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Orina F, Amukoye E, Bowyer C, Chakaya J, Das D, Devereux G, Dobson R, Dragosits U, Gray C, Kiplimo R, Lesosky M, Loh M, Meme H, Mortimer K, Ndombi A, Pearson C, Price H, Twigg M, West S, Semple S. Household carbon monoxide (CO) concentrations in a large African city: an unquantified public health burden? Environ Pollut 2024:124054. [PMID: 38677455 DOI: 10.1016/j.envpol.2024.124054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024]
Abstract
Carbon monoxide (CO) is a poisonous gas produced by incomplete combustion of carbon-based fuels that is linked to mortality and morbidity. Household air pollution from burning fuels on poorly ventilated stoves can lead to high concentrations of CO in homes. There are few datasets available on household concentrations of CO in urban areas of sub-Saharan African countries. CO was measured every minute over 24 hours in a sample of homes in Nairobi, Kenya. Data on household characteristics were gathered by questionnaire. Metrics of exposure were summarised and analysis of temporal changes in concentration was performed. Continuous 24-hour data were available from 138 homes. The mean (SD), median (IQR) and maximum 24-hour CO concentration was 4.9 (6.4), 2.8 (1.0-6.3) and 44ppm, respectively. 50% of homes had detectable CO concentrations for 847 minutes (14h07m) or longer during the 24-hour period, and 9% of homes would have activated a CO-alarm operating to European specifications. An association between a metric of total CO exposure and self-reported exposure to vapours >15 h per week was identified, however this were not statistically significant after adjustment for the multiple comparisons performed. Mean concentrations were broadly similar in homes from a more affluent area and an informal settlement. A model of typical exposure suggests that cooking is likely to be responsible for approximately 60% of the CO exposure of Nairobi schoolchildren. Household CO concentrations are substantial in Nairobi, Kenya, despite most homes using gas or liquid fuels. Concentrations tend to be highest during the evening, probably associated with periods of cooking. Household air pollution from cooking is the main source of CO exposure of Nairobi schoolchildren. The public health impacts of long-term CO exposure in cities in sub-Saharan Africa may be considerable and should be studied further.
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Affiliation(s)
- F Orina
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - E Amukoye
- Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - C Bowyer
- Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK
| | - J Chakaya
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - D Das
- Institute of Occupational Medicine, Research Avenue North Riccarton, Edinburgh EH14 4AP, UK; Department of Environment and Geography, University of York, YO10 5NG, UK
| | - G Devereux
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - R Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - U Dragosits
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian EH26 0QB, UK
| | - C Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - R Kiplimo
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - M Lesosky
- National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - M Loh
- Institute of Occupational Medicine, Research Avenue North Riccarton, Edinburgh EH14 4AP, UK
| | - H Meme
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - K Mortimer
- Cambridge Africa, Department of Pathology, University of Cambridge, Cambridge, UK; Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - A Ndombi
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - C Pearson
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian EH26 0QB, UK
| | - H Price
- Biological and Environmental Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - M Twigg
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian EH26 0QB, UK
| | - S West
- Stockholm Environment Institute, University of York, YO10 5NG, UK
| | - S Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK.
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Nash J, Debono S, Whittington B, Kaczynski J, Clark T, Macnaught G, Semple S, van Beek EJR, Tavares A, Dey D, Williams MC, Slomka PJ, Newby DE, Dweck MR, Fletcher AJ. Thoracic aortic microcalcification activity in combined positron emission tomography and magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06670-5. [PMID: 38456972 DOI: 10.1007/s00259-024-06670-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Non-invasive detection of pathological changes in thoracic aortic disease remains an unmet clinical need particularly for patients with congenital heart disease. Positron emission tomography combined with magnetic resonance imaging (PET-MRI) could provide a valuable low-radiation method of aortic surveillance in high-risk groups. Quantification of aortic microcalcification activity using sodium [18F]fluoride holds promise in the assessment of thoracic aortopathies. We sought to evaluate aortic sodium [18F]fluoride uptake in PET-MRI using three methods of attenuation correction compared to positron emission tomography computed tomography (PET-CT) in patients with bicuspid aortic valve, METHODS: Thirty asymptomatic patients under surveillance for bicuspid aortic valve disease underwent sodium [18F]fluoride PET-CT and PET-MRI of the ascending thoracic aorta during a single visit. PET-MRI data were reconstructed using three iterations of attenuation correction (Dixon, radial gradient recalled echo with two [RadialVIBE-2] or four [RadialVIBE-4] tissue segmentation). Images were qualitatively and quantitatively analysed for aortic sodium [18F]fluoride uptake on PET-CT and PET-MRI. RESULTS Aortic sodium [18F]fluoride uptake on PET-MRI was visually comparable with PET-CT using each reconstruction and total aortic standardised uptake values on PET-CT strongly correlated with each PET-MRI attenuation correction method (Dixon R = 0.70; RadialVIBE-2 R = 0.63; RadialVIBE-4 R = 0.64; p < 0.001 for all). Breathing related artefact between soft tissue and lung were detected using Dixon and RadialVIBE-4 but not RadialVIBE-2 reconstructions, with the presence of this artefact adjacent to the atria leading to variations in blood pool activity estimates. Consequently, quantitative agreements between radiotracer activity on PET-CT and PET-MRI were most consistent with RadialVIBE-2. CONCLUSION Ascending aortic microcalcification analysis in PET-MRI is feasible with comparable findings to PET-CT. RadialVIBE-2 tissue attenuation correction correlates best with the reference standard of PET-CT and is less susceptible to artefact. There remain challenges in segmenting tissue types in PET-MRI reconstructions, and improved attenuation correction methods are required.
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Affiliation(s)
- Jennifer Nash
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Samuel Debono
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Beth Whittington
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jakub Kaczynski
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Tim Clark
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Gillian Macnaught
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Department of Medical Physics, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Scott Semple
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging Facility Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging Facility Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Adriana Tavares
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Damini Dey
- Departments of Medicine, Division of Artificial Intelligence) and Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, USA
| | - Michelle C Williams
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Piotr J Slomka
- Departments of Medicine, Division of Artificial Intelligence) and Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, USA
| | - David E Newby
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Marc R Dweck
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Alexander J Fletcher
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Borgini A, Veronese C, De Marco C, Boffi R, Tittarelli A, Bertoldi M, Fern Ndez E, Tigova O, Gallus S, Lugo A, Gorini G, Carreras G, L Pez MJ, Continente X, Semple S, Dobson R, Clancy L, Keogan S, Tzortzi A, Vardavas C, Nicol S LP, Starchenko P, Soriano JB, Ruprecht AA. Particulate matter in aerosols produced by two last generation electronic cigarettes: a comparison in a real-world environment. Pulmonology 2024; 30:137-144. [PMID: 33879426 DOI: 10.1016/j.pulmoe.2021.03.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
The design of e-cigarettes (e-cigs) is constantly evolving and the latest models can aerosolize using high-power sub-ohm resistance and hence may produce specific particle concentrations. The aim of this study was to evaluate the aerosol characteristics generated by two different types of electronic cigarette in real-world conditions, such as a sitting room or a small office, in number of particles (particles/cm3). We compared the real time and time-integrated measurements of the aerosol generated by the e-cigarette types Just Fog and JUUL. Real time (10s average) number of particles (particles/cm3) in 8 different aerodynamic sizes was measured using an optical particle counter (OPC) model Profiler 212-2. Tests were conducted with and without a Heating, Ventilating Air Conditioning System (HVACS) in operation, in order to evaluate the efficiency of air filtration. During the vaping sessions the OPC recorded quite significant increases in number of particles/cm3. The JUUL e-cig produced significantly lower emissions than Just Fog with and without the HVACS in operation. The study demonstrates the rapid volatility or change from liquid or semi-liquid to gaseous status of the e-cig aerosols, with half-life in the order of a few seconds (min. 4.6, max 23.9), even without the HVACS in operation. The e-cig aerosol generated by the JUUL proved significantly lower than that generated by the Just Fog, but this reduction may not be sufficient to eliminate or consistently reduce the health risk for vulnerable non e-cig users exposed to it.
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Affiliation(s)
- A Borgini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Veronese
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - C De Marco
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Boffi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Tittarelli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Bertoldi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Fern Ndez
- Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), L...Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Unit, Department of Cancer Epidemiology and Prevention, Catalan Institute of Oncology (ICO), L...Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Spain; Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Spain
| | - O Tigova
- Tobacco Control Unit, Bellvitge Biomedical Research Institute (IDIBELL), L...Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Unit, Department of Cancer Epidemiology and Prevention, Catalan Institute of Oncology (ICO), L...Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, Campus of Bellvitge, University of Barcelona, Spain; Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Spain
| | - S Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Gorini
- Oncologic network, prevention and research institute (ISPRO), Florence, Italy
| | - G Carreras
- Oncologic network, prevention and research institute (ISPRO), Florence, Italy
| | - M J L Pez
- Public Health Agency of Barcelona (ASPB), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - X Continente
- Public Health Agency of Barcelona (ASPB), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - S Semple
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, United Kingdom
| | - R Dobson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, United Kingdom
| | - L Clancy
- Tobacco Free Research Institute Ireland (TFRI), Ireland
| | - S Keogan
- Tobacco Free Research Institute Ireland (TFRI), Ireland
| | - A Tzortzi
- Hellenic Cancer Society ... George D. Behrakis Research Lab (HCS), Greece
| | - C Vardavas
- Hellenic Cancer Society ... George D. Behrakis Research Lab (HCS), Greece
| | | | - P Starchenko
- European Network on Smoking and Tobacco Prevention (ENSP), Belgium
| | - J B Soriano
- Fundaci..n para la Investigaci..n Biom..dica del Hospital Universitario La Princesa (IISP), Spain
| | - A A Ruprecht
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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4
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Joshi SS, Singh T, Kershaw LE, Gibb FW, Dweck MR, Williams M, Idris I, Semple S, Forbes S, Newby DE, Reynolds RM. Non-invasive imaging of functional pancreatic islet beta-cell mass in people with type 1 diabetes mellitus. Diabet Med 2023; 40:e15111. [PMID: 37035965 PMCID: PMC10946460 DOI: 10.1111/dme.15111] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 04/11/2023]
Abstract
AIMS To investigate whether manganese-enhanced magnetic resonance imaging can assess functional pancreatic beta-cell mass in people with type 1 diabetes mellitus. METHODS In a prospective case-control study, 20 people with type 1 diabetes mellitus (10 with low (≥50 pmol/L) and 10 with very low (<50 pmol/L) C-peptide concentrations) and 15 healthy volunteers underwent manganese-enhanced magnetic resonance imaging of the pancreas following an oral glucose load. Scan-rescan reproducibility was performed in 10 participants. RESULTS Mean pancreatic manganese uptake was 31 ± 6 mL/100 g of tissue/min in healthy volunteers (median 32 [interquartile range 23-36] years, 6 women), falling to 23 ± 4 and 13 ± 5 mL/100 g of tissue/min (p ≤ 0.002 for both) in people with type1 diabetes mellitus (52 [44-61] years, 6 women) and low or very low plasma C-peptide concentrations respectively. Pancreatic manganese uptake correlated strongly with plasma C-peptide concentrations in people with type1 diabetes mellitus (r = 0.73, p < 0.001) but not in healthy volunteers (r = -0.054, p = 0.880). There were no statistically significant correlations between manganese uptake and age, body-mass index, or glycated haemoglobin. There was strong intra-observer (mean difference: 0.31 (limits of agreement -1.42 to 2.05) mL/100 g of tissue/min; intra-class correlation, ICC = 0.99), inter-observer (-1.23 (-5.74 to 3.27) mL/100 g of tissue/min; ICC = 0.85) and scan-rescan (-0.72 (-2.9 to 1.6) mL/100 g of tissue/min; ICC = 0.96) agreement for pancreatic manganese uptake. CONCLUSIONS Manganese-enhanced magnetic resonance imaging provides a potential reproducible non-invasive measure of functional beta-cell mass in people with type 1 diabetes mellitus. This holds major promise for investigating type 1 diabetes, monitoring disease progression and assessing novel immunomodulatory interventions.
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Affiliation(s)
- Shruti S. Joshi
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Trisha Singh
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Lucy E. Kershaw
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh ImagingUniversity of EdinburghEdinburghUK
| | - Fraser W. Gibb
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh Centre for EndocrinologyNHS LothianEdinburghUK
| | - Marc R. Dweck
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Michelle Williams
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh ImagingUniversity of EdinburghEdinburghUK
- Department of RadiologyNHS LothianEdinburghUK
| | - Iskandar Idris
- Department of EndocrinologyUniversity of NottinghamNottinghamUK
| | - Scott Semple
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh ImagingUniversity of EdinburghEdinburghUK
| | - Shareen Forbes
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh Centre for EndocrinologyNHS LothianEdinburghUK
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh ImagingUniversity of EdinburghEdinburghUK
| | - Rebecca M. Reynolds
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh Centre for EndocrinologyNHS LothianEdinburghUK
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Griffiths K, Smart SE, Barker GJ, Deakin B, Lawrie SM, Lewis S, Lythgoe DJ, Pardiñas AF, Singh K, Semple S, Walters JTR, Williams SR, Egerton A, MacCabe JH. Treatment resistance NMDA receptor pathway polygenic score is associated with brain glutamate in schizophrenia. Schizophr Res 2023; 260:152-159. [PMID: 37657282 PMCID: PMC10873209 DOI: 10.1016/j.schres.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023]
Abstract
Dysfunction of glutamate neurotransmission has been implicated in the pathophysiology of schizophrenia and may be particularly relevant in severe, treatment-resistant symptoms. The underlying mechanism may involve hypofunction of the NMDA receptor. We investigated whether schizophrenia-related pathway polygenic scores, composed of genetic variants within NMDA receptor encoding genes, are associated with cortical glutamate in schizophrenia. Anterior cingulate cortex (ACC) glutamate was measured in 70 participants across 4 research sites using Proton Magnetic Resonance Spectroscopy (1H-MRS). Two NMDA receptor gene sets were sourced from the Molecular Signatories Database and NMDA receptor pathway polygenic scores were constructed using PRSet. The NMDA receptor pathway polygenic scores were weighted by single nucleotide polymorphism (SNP) associations with treatment-resistant schizophrenia, and associations with ACC glutamate were tested. We then tested whether NMDA receptor pathway polygenic scores with SNPs weighted by associations with non-treatment-resistant schizophrenia were associated with ACC glutamate. A higher NMDA receptor complex pathway polygenic score was significantly associated with lower ACC glutamate (β = -0.25, 95 % CI = -0.49, -0.02, competitive p = 0.03). When SNPs were weighted by associations with non-treatment-resistant schizophrenia, there was no association between the NMDA receptor complex pathway polygenic score and ACC glutamate (β = 0.05, 95 % CI = -0.18, 0.27, competitive p = 0.79). These results provide initial evidence of an association between common genetic variation implicated in NMDA receptor function and ACC glutamate levels in schizophrenia. This association was specific to when the NMDA receptor complex pathway polygenic score was weighted by SNP associations with treatment-resistant schizophrenia.
