardium that may be prognostically important. Here, we review the molecular and in vivo evidence that underpins current knowledge regarding the effects of human or experimental AF on the ventricular myocardium. Potential mechanisms are explored including diffuse ventricular fibrosis, focal myocardial scarring, and impaired myocardial perfusion and perfusion reserve. The complex relationship between AF, systemic inflammation, as well as endothelial/microvascular dysfunction and the effects of AF on ventricular calcium handling and oxidative stress are also addressed. Finally, consideration is given to the clinical implications of these observations and concepts, with particular reference to rate vs. rhythm control.
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Affiliation(s)
- Rohan S Wijesurendra
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Oxford OX3 9DU, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Oxford OX3 9DU, UK
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Wijesurendra RS, Carey M, Butterworth RJ, Khiani R. Pause for thought? Syncope and sinus arrest as the presenting feature of temporal lobe epilepsy. Acute Med 2014; 13:65-67. [PMID: 24940568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Some forms of focal epilepsy, including temporal lobe epilepsy, are rarely associated with ictal bradycardia and sinus node arrest. We report a case of a previously healthy man presenting with syncope in whom telemetry revealed sinus arrest. Initial treatment was with permanent pacemaker implantation and it was only following a subsequent grand mal seizure that other symptoms suggestive of temporal lobe epilepsy were documented. Anti-epileptic medication was subsequently commenced with resolution of all symptoms. There are few previously reported cases of syncope and documented sinus node arrest as the presenting feature of temporal lobe epilepsy.
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Affiliation(s)
- R S Wijesurendra
- Department of Cardiology Milton Keynes NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes
| | - M Carey
- Department of Cardiology Milton Keynes NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes
| | - R J Butterworth
- Department of Neurology Milton Keynes NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes
| | - R Khiani
- Department of Cardiology Milton Keynes NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes
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Jefferson A, Wijesurendra RS, McAteer MA, Choudhury RP. Development and application of endothelium-targeted microparticles for molecular magnetic resonance imaging. Wiley Interdiscip Rev Nanomed Nanobiotechnol 2012; 4:247-56. [PMID: 22407676 DOI: 10.1002/wnan.1164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Molecular imaging of disease states can enhance diagnosis allowing for accurate and more effective treatment. By specifically targeting molecules differentially expressed in disease states, researchers and clinicians have a means of disease characterization at a cellular or tissue level. Targeted micron-sized particles of iron oxide (MPIO) have been used as molecule-specific contrast agents for use with magnetic resonance imaging (MRI), and early evidence suggests they may be suitable for use with other imaging modalities. Targeting of MPIO to markers of disease is commonly achieved through the covalent attachment of antibodies to the surface of the particles, providing an imaging agent that is both highly specific and which binds with high affinity. When comparing micron-sized particles with nanometre-sized particles, the former provide substantial signal dropout in MRI and confer the sensitivity to detect low levels of target. Furthermore, larger particles appear to bind to targets more potently than smaller particles. Animal models have also demonstrated favorable blood clearance characteristics of MPIO, which are important in achieving favorable signal over background and to attain clearance and disposal. Although the current generation of commercially available MPIO are not suitable for administration into humans, future work may focus on the development of biodegradable and nonimmunogenic MPIO that may allow the use of these imaging agents in a clinical setting.
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Affiliation(s)
- Andrew Jefferson
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Jefferson A, Wijesurendra RS, McAteer MA, Digby JE, Douglas G, Bannister T, Perez-Balderas F, Bagi Z, Lindsay AC, Choudhury RP. Molecular imaging with optical coherence tomography using ligand-conjugated microparticles that detect activated endothelial cells: rational design through target quantification. Atherosclerosis 2011; 219:579-87. [PMID: 21872249 PMCID: PMC3234340 DOI: 10.1016/j.atherosclerosis.2011.07.127] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/27/2011] [Accepted: 07/28/2011] [Indexed: 12/26/2022]
Abstract
Objectives Optical coherence tomography (OCT) is a high resolution imaging technique used to assess superficial atherosclerotic plaque morphology. Utility of OCT may be enhanced by contrast agents targeting molecular mediators of inflammation. Methods and results Microparticles of iron oxide (MPIO; 1 and 4.5 μm diameter) in suspension were visualized and accurately quantified using a clinical optical coherence tomography system. Bound to PECAM-1 on a plane of cultured endothelial cells under static conditions, 1 μm MPIO were also readily detected by OCT. To design a molecular contrast probe that would bind activated endothelium under conditions of shear stress, we quantified the expression (basal vs. TNF-activated; molecules μm−2) of VCAM-1 (not detected vs. 16 ± 1); PECAM-1 (132 ± 6 vs. 198 ± 10) and E-selectin (not detected vs. 46 ± 0.6) using quantitative flow cytometry. We then compared the retention of antibody-conjugated MPIO targeting each of these molecules plus a combined VCAM-1 and E-selectin (E + V) probe across a range of physiologically relevant shear stresses. E + V MPIO were consistently retained with highest efficiency (P < 0.001) and at a density that provided conspicuous contrast effects on OCT pullback. Conclusion Microparticles of iron oxide were detectable using a clinical OCT system. Assessment of binding under flow conditions recommended an approach that targeted both E-selectin and VCAM-1. Bound to HUVEC under conditions of flow, targeted 1 μm E + V MPIO were readily identified on OCT pullback. Molecular imaging with OCT may be feasible in vivo using antibody targeted MPIO.
