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Thornton GD, Vassiliou VS, Musa TA, Aziminia N, Craig N, Dattani A, Davies RH, Captur G, Moon JC, Dweck MR, Myerson SG, Prasad SK, McCann GP, Greenwood JP, Singh A, Treibel TA. Myocardial Scar and Remodelling Predict Long-Term Mortality in Severe Aortic Stenosis Beyond 10 Years. Eur Heart J 2024:ehae067. [PMID: 38271583 DOI: 10.1093/eurheartj/ehae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Affiliation(s)
- George D Thornton
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Vassilios S Vassiliou
- Imperial College London and Royal Brompton Hospital, London, United Kingdom
- University of East Anglia, United Kingdom
| | | | - Nikoo Aziminia
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Neil Craig
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Rhodri H Davies
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Saul G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - Sanjay K Prasad
- Imperial College London and Royal Brompton Hospital, London, United Kingdom
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - John P Greenwood
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- The Baker Heart and Diabetes Institute & Monash University, Melbourne, Australia
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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Thornton GD, Musa TA, Rigolli M, Loudon M, Chin C, Pica S, Malley T, Foley JRJ, Vassiliou VS, Davies RH, Captur G, Dobson LE, Moon JC, Dweck MR, Myerson SG, Prasad SK, Greenwood JP, McCann GP, Singh A, Treibel TA. Association of Myocardial Fibrosis and Stroke Volume by Cardiovascular Magnetic Resonance in Patients With Severe Aortic Stenosis With Outcome After Valve Replacement: The British Society of Cardiovascular Magnetic Resonance AS700 Study. JAMA Cardiol 2022; 7:513-520. [PMID: 35385057 PMCID: PMC8988025 DOI: 10.1001/jamacardio.2022.0340] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/09/2022] [Indexed: 01/03/2023]
Abstract
Importance Low-flow severe aortic stenosis (AS) has higher mortality than severe AS with normal flow. The conventional definition of low-flow AS is an indexed stroke volume (SVi) by echocardiography less than 35 mL/m2. Cardiovascular magnetic resonance (CMR) is the reference standard for quantifying left ventricular volumes and function from which SVi by CMR can be derived. Objective To determine the association of left ventricular SVi by CMR with myocardial remodeling and survival among patients with severe AS after valve replacement. Design, Setting, and Participants This multicenter longitudinal cohort study was conducted between January 2003 and May 2015 across 6 UK cardiothoracic centers. Patients with severe AS listed for either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were included. Patients underwent preprocedural echocardiography and CMR. Patients were stratified by echocardiography-derived aortic valve mean and/or peak gradient and SVi by CMR into 4 AS endotypes: low-flow, low-gradient AS; low-flow, high-gradient AS; normal-flow, low-gradient AS; and normal-flow, high-gradient AS. Patients were observed for a median of 3.6 years. Data were analyzed from September to November 2021. Exposures SAVR or TAVR. Main Outcomes and Measures All-cause and cardiovascular (CV) mortality after aortic valve intervention. Results Of 674 included patients, 425 (63.1%) were male, and the median (IQR) age was 75 (66-80) years. The median (IQR) aortic valve area index was 0.4 (0.3-0.4) cm2/m2. Patients with low-flow AS endotypes (low gradient and high gradient) had lower left ventricular ejection fraction, mass, and wall thickness and increased all-cause and CV mortality than patients with normal-flow AS (all-cause mortality: hazard ratio [HR], 2.08; 95% CI, 1.37-3.14; P < .001; CV mortality: HR, 3.06; 95% CI, 1.79-5.25; P < .001). CV mortality was independently associated with lower SVi (HR, 1.64; 95% CI, 1.08-2.50; P = .04), age (HR, 2.54; 95% CI, 1.29-5.01; P = .001), and higher quantity of late gadolinium enhancement (HR, 2.93; 95% CI, 1.68-5.09; P < .001). CV mortality hazard increased more rapidly in those with an SVI less than 45 mL/m2. SVi by CMR was independently associated with age, atrial fibrillation, focal scar (by late gadolinium enhancement), and parameters of cardiac remodeling (left ventricular mass and left atrial volume). Conclusions and Relevance In this cohort study, SVi by CMR was associated with CV mortality after aortic valve replacement, independent of age, focal scar, and ejection fraction. The unique capability of CMR to quantify myocardial scar, combined with other prognostically important imaging biomarkers, such as SVi by CMR, may enable comprehensive stratification of postoperative risk in patients with severe symptomatic AS.