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Affiliation(s)
- Kira Griffiths
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Sophie E Smart
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Gareth J Barker
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, University of Manchester, M13 9PT, UK
| | | | - Shon Lewis
- Division of Psychology and Mental Health, University of Manchester, M13 9PT, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
| | - David J Lythgoe
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Antonio F Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Krishna Singh
- Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff CF24 4HQ, UK
| | - Scott Semple
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Stephen R Williams
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK.
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6
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Loh MM, Yaxley N, Moore G, Holmes D, Todd S, Smith A, Macdonald E, Semple S, Cherrie M, Patel M, Hamill R, Leckie A, Dancer SJ, Cherrie JW. Measurement of SARS-CoV-2 in air and on surfaces in Scottish hospitals. J Hosp Infect 2023; 133:1-7. [PMID: 36473553 PMCID: PMC9721166 DOI: 10.1016/j.jhin.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are still uncertainties in our knowledge of the amount of SARS-CoV-2 virus present in the environment - where it can be found, and potential exposure determinants - limiting our ability to effectively model and compare interventions for risk management. AIM This study measured SARS-CoV-2 in three hospitals in Scotland on surfaces and in air, alongside ventilation and patient care activities. METHODS Air sampling at 200 L/min for 20 min and surface sampling were performed in two wards designated to treat COVID-19-positive patients and two non-COVID-19 wards across three hospitals in November and December 2020. FINDINGS Detectable samples of SARS-CoV-2 were found in COVID-19 treatment wards but not in non-COVID-19 wards. Most samples were below assay detection limits, but maximum concentrations reached 1.7×103 genomic copies/m3 in air and 1.9×104 copies per surface swab (3.2×102 copies/cm2 for surface loading). The estimated geometric mean air concentration (geometric standard deviation) across all hospitals was 0.41 (71) genomic copies/m3 and the corresponding values for surface contamination were 2.9 (29) copies/swab. SARS-CoV-2 RNA was found in non-patient areas (patient/visitor waiting rooms and personal protective equipment changing areas) associated with COVID-19 treatment wards. CONCLUSION Non-patient areas of the hospital may pose risks for infection transmission and further attention should be paid to these areas. Standardization of sampling methods will improve understanding of levels of environmental contamination. The pandemic has demonstrated a need to review and act upon the challenges of older hospital buildings meeting current ventilation guidance.
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Affiliation(s)
- M M Loh
- Institute of Occupational Medicine, Edinburgh, UK.
| | - N Yaxley
- UK Health Security Agency, Porton Down, UK
| | - G Moore
- UK Health Security Agency, Porton Down, UK
| | - D Holmes
- Institute of Occupational Medicine, Edinburgh, UK
| | - S Todd
- Institute of Occupational Medicine, Edinburgh, UK
| | - A Smith
- Institute of Occupational Medicine, Edinburgh, UK
| | | | - S Semple
- Institute for Social Marketing & Health, University of Stirling, Stirling, UK
| | - M Cherrie
- Institute of Occupational Medicine, Edinburgh, UK
| | | | | | | | - S J Dancer
- NHS Lanarkshire, UK; Edinburgh Napier University, UK
| | - J W Cherrie
- Institute of Occupational Medicine, Edinburgh, UK; Heriot Watt University, Edinburgh, UK
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7
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Naredo-Gonzalez G, Upreti R, Jansen MA, Semple S, Sutcliffe OB, Marshall I, Walker BR, Andrew R. Non-invasive in vivo assessment of 11β-hydroxysteroid dehydrogenase type 1 activity by 19F-Magnetic Resonance Spectroscopy. Sci Rep 2022; 12:16268. [PMID: 36175417 PMCID: PMC9523021 DOI: 10.1038/s41598-022-18740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1) amplifies tissue glucocorticoid levels and is a pharmaceutical target in diabetes and cognitive decline. Clinical translation of inhibitors is hampered by lack of in vivo pharmacodynamic biomarkers. Our goal was to monitor substrates and products of 11β-HSD1 non-invasively in liver via 19Fluorine magnetic resonance spectroscopy (19F-MRS). Interconversion of mono/poly-fluorinated substrate/product pairs was studied in Wistar rats (male, n = 6) and healthy men (n = 3) using 7T and 3T MRI scanners, respectively. Here we show that the in vitro limit of detection, as absolute fluorine content, was 0.625 μmole in blood. Mono-fluorinated steroids, dexamethasone and 11-dehydrodexamethasone, were detected in phantoms but not in vivo in human liver following oral dosing. A non-steroidal polyfluorinated tracer, 2-(phenylsulfonyl)-1-(4-(trifluoromethyl)phenyl)ethanone and its metabolic product were detected in vivo in rat liver after oral administration of the keto-substrate, reading out reductase activity. Administration of a selective 11β-HSD1 inhibitor in vivo in rats altered total liver 19F-MRS signal. We conclude that there is insufficient sensitivity to measure mono-fluorinated tracers in vivo in man with current dosage regimens and clinical scanners. However, since reductase activity was observed in rats using poly-fluorinated tracers, this concept could be pursued for translation to man with further development.
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Affiliation(s)
- Gregorio Naredo-Gonzalez
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK
| | - Rita Upreti
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK
| | - Maurits A Jansen
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK.,Edinburgh Imaging, Queen's Medical Research Institute, 47 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK
| | - Scott Semple
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK.,Edinburgh Imaging, Queen's Medical Research Institute, 47 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK
| | - Oliver B Sutcliffe
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Ian Marshall
- Edinburgh Imaging, Queen's Medical Research Institute, 47 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK.,Centre for Clinical Brain Sciences, Chancellor's Building, 49 Little France Crescent, University of Edinburgh, Edinburgh, EH16 4SB, Scotland, UK
| | - Brian R Walker
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK.,Institute of Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Ruth Andrew
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK.
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8
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Griffiths K, Egerton A, Millgate E, Anton A, Barker GJ, Deakin B, Drake R, Eliasson E, Gregory CJ, Howes OD, Kravariti E, Lawrie SM, Lewis S, Lythgoe DJ, Murphy A, McGuire P, Semple S, Stockton-Powdrell C, Walters JTR, Williams SR, MacCabe JH. Impaired verbal memory function is related to anterior cingulate glutamate levels in schizophrenia: findings from the STRATA study. Schizophrenia (Heidelb) 2022; 8:60. [PMID: 35853881 PMCID: PMC9279335 DOI: 10.1038/s41537-022-00265-5] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
Abstract
Impaired cognition is associated with lower quality of life and poor outcomes in schizophrenia. Brain glutamate may contribute to both clinical outcomes and cognition, but these relationships are not well-understood. We studied a multicentre cohort of 85 participants with non-affective psychosis using proton magnetic resonance spectroscopy. Glutamate neurometabolites were measured in the anterior cingulate cortex (ACC). Cognition was assessed using the Brief Assessment for Cognition in Schizophrenia (BACS). Patients were categorised as antipsychotic responders or non-responders based on treatment history and current symptom severity. Inverted U-shaped associations between glutamate or Glx (glutamate + glutamine) with BACS subscale and total scores were examined with regression analyses. We then tested for an interaction effect of the antipsychotic response group on the relationship between glutamate and cognition. ACC glutamate and Glx had a positive linear association with verbal memory after adjusting for age, sex and chlorpromazine equivalent dose (glutamate, β = 3.73, 95% CI = 1.26-6.20, P = 0.004; Glx, β = 3.38, 95% CI = 0.84-5.91, P = 0.01). This association did not differ between good and poor antipsychotic response groups. ACC glutamate was also positively associated with total BACS score (β = 3.12, 95% CI = 0.01-6.23, P = 0.046), but this was not significant after controlling for antipsychotic dose. Lower glutamatergic metabolites in the ACC were associated with worse verbal memory, and this relationship was independent of antipsychotic response. Further research on relationships between glutamate and cognition in antipsychotic responsive and non-responsive illness could aid the stratification of patient groups for targeted treatment interventions.
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Affiliation(s)
- Kira Griffiths
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Edward Millgate
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Adriana Anton
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
- Academic Radiology, Department of Infection, Immunity and Cardiovascular Disease, Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, S10 2JF, UK
| | - Gareth J Barker
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Bill Deakin
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Richard Drake
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Emma Eliasson
- Division of Psychiatry, University of Edinburgh, Edinburgh, EH10 5HF, UK
| | - Catherine J Gregory
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Psychiatric Imaging Group MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK
| | - Eugenia Kravariti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Stephen M Lawrie
- Division of Psychiatry, University of Edinburgh, Edinburgh, EH10 5HF, UK
| | - Shôn Lewis
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - David J Lythgoe
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Anna Murphy
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Scott Semple
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Charlotte Stockton-Powdrell
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Stephen R Williams
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK.
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9
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Minderhoud SCS, Fletcher AJ, MacNaught G, Cadet S, Korteland SA, Kardys I, Rizopoulos D, Slomka P, Newby DE, Roos-Hesselink JW, Walker NL, Semple S, Hirsch A, Dweck MR, Wentzel JJ. Vascular biomechanics and molecular disease activity in the thoracic aorta: a novel imaging method. Eur Heart J Cardiovasc Imaging 2022; 23:1698-1707. [PMID: 35666823 PMCID: PMC9671295 DOI: 10.1093/ehjci/jeac090] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/08/2022] [Accepted: 04/28/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS The influence haemodynamics have on vessel wall pathobiology in aortic disease is incomplete. This aim of this study was to develop a repeatable method for assessing the relationship between aortic wall shear stress (WSS) and disease activity by fusing 4D flow cardiovascular magnetic resonance (CMR) with hybrid positron emission tomography (PET). METHODS AND RESULTS As part of an ongoing clinical trial, patients with bicuspid aortic valve (BAV) were prospectively imaged with both 18F-sodium fluoride (18F-NaF) PET, a marker of calcification activity, and 4D flow CMR. We developed novel software allowing accurate 3D co-registration and high-resolution comparison of aortic peak systolic WSS and 18F-NaF PET uptake (maximum tissue-to-background ratio). Intra-observer repeatability of both measurements was determined using Bland-Altman plots and intra-class correlation coefficients (ICCs). The relationship between localized WSS and 18F-NaF uptake was analysed using linear mixed-effect models. Twenty-three patients with BAV (median age 50 [44-55] years, 22% female) were included. Intra-observer repeatability for WSS (ICC = 0.92) and 18F-NaF (ICC = 0.91) measurements obtained within 1.4 ± 0.6 cm2 regions of interest was excellent. On multivariable analysis, 18F-NaF PET uptake was independently and negatively associated with WSS as well as diastolic blood pressure (both P < 0.05), adjusted for age. CONCLUSION Fused assessment of WSS and 18F-NaF PET uptake is feasible and repeatable, demonstrating a clear association between these two factors. This high spatial resolution approach has major potential to advance our understanding of the relationship between vascular haemodynamics and disease activity.
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Affiliation(s)
| | | | - Gillian MacNaught
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, EH16 4TJ Edinburgh, UK
| | - Sebastien Cadet
- Department of Imaging (Division of Nuclear Cardiology), Cedars-Sinai Medical Centre, CA 90048 Los Angeles, CA, USA
| | - Suze-Anne Korteland
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Piotr Slomka
- Department of Imaging (Division of Nuclear Cardiology), Cedars-Sinai Medical Centre, CA 90048 Los Angeles, CA, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Niki L Walker
- Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, G81 4DY Clydebank, UK
| | - Scott Semple
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, EH16 4TJ Edinburgh, UK
| | - Alexander Hirsch
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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10
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Bularga A, Hung J, Daghem M, Stewart S, Taggart C, Wereski R, Singh T, Meah MN, Fujisawa T, Ferry AV, Chiong J, Jenkins WS, Strachan FE, Semple S, van Beek EJ, Williams M, Dey D, Tuck C, Baker AH, Newby DE, Dweck MR, Mills NL, Chapman AR. Coronary Artery and Cardiac Disease in Patients With Type 2 Myocardial Infarction: A Prospective Cohort Study. Circulation 2022; 145:1188-1200. [PMID: 35341327 PMCID: PMC9010024 DOI: 10.1161/circulationaha.121.058542] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 11/25/2021] [Accepted: 01/25/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Type 2 myocardial infarction is caused by myocardial oxygen supply-demand imbalance, and its diagnosis is increasingly common with the advent of high-sensitivity cardiac troponin assays. Although this diagnosis is associated with poor outcomes, widespread uncertainty and confusion remain among clinicians as to how to investigate and manage this heterogeneous group of patients with type 2 myocardial infarction. METHODS In a prospective cohort study, 8064 consecutive patients with increased cardiac troponin concentrations were screened to identify patients with type 2 myocardial infarction. We excluded patients with frailty or renal or hepatic failure. All study participants underwent coronary (invasive or computed tomography angiography) and cardiac (magnetic resonance or echocardiography) imaging, and the underlying causes of infarction were independently adjudicated. The primary outcome was the prevalence of coronary artery disease. RESULTS In 100 patients with a provisional diagnosis of type 2 myocardial infarction (median age, 65 years [interquartile range, 55-74 years]; 43% women), coronary and cardiac imaging reclassified the diagnosis in 7 patients: type 1 or 4b myocardial infarction in 5 and acute myocardial injury in 2 patients. In those with type 2 myocardial infarction, median cardiac troponin I concentrations were 195 ng/L (interquartile range, 62-760 ng/L) at presentation and 1165 ng/L (interquartile range, 277-3782 ng/L) on repeat testing. The prevalence of coronary artery disease was 68% (63 of 93), which was obstructive in 30% (28 of 93). Infarct-pattern late gadolinium enhancement or regional wall motion abnormalities were observed in 42% (39 of 93), and left ventricular systolic dysfunction was seen in 34% (32 of 93). Only 10 patients had both normal coronary and normal cardiac imaging. Coronary artery disease and left ventricular systolic dysfunction were previously unrecognized in 60% (38 of 63) and 84% (27 of 32), respectively, with only 33% (21 of 63) and 19% (6 of 32) on evidence-based treatments. CONCLUSIONS Systematic coronary and cardiac imaging of patients with type 2 myocardial infarction identified coronary artery disease in two-thirds and left ventricular systolic dysfunction in one-third of patients. Unrecognized and untreated coronary or cardiac disease is seen in most patients with type 2 myocardial infarction, presenting opportunities for initiation of evidence-based treatments with major potential to improve clinical outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03338504.