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Affiliation(s)
- Andrew Jefferson
- Department of Cardiovascular Medicine and Oxford Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
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Wijesurendra RS, Jefferson A, Choudhury RP. Target: ligand interactions of the vascular endothelium. Implications for molecular imaging in inflammation. Integr Biol (Camb) 2010; 2:467-82. [PMID: 20830411 DOI: 10.1039/c0ib00022a] [Citation(s) in RCA: 3] [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] [Indexed: 11/21/2022]
Abstract
Molecular imaging refers to the non-invasive visualisation of biological processes at the molecular and cellular levels within a living organism, and offers a wide range of potential benefits to both clinical medicine and research into novel therapeutic agents. Inflammation plays an important role in a wide variety of pathological processes and imaging the molecular and cellular machinery that underlies chronic inflammation is attractive and feasible. In this review, we present an overview of molecular imaging of inflammation. We start by characterising molecular and cellular events in early inflammation, identifying current and potential future imaging targets. We focus on the imaging of endothelial cells, which mediate the important first steps in inflammation in any tissue, are readily accessible to imaging probes and which present an approach that can be applied across multiple modalities. We then review the generic requirements for imaging contrast agents and focus on the important considerations in respect of ligands, ligand-target interactions and contrast vehicles. We aim to provide an integrated view of current progress with a focus on promising recent developments in experimental and translational molecular imaging.
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Affiliation(s)
- Rohan S Wijesurendra
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, UK
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Khan D, Wijesurendra RS, Orchard M, Evans P, Smith RW. Picture quiz: all in the head? Behcet disease. Acute Med 2010; 9:97-101. [PMID: 21597583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- D Khan
- Department of Medicine,Milton Keynes General Hospital, Milton Keynes, UK. Daliakhan@doctors .net.uk
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Wijesurendra RS, Bernard F, Outtrim J, Maiya B, Joshi S, Hutchinson PJ, Halsall DJ, Menon DK. Low-dose and high-dose synacthen tests and the hemodynamic response to hydrocortisone in acute traumatic brain injury. Neurocrit Care 2009; 11:158-64. [PMID: 19404783 DOI: 10.1007/s12028-009-9217-9] [Citation(s) in RCA: 3] [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: 01/18/2009] [Accepted: 04/02/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In order to identify whether low-dose (1 microg) tetracosactide (Synacthen) testing may be preferable to high-dose (250 microg) testing in the diagnosis of adrenal insufficiency in traumatic brain injury (TBI), as suggested by studies in other forms of critical illness. METHODS We retrospectively reviewed the results of modified tetracosactide tests (involving administration of both low-dose and high-dose tetracosactide) conducted for clinical indications in patients in a neurocritical care unit within 10 days of TBI. Sixty-three modified tests were included and cortisol concentrations before and after administration of tetracosactide were extracted from the hospital records. Data were also extracted regarding hemodynamic response to empirical corticosteroid therapy, based on rapid weaning from vasoactive drugs. RESULTS Cortisol increments at 30 and 60 min following tetracosactide correlated well in the low-dose test (r(2) = 0.875, P < 0.0001). The mean cortisol concentration was 581 nmol/l at 30 min and 556 nmol/l at 60 min in the low-dose test. Cortisol increments following low-dose and high-dose testing correlated well overall (r(2) = 0.839, P < 0.0001), but results were discordant in 27 of 63 cases (43%) when the same diagnostic threshold was used. ROC curve analysis showed that both tests performed poorly in identifying hemodynamic steroid responsiveness (AUC 0.553 and 0.502, respectively). CONCLUSIONS In the low-dose tetracosactide test, it is sufficient to determine cortisol concentrations at baseline and at 30 min. Low-dose and high-dose tests give discordant results in a significant proportion of cases when using the same diagnostic threshold. Neither test can be used to guide the initiation of corticosteroid therapy in acute TBI.
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Affiliation(s)
- R S Wijesurendra
- University Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Box 93, Hills Road, Cambridge CB2 2QQ, UK.
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Martin CA, Wijesurendra RS, Borland CDR, Karas JA. Femoral vein thrombophlebitis and septic pulmonary embolism due to a mixed anaerobic infection including Solobacterium moorei: a case report. J Med Case Rep 2007; 1:40. [PMID: 17605768 PMCID: PMC1929108 DOI: 10.1186/1752-1947-1-40] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 07/02/2007] [Indexed: 12/04/2022] Open
Abstract
Background Primary foci of necrobacillosis infection outside the head and neck are uncommon but have been reported in the urogenital or gastrointestinal tracts. Reports of infection with Solobacterium moorei are rare. Case presentation A 37-year-old male intravenous drug user was admitted with pain in his right groin, fever, rigors and vomiting following a recent injection into the right femoral vein. Admission blood cultures grew Fusobacterium nucleatum, Solobacterium moorei and Bacteroides ureolyticus. The patient was successfully treated with intravenous penicillin and metronidazole. Conclusion This case report describes an unusual case of femoral thrombophlebitis with septic pulmonary embolism associated with anaerobic organisms in a groin abscess. Solobacterium moorei, though rarely described, may also have clinically significant pathogenic potential.
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Affiliation(s)
- Claire A Martin
- Department of Medicine, Hinchingbrooke Hospital, Hinchingbrooke Heath Care NHS Trust, Huntingdon, Cambridgeshire, PE29 6NT, UK
| | - Rohan S Wijesurendra
- Department of Medicine, Hinchingbrooke Hospital, Hinchingbrooke Heath Care NHS Trust, Huntingdon, Cambridgeshire, PE29 6NT, UK
| | - Colin DR Borland
- Department of Medicine, Hinchingbrooke Hospital, Hinchingbrooke Heath Care NHS Trust, Huntingdon, Cambridgeshire, PE29 6NT, UK
| | - Johannis A Karas
- Department of Microbiology, Hinchingbrooke Hospital, Hinchingbrooke Heath Care NHS Trust, Huntingdon, Cambridgeshire, PE29 6NT, UK
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