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Affiliation(s)
- George D. Thornton
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Barts Heart Centre, London, United Kingdom
| | - Tarique A. Musa
- Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Marzia Rigolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, BHF Centre of Research Excellence, NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - Margaret Loudon
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | | | | | | | - James R. J. Foley
- Multidisciplinary Cardiovascular Research Centre and The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Rhodri H. Davies
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Barts Heart Centre, London, United Kingdom
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Laura E. Dobson
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - James C. Moon
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Barts Heart Centre, London, United Kingdom
| | - Marc R. Dweck
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Saul G. Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, BHF Centre of Research Excellence, NIHR Biomedical Research Centre, Oxford, United Kingdom
| | | | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre and The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Anvesha Singh
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Thomas A. Treibel
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Barts Heart Centre, London, United Kingdom
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3
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Thornton GD, Musa TA, Rigolli M, Loudon M, Chin C, Pica S, Malley T, Foley JRJ, Vassiliou VS, Davies RH, Captur G, Dobson LE, Singh A, Treibel TA. Interaction of stroke volume and myocardial phenotype in patients with severe aortic stenosis referred for intervention: outcome data from the BSCMR AS700 study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
onbehalf
The BSCMR Valve Consortium
Background
Patients with low-flow aortic stenosis (LF-AS) have higher mortality than those with high-flow severe AS. The conventional echocardiographic definition of LF-AS is an indexed stroke volume (SVi) <35ml/m2. Whether this cut-off translates to cardiac magnetic resonance (CMR), and how CMR SVi associates with myocardial remodelling (volume/function/scar) and survival is unclear.
Purpose
To determine the association between CMR SVi, myocardial remodelling and survival in severe symptomatic AS.
Methods
In a multi-centre longitudinal outcome study of patients with severe AS listed for either surgical (SAVR) or transcatheter aortic valve intervention (TAVI) at six cardiothoracic centres, survival was assessed and stratified by SVi. Patients underwent preprocedural echocardiography and CMR between January 2003 and May 2015. Standardised core-lab analyses on pre-procedural CMR for biventricular volumes, function and scar quantification were performed. All-cause and cardiovascular mortality were tracked for a minimum of two years after AVR.
Results
A total of 674 patients with severe AS (age 75 ± 14years; 63% male, aortic valve area 0.4 ± 0.1 cm2/m2) were included. Patients with low SVi by CMR <35ml/m2 were older and had a greater burden of comorbidities (atrial fibrillation [AF], diabetes, high BMI). Independent predictors of SVi were age, AF, increased left atrial volume, aortic valve regurgitant fraction and left ventricular mass (LV) mass index (by CMR). There was no difference in SVi with choice of intervention (TAVI vs SAVR) or presence of late gadolinium enhancement. In multivariate analysis (Table 1), SVi was associated with cardiovascular mortality in the whole cohort (HR 0.97, 95%CI 0.95-0.99, p = 0.02), and all-cause mortality after TAVI (HR 0.97, 95%CI 0.95-0.99, p = 0.006) but not SAVR (p = 0.6). Adjusted mortality hazard increases below 50ml/m2 and plateaus between 35-40ml/m2 (Figure 1A), adjusted for LGE, STS score (Society of Thoracic Surgery score) and wall thickness.
Conclusion
SVi by CMR is an independent predictor of cardiovascular mortality. Mortality hazard increases progressively below a SVi of 50mL/m2.