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Affiliation(s)
- Anda Bularga
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - John Hung
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Marwa Daghem
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Stacey Stewart
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Caelan Taggart
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Ryan Wereski
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Trisha Singh
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Mohammed N. Meah
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Takeshi Fujisawa
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Amy V. Ferry
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Justin Chiong
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - William S. Jenkins
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Fiona E. Strachan
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Scott Semple
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Edwin J.R. van Beek
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Michelle Williams
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.D.)
| | - Chris Tuck
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Andrew H. Baker
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - David E. Newby
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Marc R. Dweck
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | | | - Andrew R. Chapman
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
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11
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Wheater ENW, Galdi P, McCartney DL, Blesa M, Sullivan G, Stoye DQ, Lamb G, Sparrow S, Murphy L, Wrobel N, Quigley AJ, Semple S, Thrippleton MJ, Wardlaw JM, Bastin ME, Marioni RE, Cox SR, Boardman JP. DNA methylation in relation to gestational age and brain dysmaturation in preterm infants. Brain Commun 2022; 4:fcac056. [PMID: 35402911 PMCID: PMC8984700 DOI: 10.1093/braincomms/fcac056] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/10/2021] [Accepted: 03/04/2022] [Indexed: 11/14/2022] Open
Abstract
Preterm birth is associated with dysconnectivity of structural brain networks and is a leading cause of neurocognitive impairment in childhood. Variation in DNA methylation is associated with early exposure to extrauterine life but there has been little research exploring its relationship with brain development. Using genome-wide DNA methylation data from the saliva of 258 neonates, we investigated the impact of gestational age on the methylome and performed functional analysis to identify enriched gene sets from probes that contributed to differentially methylated probes or regions. We tested the hypothesis that variation in DNA methylation could underpin the association between low gestational age at birth and atypical brain development by linking differentially methylated probes with measures of white matter connectivity derived from diffusion MRI metrics: peak width skeletonized mean diffusivity, peak width skeletonized fractional anisotropy and peak width skeletonized neurite density index. Gestational age at birth was associated with widespread differential methylation at term equivalent age, with genome-wide significant associations observed for 8870 CpG probes (P < 3.6 × 10-8) and 1767 differentially methylated regions. Functional analysis identified 14 enriched gene ontology terms pertaining to cell-cell contacts and cell-extracellular matrix contacts. Principal component analysis of probes with genome-wide significance revealed a first principal component that explained 23.5% of the variance in DNA methylation, and this was negatively associated with gestational age at birth. The first principal component was associated with peak width of skeletonized mean diffusivity (β = 0.349, P = 8.37 × 10-10) and peak width skeletonized neurite density index (β = 0.364, P = 4.15 × 10-5), but not with peak width skeletonized fraction anisotropy (β = -0.035, P = 0.510); these relationships mirrored the imaging metrics' associations with gestational age at birth. Low gestational age at birth has a profound and widely distributed effect on the neonatal saliva methylome that is apparent at term equivalent age. Enriched gene ontology terms related to cell-cell contacts reveal pathways that could mediate the effect of early life environmental exposures on development. Finally, associations between differential DNA methylation and image markers of white matter tract microstructure suggest that variation in DNA methylation may provide a link between preterm birth and the dysconnectivity of developing brain networks that characterizes atypical brain development in preterm infants.
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Affiliation(s)
- Emily N. W. Wheater
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Paola Galdi
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Daniel L. McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Manuel Blesa
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - David Q. Stoye
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Gillian Lamb
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Sarah Sparrow
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Lee Murphy
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Nicola Wrobel
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Alan J. Quigley
- Department of Paediatric Radiology, Royal Hospital for Sick Children, NHS Lothian, Edinburgh, UK
| | - Scott Semple
- Edinburgh Imaging, University of Edinburgh, EH16 4SB Edinburgh, UK
- Centre for Cardiovascular Science, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Michael J. Thrippleton
- Edinburgh Imaging, University of Edinburgh, EH16 4SB Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Mark E. Bastin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Riccardo E. Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Simon R. Cox
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - James P. Boardman
- MRC Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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12
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Brennan PN, MacMillan M, Manship T, Moroni F, Glover A, Graham C, Semple S, Morris DM, Fraser AR, Pass C, McGowan NWA, Turner ML, Lachlan N, Dillon JF, Campbell JDM, Fallowfield JA, Forbes SJ. Study protocol: a multicentre, open-label, parallel-group, phase 2, randomised controlled trial of autologous macrophage therapy for liver cirrhosis (MATCH). BMJ Open 2021; 11:e053190. [PMID: 34750149 PMCID: PMC8576470 DOI: 10.1136/bmjopen-2021-053190] [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] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Liver cirrhosis is a growing global healthcare challenge. Cirrhosis is characterised by severe liver fibrosis, organ dysfunction and complications related to portal hypertension. There are no licensed antifibrotic or proregenerative medicines and liver transplantation is a scarce resource. Hepatic macrophages can promote both liver fibrogenesis and fibrosis regression. The safety and feasibility of peripheral infusion of ex vivo matured autologous monocyte-derived macrophages in patients with compensated cirrhosis has been demonstrated. METHODS AND ANALYSIS The efficacy of autologous macrophage therapy, compared with standard medical care, will be investigated in a cohort of adult patients with compensated cirrhosis in a multicentre, open-label, parallel-group, phase 2, randomised controlled trial. The primary outcome is the change in Model for End-Stage Liver Disease score at 90 days. The trial will provide the first high-quality examination of the efficacy of autologous macrophage therapy in improving liver function, non-invasive fibrosis markers and other clinical outcomes in patients with compensated cirrhosis. ETHICS AND DISSEMINATION The trial will be conducted according to the ethical principles of the Declaration of Helsinki 2013 and has been approved by Scotland A Research Ethics Committee (reference 15/SS/0121), National Health Service Lothian Research and Development department and the Medicine and Health Care Regulatory Agency-UK. Final results will be presented in peer-reviewed journals and at relevant conferences. TRIAL REGISTRATION NUMBERS ISRCTN10368050 and EudraCT; reference 2015-000963-15.
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Affiliation(s)
- Paul Noel Brennan
- Centre for Regenerative Medicine, The University of Edinburgh Medical School, Edinburgh, UK
| | - Mark MacMillan
- Centre for Regenerative Medicine, The University of Edinburgh Medical School, Edinburgh, UK
| | | | | | - Alison Glover
- Scottish National Blood Transfusion Service, Edinburgh, UK
| | - Catriona Graham
- Deanery of Clinical Sciences, The University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, The University of Edinburgh Deanery of Clinical Sciences, Edinburgh, UK
| | - David M Morris
- Centre for Cardiovascular Science, The University of Edinburgh Deanery of Clinical Sciences, Edinburgh, UK
| | | | - Chloe Pass
- Tissues, Cells and Advanced Therapeutics, SNBTS, Edinburgh, UK
| | | | - Marc L Turner
- Tissues, Cells and Advanced Therapeutics, SNBTS, Edinburgh, UK
| | - Neil Lachlan
- Department of Gastroenterology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - John F Dillon
- Liver Group, University of Dundee Division of Cardiovascular and Diabetes Medicine, Dundee, UK
| | | | - Jonathan Andrew Fallowfield
- Queen's Medical Research Institute, University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
| | - Stuart J Forbes
- Centre for Regenerative Medicine, The University of Edinburgh Deanery of Clinical Sciences, Edinburgh, UK
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13
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O'Donnell R, Amos A, Turner SW, Adams L, Henderson T, Lyttle S, Mitchell S, Semple S. 'They only smoke in the house when I'm not in': understanding the limited effectiveness of a smoke-free homes intervention. J Public Health (Oxf) 2021; 43:647-654. [PMID: 32323719 PMCID: PMC8458016 DOI: 10.1093/pubmed/fdaa042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/14/2019] [Accepted: 01/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Children’s second-hand smoke (SHS) exposure in the home is highest in socio-economically disadvantaged areas. Personalized household air-quality measurements can promote changes in smoking that reduce SHS exposure. The ‘First Steps 2 Smoke-free’ (FS2SF) intervention is the first to trial this approach delivered as part of health professionals’ routine work. This paper reports the findings of qualitative interviews with participants that explored their experiences of the intervention and why outcomes varied. Methods 120 women were recruited from the NHS First Steps Programme, which supports disadvantaged mothers. They received either personalized feedback on their home air quality and advice on reducing SHS or standard SHS advice. Qualitative interviews with 15 mothers were analyzed thematically using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Results The intervention increased women’s capability to change home-smoking behaviour, through increasing awareness and salience of SHS risks to their children, and motivation to act. However, taking effective action was constrained by their limited social and environmental opportunities, including others’ smoking in the home. Conclusions The FS2SF intervention was ineffective as it was unable to fully address the precarious, complex life circumstances that make creating a smoke-free home particularly difficult for women experiencing intersecting dimensions of disadvantage.
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Affiliation(s)
- R O'Donnell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - A Amos
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - S W Turner
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - L Adams
- NHS Lanarkshire, Airdrie ML6 6DB, UK
| | | | - S Lyttle
- NHS Lanarkshire, Hamilton ML3 0TA, UK
| | | | - S Semple
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
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14
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Warner P, Whitaker LHR, Parker RA, Weir CJ, Douglas A, Hansen CH, Madhra M, Hillier SG, Saunders PTK, Iredale JP, Semple S, Slayden OD, Walker BR, Critchley HOD. Low dose dexamethasone as treatment for women with heavy menstrual bleeding: A response-adaptive randomised placebo-controlled dose-finding parallel group trial (DexFEM). EBioMedicine 2021; 69:103434. [PMID: 34218053 PMCID: PMC8261537 DOI: 10.1016/j.ebiom.2021.103434] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The symptom of heavy menstrual bleeding (HMB) diminishes quality-of-life for many mid-age women and imposes substantial societal burden. We investigated our hypothesis that HMB reflects impaired endometrial vasoconstriction due to endometrial glucocorticoid deficiency. Does reversing this deficiency, by short-term luteal-phase treatment with exogenous glucocorticoid (dexamethasone), ameliorate HMB? METHODS In our Bayesian response-adaptive parallel-group placebo-controlled randomised trial, five pre-planned interim analyses used primary outcome data to adjust randomisation probabilities to favour doses providing most dose-response information. Participants with HMB, recruited from Lothian (Scotland) NHS clinics and via community invitations/advertisements, were aged over 18 years; reported regular 21-42 day menstrual cycles; and had measured menstrual blood loss (MBL) averaging ≥ 50 mL over two screening periods. Identically encapsulated placebo, or one of six Dexamethasone doses (0·2 mg, 0·4 mg, 0·5 mg, 0·6 mg, 0·75 mg, 0·9 mg), were taken orally twice-daily over five days in the mid-luteal phase of three menstrual cycles. Participants, investigators, and those measuring outcomes were masked to group assignment. Primary outcome, change in average MBL from screening to 'treatment', was analysed by allocated treatment, for all with data. TRIAL REGISTRATION ClinicalTrials.gov NCT01769820; EudractCT 2012-003,405-98 FINDINGS: Recruitment lasted 29/01/2014 to 25/09/2017; 176 were screened, 107 randomised and 97 provided primary outcome data (n = 24,5,9,21,8,14,16 in the seven arms, placebo to 1·8 mg total daily active dose). In Bayesian normal dynamic linear modelling, 1·8 mg dexamethasone daily showed a 25 mL greater reduction in MBL from screening, than placebo (95% credible interval 1 to 49 mL), and probability 0·98 of benefit over placebo. Adverse events were reported by 75% (58/77) receiving dexamethasone, 58% (15/26) taking placebo. Three serious adverse events occurred, two during screening, one in a placebo participant. No woman withdrew due to adverse effects. INTERPRETATION Our adaptive trial in HMB showed that dexamethasone 1·8 mg daily reduced menstrual blood loss. The role of dexamethasone in HMB management deserves further investigation. FUNDING UK MRC DCS/DPFS grant MR/J003611/1.
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Affiliation(s)
- Pamela Warner
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | | | - Richard Anthony Parker
- Usher Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christopher John Weir
- Usher Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Anne Douglas
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christian Holm Hansen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Mayank Madhra
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | | | - John Peter Iredale
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol foundation Trust, Bristol, UK
| | - Scott Semple
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ov Daniel Slayden
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon, USA
| | - Brian Robert Walker
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, UK; Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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15
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Spath NB, Singh T, Papanastasiou G, Baker A, Janiczek RJ, McCann GP, Dweck MR, Kershaw L, Newby DE, Semple S. Assessment of stunned and viable myocardium using manganese-enhanced MRI. Open Heart 2021; 8:openhrt-2021-001646. [PMID: 34099530 PMCID: PMC8186753 DOI: 10.1136/openhrt-2021-001646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE In a proof-of-concept study, to quantify myocardial viability in patients with acute myocardial infarction using manganese-enhanced MRI (MEMRI), a measure of intracellular calcium handling. METHODS Healthy volunteers (n=20) and patients with ST-elevation myocardial infarction (n=20) underwent late gadolinium enhancement (LGE) using gadobutrol and MEMRI using manganese dipyridoxyl diphosphate. Patients were scanned ≤7 days after reperfusion and rescanned after 3 months. Differential manganese uptake was described using a two-compartment model. RESULTS After manganese administration, healthy control and remote non-infarcted myocardium showed a sustained 25% reduction in T1 values (mean reductions, 288±34 and 281±12 ms). Infarcted myocardium demonstrated less T1 shortening than healthy control or remote myocardium (1157±74 vs 859±36 and 835±28 ms; both p<0.0001) with intermediate T1 values (1007±31 ms) in peri-infarct regions. Compared with LGE, MEMRI was more sensitive in detecting dysfunctional myocardium (dysfunctional fraction 40.5±11.9 vs 34.9%±13.9%; p=0.02) and tracked more closely with abnormal wall motion (r2=0.72 vs 0.55; p<0.0001). Kinetic modelling showed reduced myocardial manganese influx between remote, peri-infarct and infarct regions, enabling absolute discrimination of infarcted myocardium. After 3 months, manganese uptake increased in peri-infarct regions (16.5±3.5 vs 22.8±3.5 mL/100 g/min, p<0.0001), but not the remote (23.3±2.8 vs 23.0±3.2 mL/100 g/min, p=0.8) or infarcted (11.5±3.7 vs 14.0±1.2 mL/100 g/min, p>0.1) myocardium. CONCLUSIONS Through visualisation of intracellular calcium handling, MEMRI accurately differentiates infarcted, stunned and viable myocardium, and correlates with myocardial dysfunction better than LGE. MEMRI holds major promise in directly assessing myocardial viability, function and calcium handling across a range of cardiac diseases. TRIAL REGISTRATION NUMBERS NCT03607669; EudraCT number 2016-003782-25.
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Affiliation(s)
- Nick B Spath
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Trisha Singh
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | | | - Andrew Baker
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | | | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Lucy Kershaw
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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16
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Chapman AR, Bularga A, Hung J, Daghem M, Taggart C, Stewart S, Fujisawa T, Chiong JW, Strachan F, Semple S, Van Beek E, Williams M, Jenkins W, Dweck M, Newby D, Mills N. DETERMINING THE MECHANISM OF MYOCARDIAL INJURY AND ROLE OF CORONARY ARTERY DISEASE IN TYPE 2 MYOCARDIAL INFARCTION (DEMAND-MI). J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01425-x] [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] [Indexed: 10/21/2022]
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Macnaught G, Oikonomidou O, Rodgers CT, Clarke W, Cooper A, McVicars H, Hayward L, Mirsadraee S, Semple S, Denvir MA. Cardiac Energetics Before, During, and After Anthracycline-Based Chemotherapy in Breast Cancer Patients Using 31P Magnetic Resonance Spectroscopy: A Pilot Study. Front Cardiovasc Med 2021; 8:653648. [PMID: 33889599 PMCID: PMC8056038 DOI: 10.3389/fcvm.2021.653648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose: To explore the utility of phosphorus magnetic resonance spectroscopy (31P MRS) in identifying anthracycline-induced cardiac toxicity in patients with breast cancer. Methods: Twenty patients with newly diagnosed breast cancer receiving anthracycline-based chemotherapy had cardiac magnetic resonance assessment of left ventricular ejection fraction (LVEF) and 31P MRS to determine myocardial Phosphocreatine/Adenosine Triphosphate Ratio (PCr/ATP) at three time points: pre-, mid-, and end-chemotherapy. Plasma high sensitivity cardiac troponin-I (cTn-I) tests and electrocardiograms were also performed at these same time points. Results: Phosphocreatine/Adenosine Triphosphate did not change significantly between pre- and mid-chemo (2.16 ± 0.46 vs. 2.00 ± 0.56, p = 0.80) and pre- and end-chemo (2.16 ± 0.46 vs. 2.17 ± 0.86, p = 0.99). Mean LVEF reduced significantly by 5.1% between pre- and end-chemo (61.4 ± 4.4 vs. 56.3 ± 8.1 %, p = 0.02). Change in PCr/ATP ratios from pre- to end-chemo correlated inversely with changes in LVEF over the same period (r = −0.65, p = 0.006). Plasma cTn-I increased progressively during chemotherapy from pre- to mid-chemo (1.35 ± 0.81 to 4.40 ± 2.64 ng/L; p = 0.01) and from mid- to end-chemo (4.40 ± 2.64 to 18.33 ± 13.23 ng/L; p = 0.001). Conclusions: In this small cohort pilot study, we did not observe a clear change in mean PCr/ATP values during chemotherapy despite evidence of increased plasma cardiac biomarkers and reduced LVEF. Future similar studies should be adequately powered to take account of patient drop-out and variable changes in PCr/ATP and could include T1 and T2 mapping.
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Affiliation(s)
- Gillian Macnaught
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Olga Oikonomidou
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom.,Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Christopher T Rodgers
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - William Clarke
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Level 0, John Radcliffe Hospital, Oxford, United Kingdom
| | - Annette Cooper
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Heather McVicars
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom.,Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Larry Hayward
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom.,Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Saeed Mirsadraee
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Scott Semple
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Martin A Denvir
- Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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Egerton A, Murphy A, Donocik J, Anton A, Barker GJ, Collier T, Deakin B, Drake R, Eliasson E, Emsley R, Gregory CJ, Griffiths K, Kapur S, Kassoumeri L, Knight L, Lambe EJB, Lawrie SM, Lees J, Lewis S, Lythgoe DJ, Matthews J, McGuire P, McNamee L, Semple S, Shaw AD, Singh KD, Stockton-Powdrell C, Talbot PS, Veronese M, Wagner E, Walters JTR, Williams SR, MacCabe JH, Howes OD. Dopamine and Glutamate in Antipsychotic-Responsive Compared With Antipsychotic-Nonresponsive Psychosis: A Multicenter Positron Emission Tomography and Magnetic Resonance Spectroscopy Study (STRATA). Schizophr Bull 2021; 47:505-516. [PMID: 32910150 PMCID: PMC7965076 DOI: 10.1093/schbul/sbaa128] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Indexed: 02/06/2023]
Abstract
The variability in the response to antipsychotic medication in schizophrenia may reflect between-patient differences in neurobiology. Recent cross-sectional neuroimaging studies suggest that a poorer therapeutic response is associated with relatively normal striatal dopamine synthesis capacity but elevated anterior cingulate cortex (ACC) glutamate levels. We sought to test whether these measures can differentiate patients with psychosis who are antipsychotic responsive from those who are antipsychotic nonresponsive in a multicenter cross-sectional study. 1H-magnetic resonance spectroscopy (1H-MRS) was used to measure glutamate levels (Glucorr) in the ACC and in the right striatum in 92 patients across 4 sites (48 responders [R] and 44 nonresponders [NR]). In 54 patients at 2 sites (25 R and 29 NR), we additionally acquired 3,4-dihydroxy-6-[18F]fluoro-l-phenylalanine (18F-DOPA) positron emission tomography (PET) to index striatal dopamine function (Kicer, min-1). The mean ACC Glucorr was higher in the NR than the R group after adjustment for age and sex (F1,80 = 4.27; P = .04). This was associated with an area under the curve for the group discrimination of 0.59. There were no group differences in striatal dopamine function or striatal Glucorr. The results provide partial further support for a role of ACC glutamate, but not striatal dopamine synthesis, in determining the nature of the response to antipsychotic medication. The low discriminative accuracy might be improved in groups with greater clinical separation or increased in future studies that focus on the antipsychotic response at an earlier stage of the disorder and integrate other candidate predictive biomarkers. Greater harmonization of multicenter PET and 1H-MRS may also improve sensitivity.
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Affiliation(s)
- Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Anna Murphy
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jacek Donocik
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Adriana Anton
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Academic Unit of Radiology, Medical School, Faculty of Medicine, Dentistry & Health, University of Sheffield, Sheffield, UK
| | - Gareth J Barker
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Tracy Collier
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Drake
- Division of Psychology and Mental Health, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Emma Eliasson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Richard Emsley
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Catherine J Gregory
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Kira Griffiths
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Shitij Kapur
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Laura Kassoumeri
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Laura Knight
- CUBRIC, School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Emily J B Lambe
- CUBRIC, School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Jane Lees
- Division of Psychology and Mental Health, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David J Lythgoe
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Julian Matthews
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Lily McNamee
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alexander D Shaw
- CUBRIC, School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Krish D Singh
- CUBRIC, School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Charlotte Stockton-Powdrell
- Division of Psychology and Mental Health, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Peter S Talbot
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mattia Veronese
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ernest Wagner
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephen R Williams
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, UK
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Dobson R, Siddiqi K, Ferdous T, Huque R, Lesosky M, Balmes J, Semple S. Diurnal variability of fine-particulate pollution concentrations: data from 14 low- and middle-income countries. Int J Tuberc Lung Dis 2021; 25:206-214. [PMID: 33688809 PMCID: PMC7948758 DOI: 10.5588/ijtld.20.0704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Scientific understanding of indoor air pollution is predominately based on research carried out in cities in high-income countries (HICs). Less is known about how pollutant concentrations change over the course of a typical day in cities in low- and middle-income countries (LMICs).OBJECTIVE: To understand how concentrations of fine particulate matter smaller than 2.5 microns in diameter (PM2.5) change over the course of the day outdoors (across a range of countries) and indoors (using measurements from Dhaka, Bangladesh).DESIGN: Data on PM2.5 concentrations were gathered from 779 households in Dhaka as part of the MCLASS II (Muslim Communities Learning About Second-hand Smoke in Bangladesh) project, and compared to outdoor PM2.5 concentrations to determine the temporal variation in exposure to air pollution. Hourly PM2.5 data from 23 cities in 14 LMICs, as well as London (UK), Paris (France) and New York (NY, USA), were extracted from publicly available sources for comparison.RESULTS: PM2.5 in homes in Dhaka demonstrated a similar temporal pattern to outdoor measurements, with greater concentrations at night than in the afternoon. This pattern was also evident in 19 of 23 LMIC cities.CONCLUSION: PM2.5 concentrations are greater at night than during the afternoon in homes in Dhaka. Diurnal variations in PM2.5 in LMICs is substantial and greater than in London, Paris or New York. This has implications for public health community approaches to health effects of air pollution in LMICs.
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Affiliation(s)
- R. Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland
| | - K. Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - T. Ferdous
- Advancement through Research and Knowledge Foundation Bangladesh, Dhaka, Bangladesh
| | - R. Huque
- Advancement through Research and Knowledge Foundation Bangladesh, Dhaka, Bangladesh
| | - M. Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J. Balmes
- Department of Medicine, University of California, San Francisco, CA
,School of Public Health, University of California, Berkeley, CA, USA
| | - S. Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland
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20
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Chartsias A, Papanastasiou G, Wang C, Semple S, Newby DE, Dharmakumar R, Tsaftaris SA. Disentangle, Align and Fuse for Multimodal and Semi-Supervised Image Segmentation. IEEE Trans Med Imaging 2021; 40:781-792. [PMID: 33156786 PMCID: PMC8011298 DOI: 10.1109/tmi.2020.3036584] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Magnetic resonance (MR) protocols rely on several sequences to assess pathology and organ status properly. Despite advances in image analysis, we tend to treat each sequence, here termed modality, in isolation. Taking advantage of the common information shared between modalities (an organ's anatomy) is beneficial for multi-modality processing and learning. However, we must overcome inherent anatomical misregistrations and disparities in signal intensity across the modalities to obtain this benefit. We present a method that offers improved segmentation accuracy of the modality of interest (over a single input model), by learning to leverage information present in other modalities, even if few (semi-supervised) or no (unsupervised) annotations are available for this specific modality. Core to our method is learning a disentangled decomposition into anatomical and imaging factors. Shared anatomical factors from the different inputs are jointly processed and fused to extract more accurate segmentation masks. Image misregistrations are corrected with a Spatial Transformer Network, which non-linearly aligns the anatomical factors. The imaging factor captures signal intensity characteristics across different modality data and is used for image reconstruction, enabling semi-supervised learning. Temporal and slice pairing between inputs are learned dynamically. We demonstrate applications in Late Gadolinium Enhanced (LGE) and Blood Oxygenation Level Dependent (BOLD) cardiac segmentation, as well as in T2 abdominal segmentation. Code is available at https://github.com/vios-s/multimodal_segmentation.
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21
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Zhang Q, Werys K, Popescu IA, Biasiolli L, Ntusi NAB, Desai M, Zimmerman SL, Shah DJ, Autry K, Kim B, Kim HW, Jenista ER, Huber S, White JA, McCann GP, Mohiddin SA, Boubertakh R, Chiribiri A, Newby D, Prasad S, Radjenovic A, Dawson D, Schulz-Menger J, Mahrholdt H, Carbone I, Rimoldi O, Colagrande S, Calistri L, Michels M, Hofman MBM, Anderson L, Broberg C, Andrew F, Sanz J, Bucciarelli-Ducci C, Chow K, Higgins D, Broadbent DA, Semple S, Hafyane T, Wormleighton J, Salerno M, He T, Plein S, Kwong RY, Jerosch-Herold M, Kramer CM, Neubauer S, Ferreira VM, Piechnik SK. Quality assurance of quantitative cardiac T1-mapping in multicenter clinical trials - A T1 phantom program from the hypertrophic cardiomyopathy registry (HCMR) study. Int J Cardiol 2021; 330:251-258. [PMID: 33535074 PMCID: PMC7994017 DOI: 10.1016/j.ijcard.2021.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/07/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Quantitative cardiovascular magnetic resonance T1-mapping is increasingly used for myocardial tissue characterization. However, the lack of standardization limits direct comparability between centers and wider roll-out for clinical use or trials. PURPOSE To develop a quality assurance (QA) program assuring standardized T1 measurements for clinical use. METHODS MR phantoms manufactured in 2013 were distributed, including ShMOLLI T1-mapping and reference T1 and T2 protocols. We first studied the T1 and T2 dependency on temperature and phantom aging using phantom datasets from a single site over 4 years. Based on this, we developed a multiparametric QA model, which was then applied to 78 scans from 28 other multi-national sites. RESULTS T1 temperature sensitivity followed a second-order polynomial to baseline T1 values (R2 > 0.996). Some phantoms showed aging effects, where T1 drifted up to 49% over 40 months. The correlation model based on reference T1 and T2, developed on 1004 dedicated phantom scans, predicted ShMOLLI-T1 with high consistency (coefficient of variation 1.54%), and was robust to temperature variations and phantom aging. Using the 95% confidence interval of the correlation model residuals as the tolerance range, we analyzed 390 ShMOLLI T1-maps and confirmed accurate sequence deployment in 90%(70/78) of QA scans across 28 multiple centers, and categorized the rest with specific remedial actions. CONCLUSIONS The proposed phantom QA for T1-mapping can assure correct method implementation and protocol adherence, and is robust to temperature variation and phantom aging. This QA program circumvents the need of frequent phantom replacements, and can be readily deployed in multicenter trials.
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Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Iulia A Popescu
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Luca Biasiolli
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | | | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Kyle Autry
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Bette Kim
- Mount Sinai West Hospital; Icahn School of Medicine at Mount Sinai, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Canada
| | - Gerry P McCann
- Department of cardiovascular sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, UK
| | - Saidi A Mohiddin
- Inherited Cardiovascular Diseases, Barts Heart Centre, London, UK
| | - Redha Boubertakh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Amedeo Chiribiri
- King's College London and Guy's and St Thomas' NHS Foundation Trust, UK
| | - David Newby
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Sanjay Prasad
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Aleksandra Radjenovic
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, College of Life Sciences and Medicine, University of Aberdeen, UK
| | | | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | | | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Michelle Michels
- Erasmus MC, department of cardiology, Rotterdam, the Netherlands
| | - Mark B M Hofman
- dept. Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Lisa Anderson
- Cardiology Clinical Academic Group, St George's University of London, UK
| | - Craig Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, USA
| | | | | | | | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | | | - David A Broadbent
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Scott Semple
- Edinburgh Imaging, Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | | | | | - Taigang He
- The Cardiology Clinical Academic Group (CAG), St George's University of London, St George's University Hospitals NHS Foundation Trust, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | | | | | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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Sherif AE, McFadyen R, Boyd J, Ventre C, Glenwright M, Walker K, Zheng X, White A, McFadyen L, Connon E, Damaskos D, Steven M, Wackett A, Thomson E, Cameron DC, MacLeod J, Baxter S, Semple S, Morris D, Clark-Stewart S, Graham C, Mole DJ. Study protocol for resolution of organ injury in acute pancreatitis (RESORP): an observational prospective cohort study. BMJ Open 2020; 10:e040200. [PMID: 33293311 PMCID: PMC7722833 DOI: 10.1136/bmjopen-2020-040200] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Survivors of acute pancreatitis (AP) have shorter overall survival and increased incidence of new-onset cardiovascular, respiratory, liver and renal disease, diabetes mellitus and cancer compared with the general population, but the mechanisms that explain this are yet to be elucidated. Our aim is to characterise the precise nature and extent of organ dysfunction following an episode of AP. METHODS AND ANALYSIS This is an observational prospective cohort study in a single centre comprising a University hospital with an acute and emergency receiving unit and clinical research facility. Participants will be adult patient admitted with AP. Participants will undergo assessment at recruitment, 3 months and 3 years. At each time point, multiple biochemical and/or physiological assessments to measure cardiovascular, respiratory, liver, renal and cognitive function, diabetes mellitus and quality of life. Recruitment was from 30 November 2017 to 31 May 2020; last follow-up measurements is due on 31 May 2023. The primary outcome measure is the incidence of new-onset type 3c diabetes mellitus during follow-up. Secondary outcome measures include: quality of life analyses (SF-36, Gastrointestinal Quality of Life Index); montreal cognitive assessment; organ system physiological performance; multiomics predictors of AP severity, detection of premature cellular senescence. In a nested cohort within the main cohort, individuals may also consent to multiparameter MRI scan, echocardiography, pulmonary function testing, cardiopulmonary exercise testing and pulse-wave analysis. ETHICS AND DISSEMINATION This study has received the following approvals: UK IRAS Number 178615; South-east Scotland Research Ethics Committee number 16/SS/0065. Results will be made available to AP survivors, caregivers, funders and other researchers. Publications will be open-access. TRIAL REGISTRATION NUMBERS ClinicalTrials.gov Registry (NCT03342716) and ISRCTN50581876; Pre-results.