Abstract Figure 1
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Affiliation(s)
- GD Thornton
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - TA Musa
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Rigolli
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M Loudon
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - C Chin
- National Heart Centre Singapore, Singapore, Singapore
| | - S Pica
- Policlinico San Donato, Milan, Italy
| | - T Malley
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - JRJ Foley
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - VS Vassiliou
- University of East Anglia, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - RH Davies
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - G Captur
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - LE Dobson
- Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - A Singh
- University of Leicester, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - TA Treibel
- University College London, London, United Kingdom of Great Britain & Northern Ireland
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McDiarmid AK, Swoboda PP, Erhayiem B, Bounford KA, Bijsterveld P, Tyndall K, Fent GJ, Garg P, Dobson LE, Musa TA, Foley JRJ, Witte KK, Kearney MT, Greenwood JP, Plein S. Myocardial Effects of Aldosterone Antagonism in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2019; 9:e011521. [PMID: 31852424 PMCID: PMC6988171 DOI: 10.1161/jaha.118.011521] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Spironolactone may have prognostic benefit in selected patients with heart failure with preserved ejection fraction. This study assessed the myocardial tissue effects of spironolactone in heart failure with preserved ejection fraction. Methods and Results A 1:1 randomized controlled study of 6 months of spironolactone versus control in heart failure with preserved ejection fraction. The primary outcome was change in myocardial extracellular volume fraction by cardiovascular magnetic resonance as a surrogate of diffuse fibrosis. Of 55 randomized patients, 40 (20 women; age, 75.2±5.9 years) completed follow-up (19 treatment, 21 control). A significant change in extracellular volume over the study period was not seen (treatment, 28.7±3.7% versus 27.7±3.4% [P=0.14]; controls, 27.6±3.4% versus 28.3±4.4% [P=0.14]); however, the rate of extracellular volume expansion was decreased by spironolactone (-1.0±2.4% versus 0.8±2.2%). Indexed left ventricular mass decreased with treatment (104.4±26.6 versus 94.0±20.6 g/m2; P=0.001) but not in controls (101.4±29.4 versus 104.0±32.8 g/m2; P=0.111). Extracellular mass decreased by 13.8% (15.1±4.8 versus 13.0±3.4 g/m2; P=0.003), and cellular mass decreased by 8.3% (37.6±10.0 versus 34.3±7.9 g/m2; P=0.001) with spironolactone, but was static in controls. Conclusions Spironolactone did not lead to significant change in extracellular volume. However, spironolactone did decrease rate of extracellular expansion, with a decrease in the mass of both cellular and extracellular myocardial compartments. These data point to the mechanism of action of spironolactone in heart failure with preserved ejection fraction, including a direct tissue effect with a reduction in rate of myocardial fibrosis.
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Affiliation(s)
- Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom.,Department of Cardiology Freeman Hospital Newcastle-upon-Tyne United Kingdom
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | | | - Petra Bijsterveld
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - Keith Tyndall
- Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - James R J Foley
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - Klaus K Witte
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - Mark T Kearney
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
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5
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Rigolli M, Musa TA, Treibel TA, Loudon M, Vassiliou VS, Captur G, Singh A, Chin C, Dobson LE, Pica S, Malley T, Foley JRJ, Bijsterveld P, Law GR, Myerson SG. 480Right ventricular dysfunction is associated with late mortality in severe aortic stenosis: results from a multi-centre outcome study in patients undergoing aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The right ventricle (RV) is relatively understudied and often not routinely assessed in aortic stenosis (AS). However, there are several potential reasons for its importance. RV function is sensitive to left-sided afterload changes which can result in pulmonary hypertension (PH) in severe AS. PH is also a recognised predictor of poor prognosis in AS, but RV afterload and function can be difficult to assess. Cardiovascular magnetic resonance (CMR) may reveal unrecognised RV dysfunction and simultaneously evaluate other prognostic markers in AS.