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Affiliation(s)
- Ahmed E Sherif
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Rory McFadyen
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Julia Boyd
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Chiara Ventre
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | | | - Kim Walker
- Clinical Research Facility, NHS Lothian, Edinburgh, UK
| | - Xiaozhong Zheng
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Audrey White
- Clinical Research Facility, NHS Lothian, Edinburgh, UK
| | | | - Emma Connon
- Clinical Research Facility, NHS Lothian, Edinburgh, UK
| | | | - Michelle Steven
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Anthony Wackett
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Euan Thomson
- Anaesthesia and Critical Care, NHS Lothian, Edinburgh, UK
| | | | - Jill MacLeod
- Respiratory Physiology, NHS Lothian, Edinburgh, UK
| | - Shaun Baxter
- Respiratory Physiology, NHS Lothian, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David Morris
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | | | - Catriona Graham
- Epidemiology and Statistics Core, Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, UK
| | - Damian J Mole
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
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23
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Mole DJ, Fallowfield JA, Sherif AE, Kendall T, Semple S, Kelly M, Ridgway G, Connell JJ, McGonigle J, Banerjee R, Brady JM, Zheng X, Hughes M, Neyton L, McClintock J, Tucker G, Nailon H, Patel D, Wackett A, Steven M, Welsh F, Rees M. Quantitative magnetic resonance imaging predicts individual future liver performance after liver resection for cancer. PLoS One 2020; 15:e0238568. [PMID: 33264327 PMCID: PMC7710097 DOI: 10.1371/journal.pone.0238568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/12/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
The risk of poor post-operative outcome and the benefits of surgical resection as a curative therapy require careful assessment by the clinical care team for patients with primary and secondary liver cancer. Advances in surgical techniques have improved patient outcomes but identifying which individual patients are at greatest risk of poor post-operative liver performance remains a challenge. Here we report results from a multicentre observational clinical trial (ClinicalTrials.gov NCT03213314) which aimed to inform personalised pre-operative risk assessment in liver cancer surgery by evaluating liver health using quantitative multiparametric magnetic resonance imaging (MRI). We combined estimation of future liver remnant (FLR) volume with corrected T1 (cT1) of the liver parenchyma as a representation of liver health in 143 patients prior to treatment. Patients with an elevated preoperative liver cT1, indicative of fibroinflammation, had a longer post-operative hospital stay compared to those with a cT1 within the normal range (6.5 vs 5 days; p = 0.0053). A composite score combining FLR and cT1 predicted poor liver performance in the 5 days immediately following surgery (AUROC = 0.78). Furthermore, this composite score correlated with the regenerative performance of the liver in the 3 months following resection. This study highlights the utility of quantitative MRI for identifying patients at increased risk of poor post-operative liver performance and a longer stay in hospital. This approach has the potential to inform the assessment of individualised patient risk as part of the clinical decision-making process for liver cancer surgery.
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Affiliation(s)
- Damian J. Mole
- Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Inflammation Research, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Jonathan A. Fallowfield
- Centre for Inflammation Research, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Ahmed E. Sherif
- Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
- Department of HPB Surgery, National Liver Institute, Menoufia University, Shibin Elkom, Egypt
| | - Timothy Kendall
- Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom
- Department of Pathology, NHS Lothian, Edinburgh, United Kingdom
| | - Scott Semple
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Matt Kelly
- Perspectum, Gemini One, Oxford, United Kingdom
| | | | | | | | | | | | - Xiaozhong Zheng
- Centre for Inflammation Research, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Michael Hughes
- Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucile Neyton
- Centre for Inflammation Research, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | | | - Garry Tucker
- Clinical Research Facility, NHS Lothian, Edinburgh, United Kingdom
| | - Hilary Nailon
- Clinical Research Facility, NHS Lothian, Edinburgh, United Kingdom
| | - Dilip Patel
- Clinical Radiology, NHS Lothian, Edinburgh, United Kingdom
| | | | | | - Fenella Welsh
- Hampshire Hospitals Foundation Trust, Basingstoke, United Kingdom
| | - Myrddin Rees
- Hampshire Hospitals Foundation Trust, Basingstoke, United Kingdom
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Bing R, Andrews J, Williams M, Clark T, Semple S, Van Beek E, Lucatelli C, Sellers S, Leipsic J, Tavares A, Stephens A, Koglin N, Dweck M, Newby D. Thrombus formation on bioprosthetic aortic valves. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
18F-GP1 is a novel radiotracer with a high affinity for the platelet glycoprotein IIb/IIIa receptor. Subclinical bioprosthetic valve thrombus has been postulated as a trigger for accelerated valve degeneration.
Purpose
To determine the feasibility of 18F-GP1 positron-emission tomography-computed tomography (PET-CT) for the detection of subclinical bioprosthetic aortic valve thrombus.
Methods
(i) Explanted degenerated aortic valve prostheses underwent histology and imaging. (ii) In a prospective observational study, patients with bioprosthetic aortic valve replacement (AVR) underwent echocardiography and 18F-GP1 PET-CT. Valves were assessed for hypoattenuating leaflet thickening (HALT), hypo-attenuation affection leaflet motion (HAM) and GP1 uptake.
Results
(i) GP1 correlated with thrombus on explanted valves (Figure). (ii) The first 6 patients (Table) were asymptomatic and had normally functioning surgical bioprostheses on echocardiography. At a median of 166 (range 122–189) days post-AVR, no patients had HALT or HAM on CT. There was avid focal GP1 uptake on the leaflets of all 6 patients which appeared most prominent along the leaflet edges (Figure). Only one patient had focal uptake in the valve frame, remote from the leaflets. In a separate cohort undergoing 18F-GP1 PET-CT for other conditions, there was no uptake on normal, native aortic valves (n=8).
Conclusion
For the first time, we demonstrate that 18F-GP1 PET-CT is a highly sensitive method of assessing platelet activation on bioprosthetic aortic valves. Despite the absence of CT evidence, early thrombus appeared to be a universal finding on recently implanted valve prostheses. The biological and clinical implications of subclinical bioprosthetic aortic valve thrombus have yet to be established.
GP1 uptake in AVR
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
- R Bing
- University of Edinburgh, Edinburgh, United Kingdom
| | - J Andrews
- University of Edinburgh, Edinburgh, United Kingdom
| | - M Williams
- University of Edinburgh, Edinburgh, United Kingdom
| | - T Clark
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Semple
- University of Edinburgh, Edinburgh, United Kingdom
| | - E Van Beek
- University of Edinburgh, Edinburgh, United Kingdom
| | - C Lucatelli
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Sellers
- University of British Columbia, Vancouver, Canada
| | - J Leipsic
- University of British Columbia, Vancouver, Canada
| | - A Tavares
- University of Edinburgh, Edinburgh, United Kingdom
| | | | - N Koglin
- Life Molecular Imaging, Berlin, Germany
| | - M Dweck
- University of Edinburgh, Edinburgh, United Kingdom
| | - D Newby
- University of Edinburgh, Edinburgh, United Kingdom
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Best C, Brown A, Semple S, Hunt K. How does smokefree policy impact nicotine-related and other prisoner spend (e.g. HFSS foods)? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
People in custody (PiC) have poor health compared to the general population, in part due to high smoking rates. Scotland's prisons became smokefree in 2018. Rechargeable e-cigarettes became available a few weeks before the removal of tobacco from the 'canteen' (prison shop for PiC).
Methods
Routinely collected weekly 'canteen' purchase data (no of units of given product purchased by an individual by date) were available for 29-7-18 to 31-3-19 (2112638 rows of data, 645 unique products). Products were categorised into: tobacco; e-cigarettes; food/drink; communication; hygiene; NRT; other and graphed as mean/person/week, for 'smokers' and 'non-smokers' (at baseline). Spend by product type pre- and post-implementation was compared in PiC for 31+ weeks over this period, using mixed effects models.
Results
Mean weekly spend for 'smokers' in custody for 31+ weeks over the pre-post ban comparison period (n = 2541) decreased from £21.36 to £19.80; mean weekly nicotine-related spend reduced from £6.64 (pre-) to £5.55 (post-) (p < 0.001), but showed an increasing trend in nicotine-related spend (£0.08/week) post-ban. No changes were seen for 'non-smokers' (n = 342) overall) or in nicotine-related spend. Trends in mean spend for other products remained flat, suggesting positive transfers of spend noted in qualitative interviews over a comparable period were not evident at population level.
Conclusions
Whilst there are benefits of removing tobacco from prisons, for staff and PiC, previously heavy smokers may find (mandated) tobacco abstinence difficult. Some jurisdictions have made e-cigarettes available to support people quitting/managing without tobacco, but long-term implications of e-cigarette use in this population are as yet unknown. When the introduction of smokefree policy is facilitated by the introduction of e-cigarettes, nicotine spend by PiC may remain high; the implications for whether or not PiC return to smoking on release from custody are unclear.
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Affiliation(s)
- C Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - A Brown
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - S Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - K Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Demou E, Dobson R, Sweeting H, Brown A, Sidwell S, O'Donnell R, Hunt K, Semple S. Changes in exposure to second-hand smoke following a smoking ban across a national prison system. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Prisons were one of few workplaces where smoking was still permitted after the smoking ban in indoor public places in Scotland in 2006. This study compares SHS exposure assessments in Scotland's 15 prisons six months after smokefree policy was introduced (in Nov 2018) with levels measured in 2016 before the policy was announced.
Methods
In 2016, 128,431 mins of PM2.5 (marker of SHS) concentration data were collected from residential halls and 2,860 mins for 'task-based' measures; 2019 figures were 126,777 and 3,073 mins. Six days of fixed-site monitoring in halls in each prison commenced on 22.5.19. Task-based measurements were conducted to assess SHS for specific locations and activities (e.g. cell searches). Typical daily PM2.5 exposure profiles were constructed for the prison service and time-weighted average exposure concentrations were estimated for shift patterns for residential staff pre- and post-implementation of the policy. Staff self-reports of exposure to SHS were gathered via surveys.
Results
Measured PM2.5 in residential halls declined markedly; median fixed-site concentrations reduced by > 91% compared to baseline. Changes in the task-based measurements (89% average decrease for high-exposure tasks) and time-weighted average concentrations across shifts (>90% decrease across all shifts), provide evidence that staff exposure to SHS has significantly reduced. The percentage of staff reporting no exposure to SHS rose post-ban.
Conclusions
This is the first study to objectively measure SHS levels before, during and after implementation of smokefree policy across a country's prison system. The dramatic reduction in SHS exposures confirm complementary qualitative data and stakeholder reports of the ban's success in removing tobacco. The findings show that SHS can be effectively eliminated through a well-applied smoking ban in the challenging context of prisons; and are highly relevant for other jurisdictions considering changes to prison smoking rules.
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Affiliation(s)
- E Demou
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - R Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - H Sweeting
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - A Brown
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - S Sidwell
- Scottish Prison Service, SPS, Edinburgh, UK
| | - R O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - K Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - S Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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27
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Spath N, Spath N, Papanastastiou G, Singh T, Gulsin G, Baker A, Janiczek R, McCann G, Dweck M, Newby DE, Semple S. MANGANESE-ENHANCED T1MAPPING IN NON-ISCHAEMIC CARDIOMYOPATHY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32388-3] [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] [Indexed: 11/28/2022]
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Spath N, Spath N, Tavares A, Gray G, Dweck M, Newby DE, Yang PC, Jansen M, Semple S. MANGANESE-ENHANCED T1 MAPPING IN MYOCARDIAL VIABILITY: VALIDATION WITH 18F-FDG PETMR. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32389-5] [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] [Indexed: 11/30/2022]
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Spath N, Spath N, Papanastasiou G, Singh T, Baker A, Janiczek R, McCann G, Dweck M, Newby DE, Semple S. MANGANESE-ENHANCED T1MAPPING FOR THE DETECTION OF VIABLE AND STUNNED MYOCARDIUM FOLLOWING MYOCARDIAL INFARCTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32194-x] [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] [Indexed: 11/30/2022]
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Oikonomidou O, Macnaught GM, Rodgers CT, Clarke W, Cooper A, McVicars H, Turnbull AK, Mirsadraee S, Semple S, Denvir M. Abstract P1-01-03: Association of cardiac energetics and plasma biomarkers with anthracycline-based chemotherapy in breast cancer patients. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND Anthracyclines are widely used in the treatment of breast cancer and are well recognised to carry increased risk of cardiotoxicity. This can occur as an early, acute manifestation or many years after treatment as late onset cardiomyopathy. It is increasingly apparent that there may be a chronic subclinical phase associated with low grade cardiac injury with no apparent clinical impact on the contractile function of the heart. This period may remain latent for many years with the patient remaining asymptomatic and with apparently normal cardiac function. Identification of early and subtle cardiac dysfunction during this period could provide a window of opportunity for therapeutic intervention if those at risk or those experiencing this low-grade decline could be accurately identified. This study explores the potential utility of phosphorus magnetic resonance spectroscopy (31P-MRS) to identify very early anthracycline-induced cardiac toxicity and baseline predisposition to cardiac injury. This technique measures the phosphocreatine/adenosine triphosphate concentration ratio (PCr/ATP), which reflects cardiac cellular energetics. The normal range of PCr/ATP is approximately 1.8 - 2.2, whereas decreased PCr/ATP is associated with a drop in available energy reserve in the heart, associated with many forms of heart failure. Conventional cardiac investigations of electrocardiogram, multiple gated acquisition radionuclide scans (MUGA) and ultra-high sensitivity plasma cardiac troponin-I (cTn-I) have also been applied. METHODS 20 newly diagnosed breast cancer patients, receiving anthracycline-based chemotherapy, had magnetic resonance imaging to assess left ventricular ejection fraction and 31P magnetic resonance spectroscopy (31P MRS) to assess phosphocreatine to adenosine triphosphate concentration ratio (“PCr/ATP”). Measurements were performed pre-chemo, mid-chemo and post-chemo. Plasma high sensitivity cardiac troponin-I (cTn-I) and electrocardiograms were performed. RESULTS There was a significant negative correlation between change in PCr/ATP pre- to mid- chemo and change mid- to post-chemo (r=-0.68, p=0.04). Mean ejection fraction reduced significantly (5.1%) pre- to post-chemo (p=0.02). Change in PCr/ATP ratios pre- to post-chemo correlated inversely with changes in LVEF over the same period (r=-0.65, p=0.006) and mid- to post-chemotherapy (r=-0.77, p=0.002). Plasma cTn-I increased pre- to mid-chemo (1.35±0.81 to 4.40±2.64 ng/L; p=0.0001) and mid to post-chemo (4.40±2.64 to 18.33±13.23 ng/L; p=0.0001). CONCLUSIONS This study has demonstrated the use of 31P MRS in exploring cardiac energetics of breast cancer patients undergoing chemotherapy. Pre-chemotherapy PCr/ATP ratios were in line with healthy control values obtained using our system. This technique detected a pattern of recovery of PCr/ATP ratios following an initial 3 cycles of anthracyclines. Changes in PCr/ATP ratios were found to be significantly negatively correlated with changes in LVEF from pre to post chemotherapy. The significant decrease in LVEF from pre-post chemo may be due to the delayed response of LVEF to the initial 3 cycles of anthracyclines. Small but significant increases in plasma levels of cardiac troponin-I were observed early after initiation of anthracyclines. PCr/ATP ratios were not found to be related to cTn-I values but LVEF and cTn-I were found to be positively correlated. Future studies should take account of background factors that could influence cardiac PCr/ATP ratio such as age, physical fitness and regular medication whilst the improved sensitivity of 7T MRI scanners may also help in detecting earlier changes in cardiac energetics in this patient group.
Citation Format: Olga Oikonomidou, Gillian Macnaught Macnaught, Christopher T Rodgers, William Clarke, Annette Cooper, Heather McVicars, Arran K Turnbull, Saeed Mirsadraee, Scott Semple, Martin Denvir. Association of cardiac energetics and plasma biomarkers with anthracycline-based chemotherapy in breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-01-03.
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Affiliation(s)
- Olga Oikonomidou
- 1Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Gillian Macnaught Macnaught
- 2Edinburgh Imaging Facility QMRI, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Christopher T Rodgers
- 3Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, United Kingdom
| | - William Clarke
- 3Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, United Kingdom
| | - Annette Cooper
- 2Edinburgh Imaging Facility QMRI, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Heather McVicars
- 4Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Arran K Turnbull
- 1Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Saeed Mirsadraee
- 5Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Scott Semple
- 6Centre for Cardiovascular Sciences, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Martin Denvir
- 6Centre for Cardiovascular Sciences, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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Scally C, Abbas H, Ahearn T, Srinivasan J, Mezincescu A, Rudd A, Spath N, Yucel-Finn A, Yuecel R, Oldroyd K, Dospinescu C, Horgan G, Broadhurst P, Henning A, Newby DE, Semple S, Wilson HM, Dawson DK. Myocardial and Systemic Inflammation in Acute Stress-Induced (Takotsubo) Cardiomyopathy. Circulation 2019; 139:1581-1592. [PMID: 30586731 DOI: 10.1161/circulationaha.118.037975] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute stress-induced (takotsubo) cardiomyopathy can result in a heart failure phenotype with a prognosis comparable with that of myocardial infarction. In this study, we hypothesized that inflammation is central to the pathophysiology and natural history of takotsubo cardiomyopathy. METHODS In a multicenter study, we prospectively recruited 55 patients with takotsubo cardiomyopathy and 51 age-, sex-, and comorbidity-matched control subjects. During the index event and at the 5-month follow-up, patients with takotsubo cardiomyopathy underwent multiparametric cardiac magnetic resonance imaging, including ultrasmall superparamagnetic particles of iron oxide (USPIO) enhancement for detection of inflammatory macrophages in the myocardium. Blood monocyte subpopulations and serum cytokines were assessed as measures of systemic inflammation. Matched control subjects underwent investigation at a single time point. RESULTS Subjects were predominantly middle-aged (64±14 years) women (90%). Compared with control subjects, patients with takotsubo cardiomyopathy had greater USPIO enhancement (expressed as the difference between pre-USPIO and post-USPIO T2*) in both ballooning (14.3±0.6 milliseconds versus 10.5±0.9 milliseconds; P<0.001) and nonballooning (12.9±0.6 milliseconds versus 10.5±0.9 milliseconds; P=0.02) left ventricular myocardial segments. Serum interleukin-6 (23.1±4.5 pg/mL versus 6.5±5.8 pg/mL; P<0.001) and chemokine (C-X-C motif) ligand 1 (1903±168 pg/mL versus 1272±177 pg/mL; P=0.01) concentrations and classic CD14++CD16- monocytes (90±0.5% versus 87±0.9%; P=0.01) were also increased whereas intermediate CD14++CD16+ (5.4±0.3% versus 6.9±0.6%; P=0.01) and nonclassic CD14+CD16++ (2.7±0.3% versus 4.2±0.5%; P=0.006) monocytes were reduced in patients with takotsubo cardiomyopathy. At 5 months, USPIO enhancement was no longer detectable in the left ventricular myocardium, although persistent elevations in serum interleukin-6 concentrations ( P=0.009) and reductions in intermediate CD14++CD16+ monocytes (5.6±0.4% versus 6.9±0.6%; P=0.01) remained. CONCLUSIONS We demonstrate for the first time that takotsubo cardiomyopathy is characterized by a myocardial macrophage inflammatory infiltrate, changes in the distribution of monocyte subsets, and an increase in systemic proinflammatory cytokines. Many of these changes persisted for at least 5 months, suggesting a low-grade chronic inflammatory state. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02897739.
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Affiliation(s)
- Caroline Scally
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Hassan Abbas
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Trevor Ahearn
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Janaki Srinivasan
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Alice Mezincescu
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Amelia Rudd
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Nicholas Spath
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, UK (N.S., D.E.N., S.S.)
| | - Alim Yucel-Finn
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Raif Yuecel
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Keith Oldroyd
- West of Scotland Regional Heart & Lung Centre, Glasgow, UK (K.O.)
| | - Ciprian Dospinescu
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Graham Horgan
- Biomathematics & Statistics Scotland, Aberdeen, UK (G.H.)
| | - Paul Broadhurst
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | | | - David E Newby
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, UK (N.S., D.E.N., S.S.)
| | - Scott Semple
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, UK (N.S., D.E.N., S.S.)
| | - Heather M Wilson
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
| | - Dana K Dawson
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK (C.S., H.A., T.A., J.S., A.M., A.R., A.Y.-F., R.Y., C.D., P.B., H.M.W., D.K.D.)
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Spath NB, Gomez M, Everett RJ, Semple S, Chin CWL, White AC, Japp AG, Newby DE, Dweck MR. Global Longitudinal Strain Analysis Using Cardiac MRI in Aortic Stenosis: Comparison with Left Ventricular Remodeling, Myocardial Fibrosis, and 2-year Clinical Outcomes. Radiol Cardiothorac Imaging 2019; 1:e190027. [PMID: 33778518 DOI: 10.1148/ryct.2019190027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 12/20/2022]
Abstract
Purpose To use global longitudinal strain (GLS) as a marker of left ventricular decompensation in aortic stenosis and to investigate the relationship of GLS measured with cardiac MRI with markers of myocardial fibrosis, symptom development, remodeling, and clinical outcomes. Materials and Methods Patients with aortic stenosis and healthy control subjects were assessed. GLS was assessed by using cardiac MRI feature tracking, diffuse fibrosis by T1 mapping, and replacement fibrosis using late gadolinium enhancement. Follow-up was prospective for the primary endpoint of all-cause mortality. Results GLS was reduced in aortic stenosis (n = 159) compared with control subjects (n = 41) (-17.6% ± 3.1 [standard deviation] vs -18.9% ± 2.6, P = .02). GLS demonstrated weak associations with aortic stenosis severity (Vmax; r = 0.24, P = .0005) but showed moderate correlation with T1 mapping measures of myocardial fibrosis (eg, indexed extracellular volume [iECV]; r = 0.43, P < .0001). Moreover, GLS was reduced in patients with midwall fibrosis compared with control subjects (P < .001), although values were similar to those of patients with myocardial infarction (P = .25). In adjusted analyses, GLS was associated with total myocardial fibrosis burden (iECV) and ejection fraction (both P < .001). GLS offered poor discrimination between disease states, inability to distinguish between control subjects and patients (area under the curve [AUC], 0.60), presence or absence of fibrosis (AUC, 0.63), or symptomatic severity (left ventricular decompensation AUC, 0.64). At follow-up (median, 1466 days), 21 patients died. GLS did not independently predict clinical outcomes. Conclusion GLS correlates with established markers of myocardial fibrosis. However, widespread utility of single GLS measurements may be limited by overlap between disease states and its inability to predict clinical outcomes beyond current established markers.© RSNA, 2019Supplemental material is available for this article.
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Affiliation(s)
- Nicholas B Spath
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Miquel Gomez
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Russell J Everett
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Scott Semple
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Calvin W L Chin
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Audrey C White
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Alan G Japp
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - David E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Marc R Dweck
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
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Stirrat CG, Alam S, MacGillivray TJ, Gray C, Dweck MR, Jones V, Wallace W, Payne JR, Prasad SK, Gardner RS, Petrie MC, Mirsadraee S, Henriksen P, Newby DE, Semple S. Ferumoxytol-enhanced MRI in patients with prior cardiac transplantation. Open Heart 2019; 6:e001115. [PMID: 31673393 PMCID: PMC6802993 DOI: 10.1136/openhrt-2019-001115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/10/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023] Open
Abstract
Objectives Ultra-small superparamagnetic particles of iron oxide (USPIO)-enhanced MRI can detect cellular inflammation within tissues and may help non-invasively identify cardiac transplant rejection. Here, we aimed to determine the normal reference values for USPIO-enhanced MRI in patients with a prior cardiac transplant and examine whether USPIO-enhanced MRI could detect myocardial inflammation in patients with transplant rejection. Methods Ten volunteers and 11 patients with cardiac transplant underwent T2, T2* and late gadolinium enhancement 1.5T MRI, with further T2* imaging at 24 hours after USPIO (ferumoxytol, 4 mg/kg) infusion, at baseline and 3 months. Results Ten patients with clinically stable cardiac transplantation were retained for analysis. Myocardial T2 values were higher in patients with cardiac transplant versus healthy volunteers (53.8±5.2 vs 48.6±1.9 ms, respectively; p=0.003). There were no differences in the magnitude of USPIO-induced change in R2* in patients with transplantation (change in R2*, 26.6±7.3 vs 22.0±10.4 s-1 in healthy volunteers; p=0.28). After 3 months, patients with transplantation (n=5) had unaltered T2 values (52.7±2.8 vs 52.12±3.4 ms; p=0.80) and changes in R2* following USPIO (29.42±8.14 vs 25.8±7.8 s-1; p=0.43). Conclusion Stable patients with cardiac transplantation have increased myocardial T2 values, consistent with resting myocardial oedema or fibrosis. In contrast, USPIO-enhanced MRI is normal and stable over time suggesting the absence of chronic macrophage-driven cellular inflammation. It remains to be determined whether USPIO-enhanced MRI may be able to identify acute cardiac transplant rejection. Trial registration number NCT02319278349 (https://clinicaltrials.gov/ct2/show/NCT02319278) Registered 03.12.2014 EUDraCT 2013-002336-24.
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Affiliation(s)
- Colin G Stirrat
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shirjel Alam
- Department of Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Calum Gray
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Marc Richard Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Victor Jones
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - William Wallace
- Department of Pathology, University of Edinburgh, Edinburgh, UK
| | - John R Payne
- Scottish National Advanced Heart Failure Service (SNAHFS), Golden Jubilee National Hospital, Clydebank, UK
| | - Sanjay K Prasad
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Roy S Gardner
- Scottish Advanced Heart Failure Unit, Golden Jubilee National Hospital, Clydebank, UK
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK,Golden Jubilee National Hospital, Clydebank, UK
| | - Saeed Mirsadraee
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Peter Henriksen
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
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Everett RJ, Tastet L, Clavel MA, Chin CWL, Capoulade R, Vassiliou VS, Kwiecinski J, Gomez M, van Beek EJR, White AC, Prasad SK, Larose E, Tuck C, Semple S, Newby DE, Pibarot P, Dweck MR. Progression of Hypertrophy and Myocardial Fibrosis in Aortic Stenosis: A Multicenter Cardiac Magnetic Resonance Study. Circ Cardiovasc Imaging 2019; 11:e007451. [PMID: 29914867 PMCID: PMC6023592 DOI: 10.1161/circimaging.117.007451] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/23/2018] [Indexed: 01/20/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Aortic stenosis is accompanied by progressive left ventricular hypertrophy and fibrosis. We investigated the natural history of these processes in asymptomatic patients and their potential reversal post-aortic valve replacement (AVR). Methods: Asymptomatic and symptomatic patients with aortic stenosis underwent repeat echocardiography and magnetic resonance imaging. Changes in peak aortic-jet velocity, left ventricular mass index, diffuse fibrosis (indexed extracellular volume), and replacement fibrosis (late gadolinium enhancement [LGE]) were quantified. Results: In 61 asymptomatic patients (43% mild, 34% moderate, and 23% severe aortic stenosis), significant increases in peak aortic-jet velocity, left ventricular mass index, indexed extracellular volume, and LGE mass were observed after 2.1±0.7 years, with the most rapid progression observed in patients with most severe stenosis. Patients with baseline midwall LGE (n=16 [26%]; LGE mass, 2.5 g [0.8–4.8 g]) demonstrated particularly rapid increases in scar burden (78% [50%–158%] increase in LGE mass per year). In 38 symptomatic patients (age, 66±8 years; 76% men) who underwent AVR, there was a 19% (11%–25%) reduction in left ventricular mass index (P<0.0001) and an 11% (4%–16%) reduction in indexed extracellular volume (P=0.003) 0.9±0.3 years after surgery. By contrast midwall LGE (n=10 [26%]; mass, 3.3 g [2.6–8.0 g]) did not change post-AVR (n=10; 3.5 g [2.1–8.0 g]; P=0.23), with no evidence of regression even out to 2 years. Conclusions: In patients with aortic stenosis, cellular hypertrophy and diffuse fibrosis progress in a rapid and balanced manner but are reversible after AVR. Once established, midwall LGE also accumulates rapidly but is irreversible post valve replacement. Given its adverse long-term prognosis, prompt AVR when midwall LGE is first identified may improve clinical outcomes. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01755936 and NCT01679431.
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Affiliation(s)
- Russell J Everett
- British Heart Foundation Centre for Cardiovascular Science (R.J.E., J.K., M.G., E.J.R.v.B., C.W., S.S., D.E.N., M.R.D.)
| | - Lionel Tastet
- University of Edinburgh, United Kingdom. Department of Medicine, Quebec Heart and Lung Institute, Canada (L.T., M.-A.C., R.C., E.L., P.P.)
| | - Marie-Annick Clavel
- University of Edinburgh, United Kingdom. Department of Medicine, Quebec Heart and Lung Institute, Canada (L.T., M.-A.C., R.C., E.L., P.P.)
| | - Calvin W L Chin
- Department of Cardiovascular Science, National Heart Center Singapore (C.W.L.C.)
| | - Romain Capoulade
- University of Edinburgh, United Kingdom. Department of Medicine, Quebec Heart and Lung Institute, Canada (L.T., M.-A.C., R.C., E.L., P.P.)
| | - Vassilios S Vassiliou
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom (V.S.V., S.K.P.).,Norwich Medical School, Norfolk and Norwich University Hospital, United Kingdom (V.S.V.)
| | - Jacek Kwiecinski
- British Heart Foundation Centre for Cardiovascular Science (R.J.E., J.K., M.G., E.J.R.v.B., C.W., S.S., D.E.N., M.R.D.).,First Department of Cardiology, Poznan University of Medical Sciences, Poland (J.K.)
| | - Miquel Gomez
- British Heart Foundation Centre for Cardiovascular Science (R.J.E., J.K., M.G., E.J.R.v.B., C.W., S.S., D.E.N., M.R.D.).,Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Barcelona, Spain (M.G.)