Purpose
To investigate preoperative RV function assessed by CMR in severe AS and its association with mortality after aortic valve replacement (AVR).
Methods
674 severe AS patients listed for either surgical or percutaneous AVR at six cardiothoracic centres underwent preoperative CMR (for ventricular function, mass and scar) along with echocardiography for valve severity. Scans were core-lab analysed for LV and RV volumes, function and scar quantification. Eight patients were excluded due to inadequate RV image quality for a total of 666 patients finally included. All-cause mortality was tracked for a minimum of 2 years after AVR.
Results
107 (16%) of severe AS undergoing invasive AVR had a RV ejection fraction (RVEF) <55%. CMR detected overt RV dysfunction (RVEF <50%) in 61 (9%) patients. During a median 3.6 years follow-up, 145 (22%) patients died. Baseline RV dysfunction was the most powerful predictor of all-cause mortality (hazard ratio [HR] 2.5, 95% CI 1.6–3.9, p<0.0001). RV function was independent from other clinical characteristics but associated with signs of LV maladaptation (LV ejection fraction [LVEF] and late gadolinium enhancement [LGE]). The strongest Cox multivariable model for all-cause mortality accounted for RV dysfunction, age and LGE (adjusted HRs 1.7, 1.1, 2.2, respectively). Even early stages of pre-procedural RV dysfunction (RVEF 45–50%) were associated with reduced long-term survival.
Cox and Kaplan-Meier for all-cause death
Conclusion
One out of 6 patients with severe AS undergoing valve replacement manifests a reduction in RV function detectable by CMR. Those with RV dysfunction (RVEF<50%) have a 2.5-fold increase in all-cause mortality after AVR at 3.6 years. Whilst RV dysfunction is associated with LV maladaptation (LGE, LVEF), it is a powerful independent factor associated with all-cause mortality and impacts survival even at early stages. Thus, the RV appears to be important in cardiac adaptation to AS and longevity after AS intervention.
Acknowledgement/Funding
British Heart Foundation and National Institute of Health Research
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Affiliation(s)
- M Rigolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - T A Musa
- University of Leeds, Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - T A Treibel
- University College London, Barts Health National Health Service Trust, London, United Kingdom
| | - M Loudon
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - V S Vassiliou
- Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - G Captur
- University College London, Barts Health National Health Service Trust, London, United Kingdom
| | - A Singh
- University of Leicester, Department of Cardiovascular Science, Leicester, United Kingdom
| | - C Chin
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - L E Dobson
- University of Leeds, Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - S Pica
- University College London, Barts Health National Health Service Trust, London, United Kingdom
| | - T Malley
- Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - J R J Foley
- University of Leeds, Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - P Bijsterveld
- University of Leeds, Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - G R Law
- University of Leeds, Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - S G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
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Everett R, Treibel T, Fukui M, Lee H, Rigolli M, Singh A, Tastet L, Musa TA, Chin C, Om SY, Captur G, Funk S, Clavel MA, Clavel MA, Cavalcante J, Cavalcante J, Dweck MR, Dweck MR. 1337Myocardial extracellular volume in patients with aortic stenosis undergoing valve intervention - A multicentre T1 mapping study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The development of myocardial fibrosis is a key mechanism in the transition from compensated hypertrophy to heart failure in aortic stenosis (AS). Focal and diffuse fibrosis can be quantified using cardiac magnetic resonance (CMR) imaging late gadolinium-enhanced (LGE) and T1 mapping techniques.
Purpose
To assess T1 mapping measures of fibrosis in patients with severe AS referred for aortic valve intervention, and determine their associations with clinical characteristics, disease severity and long-term clinical outcome.
Methods
In this international prospective cohort study, patients with severe AS underwent contrast enhanced CMR with T1 mapping and LGE prior to aortic valve intervention. Image analysis was performed by a single core laboratory and the extracellular volume fraction [ECV%] calculated from T1 mapping images. The presence of LGE was determined visually and quantified using the full-width-at-half-maximum technique.