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science (R.J.E., J.K., M.G., E.J.R.v.B., C.W., S.S., D.E.N., M.R.D.).,Edinburgh Imaging Queen's Medical Research Institute Facility (E.J.R.v.B., S.S.)
| | | | - Sanjay K Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom (V.S.V., S.K.P.)
| | - Eric Larose
- University of Edinburgh, United Kingdom. Department of Medicine, Quebec Heart and Lung Institute, Canada (L.T., M.-A.C., R.C., E.L., P.P.)
| | - Christopher Tuck
- British Heart Foundation Centre for Cardiovascular Science (R.J.E., J.K., M.G., E.J.R.v.B., C.W., S.S., D.E.N., M.R.D.).,Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics (C.T.)
| | - Scott Semple
- British Heart Foundation Centre for Cardiovascular Science (R.J.E., J.K., M.G., E.J.R.v.B., C.W., S.S., D.E.N., M.R.D.).,Edinburgh Imaging Queen's Medical Research Institute Facility (E.J.R.v.B., S.S.)
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science (R.J.E., J.K., M.G., E.J.R.v.B., C.W., S.S., D.E.N., M.R.D.)
| | - Philippe Pibarot
- University of Edinburgh, United Kingdom. Department of Medicine, Quebec Heart and Lung Institute, Canada (L.T., M.-A.C., R.C., E.L., P.P.)
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science (R.J.E., J.K., M.G., E.J.R.v.B., C.W., S.S., D.E.N., M.R.D.)
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35
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Chartsias A, Joyce T, Papanastasiou G, Semple S, Williams M, Newby DE, Dharmakumar R, Tsaftaris SA. Disentangled representation learning in cardiac image analysis. Med Image Anal 2019; 58:101535. [PMID: 31351230 PMCID: PMC6815716 DOI: 10.1016/j.media.2019.101535] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [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: 10/31/2018] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 01/08/2023]
Abstract
Typically, a medical image offers spatial information on the anatomy (and pathology) modulated by imaging specific characteristics. Many imaging modalities including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) can be interpreted in this way. We can venture further and consider that a medical image naturally factors into some spatial factors depicting anatomy and factors that denote the imaging characteristics. Here, we explicitly learn this decomposed (disentangled) representation of imaging data, focusing in particular on cardiac images. We propose Spatial Decomposition Network (SDNet), which factorises 2D medical images into spatial anatomical factors and non-spatial modality factors. We demonstrate that this high-level representation is ideally suited for several medical image analysis tasks, such as semi-supervised segmentation, multi-task segmentation and regression, and image-to-image synthesis. Specifically, we show that our model can match the performance of fully supervised segmentation models, using only a fraction of the labelled images. Critically, we show that our factorised representation also benefits from supervision obtained either when we use auxiliary tasks to train the model in a multi-task setting (e.g. regressing to known cardiac indices), or when aggregating multimodal data from different sources (e.g. pooling together MRI and CT data). To explore the properties of the learned factorisation, we perform latent-space arithmetic and show that we can synthesise CT from MR and vice versa, by swapping the modality factors. We also demonstrate that the factor holding image specific information can be used to predict the input modality with high accuracy. Code will be made available at https://github.com/agis85/anatomy_modality_decomposition.
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Affiliation(s)
- Agisilaos Chartsias
- Institute for Digital Communications, School of Engineering, University of Edinburgh, West Mains Rd, Edinburgh EH9 3FB, UK.
| | - Thomas Joyce
- Institute for Digital Communications, School of Engineering, University of Edinburgh, West Mains Rd, Edinburgh EH9 3FB, UK
| | - Giorgos Papanastasiou
- Edinburgh Imaging Facility QMRI, Edinburgh, EH16 4TJ, UK; Centre for Cardiovascular Science, Edinburgh, EH16 4TJ, UK
| | - Scott Semple
- Edinburgh Imaging Facility QMRI, Edinburgh, EH16 4TJ, UK; Centre for Cardiovascular Science, Edinburgh, EH16 4TJ, UK
| | - Michelle Williams
- Edinburgh Imaging Facility QMRI, Edinburgh, EH16 4TJ, UK; Centre for Cardiovascular Science, Edinburgh, EH16 4TJ, UK
| | - David E Newby
- Edinburgh Imaging Facility QMRI, Edinburgh, EH16 4TJ, UK; Centre for Cardiovascular Science, Edinburgh, EH16 4TJ, UK
| | | | - Sotirios A Tsaftaris
- Institute for Digital Communications, School of Engineering, University of Edinburgh, West Mains Rd, Edinburgh EH9 3FB, UK; The Alan Turing Institute, London, UK
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36
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Everett R, Macnaught G, Spath N, Doris M, Andrews J, Munoz C, Fontana M, Robson P, Botnar R, Semple S, Prieto C, Newby D, Dweck M. P595Hybrid magnetic resonance imaging / positron emission tomography in aortic stenosis: feasibility and initial experience. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez116.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Everett
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - G Macnaught
- University of Edinburgh, Edinburgh Imaging Facility, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - N Spath
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - M Doris
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - J Andrews
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - C Munoz
- Kings College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College London, National Amyloidosis Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - P Robson
- Mount Sinai School of Medicine, Translational and Molecular Imaging Institute, New York, United States of America
| | - R Botnar
- Kings College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - S Semple
- University of Edinburgh, Edinburgh Imaging Facility, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - C Prieto
- Kings College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - D Newby
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - M Dweck
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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Spath N, Dweck M, Baker A, Newby D, Semple S. 19 Manganese-enhanced T1 mapping for the detection of left ventricular remodelling and viability after myocardial infarction. Imaging 2019. [DOI: 10.1136/heartjnl-2019-bcs.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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38
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Kwiecinski J, Chin CWL, Everett RJ, White AC, Semple S, Yeung E, Jenkins WJ, Shah ASV, Koo M, Mirsadraee S, Lang CC, Mills N, Prasad SK, Jansen MA, Japp AG, Newby DE, Dweck MR. Adverse prognosis associated with asymmetric myocardial thickening in aortic stenosis. Eur Heart J Cardiovasc Imaging 2018; 19:347-356. [PMID: 28379401 PMCID: PMC5837366 DOI: 10.1093/ehjci/jex052] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Asymmetric wall thickening has been described in patients with aortic stenosis. However, it remains poorly characterized and its prognostic implications are unclear. We hypothesized this pattern of adaptation is associated with advanced remodelling, left ventricular decompenzation, and a poor prognosis. Methods and results In a prospective observational cohort study, 166 patients with aortic stenosis (age 69, 69% males, mean aortic valve area 1.0 ± 0.4 cm2) and 37 age and sex-matched healthy volunteers underwent phenotypic characterization with comprehensive clinical, imaging, and biomarker evaluation. Asymmetric wall thickening on both echocardiography and cardiovascular magnetic resonance was defined as regional wall thickening ≥ 13 mm and > 1.5-fold the thickness of the opposing myocardial segment. Although no control subject had asymmetric wall thickening, it was observed in 26% (n = 43) of patients with aortic stenosis using magnetic resonance and 17% (n = 29) using echocardiography. Despite similar demographics, co-morbidities, valve narrowing, myocardial hypertrophy, and fibrosis, patients with asymmetric wall thickening had increased cardiac troponin I and brain natriuretic peptide concentrations (both P < 0.001). Over 28 [22, 33] months of follow-up, asymmetric wall thickening was an independent predictor of aortic valve replacement (AVR) or death whether detected by magnetic resonance [hazard ratio (HR) = 2.15; 95% confidence interval (CI) 1.29-3.59; P = 0.003] or echocardiography (HR = 1.79; 95% CI 1.08-3.69; P = 0.021). Conclusion Asymmetric wall thickening is common in aortic stenosis and is associated with increased myocardial injury, left ventricular decompenzation, and adverse events. Its presence may help identify patients likely to proceed quickly towards AVR. Clinical Trial Registration https://clinicaltrials.gov/show/NCT01755936: NCT01755936.
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Affiliation(s)
- Jacek Kwiecinski
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- First Department of Cardiology, Poznan University of Medical Sciences, 1/2 Dluga, 61-848 Poznan, Poland
| | - Calvin W L Chin
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- Department of Cardiovascular Science, National Heart Center Singapore
| | - Russell J Everett
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Audrey C White
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Scott Semple
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- Clinical Research Imaging Centre, University of Edinburgh, UK
| | - Emily Yeung
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - William J Jenkins
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Anoop S V Shah
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Maria Koo
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Saeed Mirsadraee
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Chim C Lang
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, UK
| | - Nicholas Mills
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | | | - Maurits A Jansen
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Alan G Japp
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - David E Newby
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Marc R Dweck
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York
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Alam SR, Stirrat C, Spath N, Zamvar V, Pessotto R, Dweck MR, Moore C, Semple S, El-Medany A, Manoharan D, Mills NL, Shah A, Mirsadraee S, Newby DE, Henriksen PA. Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery. J Cardiothorac Surg 2017; 12:115. [PMID: 29246240 PMCID: PMC5732376 DOI: 10.1186/s13019-017-0681-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Myocardial inflammation and injury occur during coronary artery bypass graft (CABG) surgery. We aimed to characterise these processes during routine CABG surgery to inform the diagnosis of type 5 myocardial infarction. METHODS We assessed 87 patients with stable coronary artery disease who underwent elective CABG surgery. Myocardial inflammation, injury and infarction were assessed using plasma inflammatory biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magnetic resonance imaging (CMR) using both late gadolinium enhancement (LGE) and ultrasmall superparamagnetic particles of iron oxide (USPIO). RESULTS Systemic humoral inflammatory biomarkers (myeloperoxidase, interleukin-6, interleukin-8 and c-reactive protein) increased in the post-operative period with C-reactive protein concentrations plateauing by 48 h (median area under the curve (AUC) 7530 [interquartile range (IQR) 6088 to 9027] mg/L/48 h). USPIO-defined cellular myocardial inflammation ranged from normal to those associated with type 1 myocardial infarction (median 80.2 [IQR 67.4 to 104.8] /s). Plasma hs-cTnI concentrations rose by ≥50-fold from baseline and exceeded 10-fold the upper limit of normal in all patients. Two distinct patterns of peak cTnI release were observed at 6 and 24 h. After CABG surgery, new LGE was seen in 20% (n = 18) of patients although clinical peri-operative type 5 myocardial infarction was diagnosed in only 9% (n = 8). LGE was associated with the delayed 24-h peak in hs-cTnI and its magnitude correlated with AUC plasma hs-cTnI concentrations (r = 0.33, p < 0.01) but not systemic inflammation, myocardial inflammation or bypass time. CONCLUSION Patients undergoing CABG surgery invariably have plasma hs-cTnI concentrations >10-fold the 99th centile upper limit of normal that is not attributable to inflammatory or ischemic injury alone. Peri-operative type 5 myocardial infarction is often unrecognised and is associated with a delayed 24-h peak in plasma hs-cTnI concentrations.
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Affiliation(s)
- Shirjel R Alam
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK.
| | - Colin Stirrat
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK
| | - Nick Spath
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK
| | - Vipin Zamvar
- Department of Cardiothoracic Surgery, Edinburgh Heart Centre, Edinburgh, UK
| | - Renzo Pessotto
- Department of Cardiothoracic Surgery, Edinburgh Heart Centre, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK
| | - Colin Moore
- Department of Cardiothoracic Surgery, Edinburgh Heart Centre, Edinburgh, UK
| | - Scott Semple
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK.,Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | | | - Divya Manoharan
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK
| | - Anoop Shah
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK
| | - Saeed Mirsadraee
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK
| | - Peter A Henriksen
- BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Edinburgh, EH16 5SA, UK
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40
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Hayer MK, Edwards NC, Slinn G, Moody WE, Steeds RP, Ferro CJ, Price AM, Andujar C, Dutton M, Webster R, Webb DJ, Semple S, MacIntyre I, Melville V, Wilkinson IB, Hiemstra TF, Wheeler DC, Herrey A, Grant M, Mehta S, Ives N, Townend JN. A randomized, multicenter, open-label, blinded end point trial comparing the effects of spironolactone to chlorthalidone on left ventricular mass in patients with early-stage chronic kidney disease: Rationale and design of the SPIRO-CKD trial. Am Heart J 2017; 191:37-46. [PMID: 28888268 PMCID: PMC5603966 DOI: 10.1016/j.ahj.2017.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/18/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with increased left ventricular (LV) mass and arterial stiffness. In a previous trial, spironolactone improved these end points compared with placebo in subjects with early-stage CKD, but it is not known whether these effects were specific to the drug or secondary to blood pressure lowering. AIM The aim was to investigate the hypothesis that spironolactone is superior to chlorthalidone in the reduction of LV mass while exerting similar effects on blood pressure. DESIGN This is a multicenter, prospective, randomized, open-label, blinded end point clinical trial initially designed to compare the effects of 40weeks of treatment with spironolactone 25mg once daily to chlorthalidone 25mg once daily on the co-primary end points of change in pulse wave velocity and change in LV mass in 350 patients with stages 2 and 3 CKD on established treatment with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Because of slow recruitment rates, it became apparent that it would not be possible to recruit this sample size within the funded time period. The study design was therefore changed to one with a single primary end point of LV mass requiring 150 patients. Recruitment was completed on 31 December 2016, at which time 154 patients had been recruited. Investigations included cardiac magnetic resonance imaging, applanation tonometry, 24-hour ambulatory blood pressure monitoring, and laboratory tests. Subjects are assessed before and after 40weeks of randomly allocated drug therapy and at 46weeks after discontinuation of the study drug.
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Affiliation(s)
- Manvir K Hayer
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham
| | - Nicola C Edwards
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham
| | - Gemma Slinn
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham
| | - William E Moody
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham
| | - Rick P Steeds
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham
| | - Charles J Ferro
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham
| | - Anna M Price
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham
| | - Cecilio Andujar
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham
| | - Mary Dutton
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham
| | - Rachel Webster
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham
| | - David J Webb
- Edinburgh Hypertension Excellence Centre and Clinical Research Centre, BHF Centre of Research Excellence, University of Edinburgh, 47 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Scott Semple
- Edinburgh Hypertension Excellence Centre and Clinical Research Centre, BHF Centre of Research Excellence, University of Edinburgh, 47 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Iain MacIntyre
- Edinburgh Hypertension Excellence Centre and Clinical Research Centre, BHF Centre of Research Excellence, University of Edinburgh, 47 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Vanessa Melville
- Edinburgh Hypertension Excellence Centre and Clinical Research Centre, BHF Centre of Research Excellence, University of Edinburgh, 47 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, and Cambridge Clinical Trials Unit, Cambridge University Hospitals, PO Box 98, Addenbrooke's Hospital, Cambridge
| | - Thomas F Hiemstra
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, and Cambridge Clinical Trials Unit, Cambridge University Hospitals, PO Box 98, Addenbrooke's Hospital, Cambridge
| | - David C Wheeler
- Department of Renal Medicine, Royal Free Hospital, Pond St, London
| | - Anna Herrey
- Department of Renal Medicine, Royal Free Hospital, Pond St, London
| | - Margaret Grant
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Samir Mehta
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Jonathan N Townend
- Birmingham Cardio-Renal Group (University of Birmingham Institute of Cardiovascular Sciences), Queen Elizabeth Hospital, Edgbaston, Birmingham.
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Everett R, Chin C, Kwiencinski J, Jenkins W, Clavel M, Mirsadree S, White A, Semple S, Prasad S, Pibarot P, Newby D, Dweck M. P457Longitudinal cardiac magnetic resonance assessment in patients with aortic stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p457] [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] [Indexed: 11/14/2022] Open
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42
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Everett RJ, Chin CWL, Kwiecinski J, Jenkins WJ, Mirsadraee S, White A, Prasad SK, Semple S, Newby DE, Dweck MR. 012 Longitudinal cardiac magnetic resonance assessment of diffuse and replacement myocardial fibrosis in aortic stenosis. Heart 2017. [DOI: 10.1136/heartjnl-2017-311399.12] [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: 11/03/2022]
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Elfick A, Rischitor G, Mouras R, Azfer A, Lungaro L, Uhlarz M, Herrmannsdörfer T, Lucocq J, Gamal W, Bagnaninchi P, Semple S, Salter DM. Biosynthesis of magnetic nanoparticles by human mesenchymal stem cells following transfection with the magnetotactic bacterial gene mms6. Sci Rep 2017; 7:39755. [PMID: 28051139 PMCID: PMC5209691 DOI: 10.1038/srep39755] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 02/19/2016] [Accepted: 11/28/2016] [Indexed: 12/23/2022] Open
Abstract
The use of stem cells to support tissue repair is facilitated by loading of the therapeutic cells with magnetic nanoparticles (MNPs) enabling magnetic tracking and targeting. Current methods for magnetizing cells use artificial MNPs and have disadvantages of variable uptake, cellular cytotoxicity and loss of nanoparticles on cell division. Here we demonstrate a transgenic approach to magnetize human mesenchymal stem cells (MSCs). MSCs are genetically modified by transfection with the mms6 gene derived from Magnetospirillum magneticum AMB-1, a magnetotactic bacterium that synthesises single-magnetic domain crystals which are incorporated into magnetosomes. Following transfection of MSCs with the mms6 gene there is bio-assimilated synthesis of intracytoplasmic magnetic nanoparticles which can be imaged by MR and which have no deleterious effects on cell proliferation, migration or differentiation. The assimilation of magnetic nanoparticle synthesis into mammalian cells creates a real and compelling, cytocompatible, alternative to exogenous administration of MNPs.
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Affiliation(s)
- Alistair Elfick
- University of Edinburgh, Institute for Bioengineering, School of Engineering, Edinburgh, EH9 3FB, UK.,University of Edinburgh, UK Centre for Mammalian Synthetic Biology, Edinburgh, EH9 3FB, UK
| | - Grigore Rischitor
- University of Edinburgh, Centre for Genomics and Experimental Medicine, MRC IGMM, Edinburgh, EH4 2XU, UK
| | - Rabah Mouras
- University of Edinburgh, Institute for Bioengineering, School of Engineering, Edinburgh, EH9 3FB, UK
| | - Asim Azfer
- University of Edinburgh, Centre for Genomics and Experimental Medicine, MRC IGMM, Edinburgh, EH4 2XU, UK
| | - Lisa Lungaro
- University of Edinburgh, Institute for Bioengineering, School of Engineering, Edinburgh, EH9 3FB, UK.,University of Edinburgh, Centre for Genomics and Experimental Medicine, MRC IGMM, Edinburgh, EH4 2XU, UK
| | - Marc Uhlarz
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden High Magnetic Field Laboratory (HLD-EMFL), Dresden, 01328, Germany
| | - Thomas Herrmannsdörfer
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden High Magnetic Field Laboratory (HLD-EMFL), Dresden, 01328, Germany
| | - John Lucocq
- University of St Andrews, School of Medicine, St Andrews, KY16 9TF, UK
| | - Wesam Gamal
- University of Edinburgh, Centre for Regenerative Medicine, Edinburgh, EH16 4UU, UK
| | - Pierre Bagnaninchi
- University of Edinburgh, Centre for Regenerative Medicine, Edinburgh, EH16 4UU, UK
| | - Scott Semple
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, EH16 4TJ UK
| | - Donald M Salter
- University of Edinburgh, Centre for Genomics and Experimental Medicine, MRC IGMM, Edinburgh, EH4 2XU, UK
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Wicks L, Telford R, Olive L, Cunningham R, Semple S, Telford R. Eye-hand coordination – An important motor skill in children: Evidence from the LOOK longitudinal study. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chin CWL, Everett RJ, Kwiecinski J, Vesey AT, Yeung E, Esson G, Jenkins W, Koo M, Mirsadraee S, White AC, Japp AG, Prasad SK, Semple S, Newby DE, Dweck MR. Myocardial Fibrosis and Cardiac Decompensation in Aortic Stenosis. JACC Cardiovasc Imaging 2016; 10:1320-1333. [PMID: 28017384 PMCID: PMC5683736 DOI: 10.1016/j.jcmg.2016.10.007] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [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: 06/21/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Cardiac magnetic resonance (CMR) was used to investigate the extracellular compartment and myocardial fibrosis in patients with aortic stenosis, as well as their association with other measures of left ventricular decompensation and mortality. BACKGROUND Progressive myocardial fibrosis drives the transition from hypertrophy to heart failure in aortic stenosis. Diffuse fibrosis is associated with extracellular volume expansion that is detectable by T1 mapping, whereas late gadolinium enhancement (LGE) detects replacement fibrosis. METHODS In a prospective observational cohort study, 203 subjects (166 with aortic stenosis [69 years; 69% male]; 37 healthy volunteers [68 years; 65% male]) underwent comprehensive phenotypic characterization with clinical imaging and biomarker evaluation. On CMR, we quantified the total extracellular volume of the myocardium indexed to body surface area (iECV). The iECV upper limit of normal from the control group (22.5 ml/m2) was used to define extracellular compartment expansion. Areas of replacement mid-wall LGE were also identified. All-cause mortality was determined during 2.9 ± 0.8 years of follow up. RESULTS iECV demonstrated a good correlation with diffuse histological fibrosis on myocardial biopsies (r = 0.87; p < 0.001; n = 11) and was increased in patients with aortic stenosis (23.6 ± 7.2 ml/m2 vs. 16.1 ± 3.2 ml/m2 in control subjects; p < 0.001). iECV was used together with LGE to categorize patients with normal myocardium (iECV <22.5 ml/m2; 51% of patients), extracellular expansion (iECV ≥22.5 ml/m2; 22%), and replacement fibrosis (presence of mid-wall LGE, 27%). There was evidence of increasing hypertrophy, myocardial injury, diastolic dysfunction, and longitudinal systolic dysfunction consistent with progressive left ventricular decompensation (all p < 0.05) across these groups. Moreover, this categorization was of prognostic value with stepwise increases in unadjusted all-cause mortality (8 deaths/1,000 patient-years vs. 36 deaths/1,000 patient-years vs. 71 deaths/1,000 patient-years, respectively; p = 0.009). CONCLUSIONS CMR detects ventricular decompensation in aortic stenosis through the identification of myocardial extracellular expansion and replacement fibrosis. This holds major promise in tracking myocardial health in valve disease and for optimizing the timing of valve replacement. (The Role of Myocardial Fibrosis in Patients With Aortic Stenosis; NCT01755936).
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Affiliation(s)
- Calvin W L Chin
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Department of Cardiovascular Science, National Heart Center, Singapore
| | - Russell J Everett
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jacek Kwiecinski
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Alex T Vesey
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Emily Yeung
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Gavin Esson
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - William Jenkins
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Maria Koo
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Saeed Mirsadraee
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Audrey C White
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alan G Japp
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Scott Semple
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- BHF/Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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Piccini D, Weale PJ, Cooper AS, Forsythe RO, Newby D, Semple S. Respiratory self navigated whole-heart angiography with ultra-small super-paramagnetic iron oxide particles: a feasibility study. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032064 DOI: 10.1186/1532-429x-18-s1-p56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hickey L, Semple S, Scott M. Outcomes following emergency abdominal wall hernia repair-our local experience. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McAvoy NC, Semple S, Richards JMJ, Robson AJ, Patel D, Jardine AGM, Leyland K, Cooper AS, Newby DE, Hayes PC. Differential visceral blood flow in the hyperdynamic circulation of patients with liver cirrhosis. Aliment Pharmacol Ther 2016; 43:947-54. [PMID: 26947424 DOI: 10.1111/apt.13571] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/14/2015] [Accepted: 02/04/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND With advancing liver disease and the development of portal hypertension, there are major alterations in somatic and visceral blood flow. Using phase-contrast magnetic resonance angiography, we characterised alterations in blood flow within the hepatic, splanchnic and extra-splanchnic circulations of patients with established liver cirrhosis. AIM To compare blood flow in splanchnic and extra-splanchnic circulations in patients with varying degrees of cirrhosis and healthy controls. METHODS In a single-centre prospective study, 21 healthy volunteers and 19 patients with established liver disease (Child's stage B and C) underwent electrocardiogram-gated phase-contrast-enhanced 3T magnetic resonance angiography of the aorta, hepatic artery, portal vein, superior mesenteric artery, and the renal and common carotid arteries. RESULTS In comparison to healthy volunteers, resting blood flow in the descending thoracic aorta was increased by 43% in patients with liver disease (4.31 ± 1.47 vs. 3.31 ± 0.80 L/min, P = 0.011). While portal vein flow was similar (0.83 ± 0.38 vs. 0.77 ± 0.35 L/min, P = 0.649), hepatic artery flow doubled (0.50 ± 0.46 vs. 0.25 ± 0.15 L/min, P = 0.021) and consequently total liver blood flow increased by 30% (1.33 ± 0.84 vs. 1.027 ± 0.5 L/min, P = 0.043). In patients with liver disease, superior mesenteric artery flow was threefold higher (0.65 ± 0.35 vs. 0.22 ± 0.13 L/min, P < 0.001), while total renal blood flow was reduced by 40% (0.37 ± 0.14 vs. 0.62 ± 0.22 L/min, P < 0.001) and total carotid blood flow unchanged (0.62 ± 0.20 vs. 0.65 ± 0.13 L/min, P = 0.315). CONCLUSIONS Rather than a generalised systemic hyperdynamic circulation, liver disease is associated with dysregulated splanchnic vasodilatation and portosystemic shunting that, while inducing a high cardiac output, causes compensatory extra-splanchnic vasoconstriction - the 'splanchnic steal' phenomenon. These circulatory disturbances may underlie many of the manifestations of advanced liver disease.
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Affiliation(s)
- N C McAvoy
- Department of Hepatology, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Semple
- Clinical Research Imaging Centre, Queen's Medical Research Institute, Edinburgh, UK.,Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - J M J Richards
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - A J Robson
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - D Patel
- Clinical Research Imaging Centre, Queen's Medical Research Institute, Edinburgh, UK.,Department of Radiology, Royal infirmary of Edinburgh, Edinburgh, UK
| | - A G M Jardine
- Medical School, University of Edinburgh, Edinburgh, UK
| | - K Leyland
- Medical School, University of Edinburgh, Edinburgh, UK
| | - A S Cooper
- Clinical Research Imaging Centre, Queen's Medical Research Institute, Edinburgh, UK
| | - D E Newby
- Clinical Research Imaging Centre, Queen's Medical Research Institute, Edinburgh, UK.,Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - P C Hayes
- Department of Hepatology, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Mirsadraee S, Tse M, Kershaw L, Semple S, Schembri N, Chin C, Murchison JT, Hirani N, van Beek EJR. T1 characteristics of interstitial pulmonary fibrosis on 3T MRI-a predictor of early interstitial change? Quant Imaging Med Surg 2016; 6:42-9. [PMID: 26981454 DOI: 10.3978/j.issn.2223-4292.2016.02.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Computed tomography (CT) is routinely used for diagnosis and characterisation of idiopathic pulmonary fibrosis (IPF). The technique however has limited sensitivity in detection and monitoring of early fibrotic changes. The aim of this study was to evaluate T1 characteristics in the radiologically diseased lung parenchyma in IPF patient compared to apparently normal parenchyma in both interstitial lung disease (ILD) patients and healthy volunteers and to investigate the feasibility of the technique in prediction of early fibrotic lung changes that may not be visible on CT. METHODS Ten patients with IPF underwent high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) on the same day of attendance. 3T MRI was repeated in seven patients with IPF to test the reproducibility of results. The control group included healthy volunteers (n=10). A modified look-locker inversion-recovery (MOLLI) sequence (124×192 acquisition matrix; 8 mm slice) was performed during a 15-20 s breathhold in a single slice. The position of MR slice was pre-selected where there was CT evidence of normal and fibrotic lung. MOLLI imaging was performed prior to the contrast administration, and at 15, 25, 30 and 35 min post Gadolinium. The imaging data were then processed with a curve-fitting technique to estimate T1 values. T1 values of the apparent fibrotic and normal lung in IPF patients and normal lung were compared. RESULTS Fibrotic lung had a higher pre-contrast T1 than either morphologically normal lung in ILD patients or control lung (P=0.02) in healthy volunteers (1309±123, 1069±71, and 1011±172 ms, respectively). Morphologically normal lung T1 and control lung T1 were not significantly different pre-contrast, however, at 10 min after administration of Gadolinium, control lung had a significantly shorter T1 than either fibrotic or morphologically normal lung (494±34, 670±63, and 619±41 ms, respectively; P=0.001). T1 for fibrotic lung continued to decrease until 20 min after contrast agent administration (P≤0.0001), whereas morphologically normal lung T1 did not significantly change after 10 min (P>0.3). This indicates delayed uptake of contrast agent in the fibrotic lung compared with morphologically normal lung. CONCLUSIONS T1 mapping of patients with IPF at 3T is feasible and demonstrates a significant difference between fibrotic lung tissue and morphologically normal lung tissue both before Gadolinium administration and at 10 min delayed post-contrast images. The technique is able to evaluate early fibrosis in patients with apparently morphologically normal lung.
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Affiliation(s)
- Saeed Mirsadraee
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Matthew Tse
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Lucy Kershaw
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Nicola Schembri
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Calvin Chin
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - John T Murchison
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Nik Hirani
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- 1 Clinical Research Imaging Centre, 2 MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Semple S. COPD: Is there evidence to support a role for resistance training in improving measurable health-related quality of life in pulmonary rehabilitation? S Afr J SM 2016. [DOI: 10.17159/2413-3108/2007/v19i5a654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. As such, the disease places a significant burden on health care services. Although the pathogenesis of COPD is complex, progressive airflow limitation and a chronic inflammatory response are two hallmark characteristics of the disease. In addition, systemic manifestations such as peripheral muscle dysfunction have recently received considerable attention in the literature. Pulmonary rehabilitation is an evidence-based multidisciplinary intervention that has been shown to produce clinically relevant outcomes. One important component of rehabilitation is exercise. With the majority of COPD patients presenting with muscle weakness and exercise intolerance, the inclusion of resistance training into a pulmonary rehabilitation programme would seem appropriate. Compared with other exercise/training modalities only a small number of studies have investigated the effects of resistance training in COPD patients. Although further research is required to identify the optimal mode, intensity and frequency, it appears that resistance training may prove to be a valuable intervention for COPD patients enrolled in pulmonary rehabilitation programmes.
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