Results
Four-hundred and forty patients (70±10 years, 59% male) from ten international centres were enrolled. Aortic valve intervention was performed 15 [4 to 58] days following CMR. Within a follow-up of 3.8 [2.8 to 4.6] years, 52 patients died.
ECV% (mean 27.7±3.6%) correlated with increasing age, Society of Thoracic Surgeons Predicted Risk of Mortality score, known coronary artery disease, lower peak aortic-jet velocity, larger left ventricular (LV) mass, lower LV ejection fraction, and presence of LGE (P<0.05 for all). Following adjustment for all demographic and clinical variables, ECV% remained associated with age (P=0.028), LV ejection fraction (P<0.001) and presence of LGE (P=0.035).
Univariable predictors of all-cause mortality included age, male sex, impaired LV ejection fraction and presence of LGE (all P<0.05). A progressive increase in all-cause mortality was seen across tertiles of ECV% (17.3, 31.6 and 52.7 deaths per 1000 patient-years; log-rank test, P=0.009). ECV% was independently associated with all-cause mortality following adjustment for age, sex, impaired LV ejection fraction and presence of LGE (HR per unit increase in ECV: 1.10, 95%, (1.02–1.19), P=0.013).
ECV440 abstract iamge
Conclusion
In patients with severe aortic stenosis scheduled for aortic valve intervention, extracellular volume-based T1 mapping correlates with LV decompensation. ECV% is a strong independent predictor of late all-cause mortality and is a potential therapeutic target.
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Affiliation(s)
- R Everett
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - T Treibel
- Barts Health NHS Trust, London, United Kingdom
| | - M Fukui
- University of Pittsburgh, Pittsburgh, United States of America
| | - H Lee
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - M Rigolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - A Singh
- NIHR Biomedical Research Unit in Cardiovascular Disease, Leicester, United Kingdom
| | - L Tastet
- Quebec Heart and Lung Institute, Quebec, Canada
| | - T A Musa
- University of Leeds, Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - C Chin
- National Heart Centre Singapore, Singapore, Singapore
| | - S Y Om
- Asan Medical Center, Seoul, Korea (Republic of)
| | - G Captur
- Barts Health NHS Trust, London, United Kingdom
| | - S Funk
- Helios Clinic Berlin-Buch, Berlin, Germany
| | - M A Clavel
- Quebec Heart and Lung Institute, Quebec, Canada
| | - M A Clavel
- Quebec Heart and Lung Institute, Quebec, Canada
| | - J Cavalcante
- University of Pittsburgh, Pittsburgh, United States of America
| | - J Cavalcante
- University of Pittsburgh, Pittsburgh, United States of America
| | - M R Dweck
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
| | - M R Dweck
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom
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7
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Musa TA, Treibel TA, Vassiliou VS, Captur G, Singh A, Chin C, Dobson LE, Pica S, Loudon M, Malley T, Rigolli M, Foley JRJ, Bijsterveld P, Law GR, Dweck MR, Myerson SG, McCann GP, Prasad SK, Moon JC, Greenwood JP. Myocardial Scar and Mortality in Severe Aortic Stenosis. Circulation 2019; 138:1935-1947. [PMID: 30002099 PMCID: PMC6221382 DOI: 10.1161/circulationaha.117.032839] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Aortic valve replacement (AVR) for aortic stenosis is timed primarily on the development of symptoms, but late surgery can result in irreversible myocardial dysfunction and additional risk. The aim of this study was to determine whether the presence of focal myocardial scar preoperatively was associated with long-term mortality. Methods: In a longitudinal observational outcome study, survival analysis was performed in patients with severe aortic stenosis listed for valve intervention at 6 UK cardiothoracic centers. Patients underwent preprocedural echocardiography (for valve severity assessment) and cardiovascular magnetic resonance for ventricular volumes, function and scar quantification between January 2003 and May 2015. Myocardial scar was categorized into 3 patterns (none, infarct, or noninfarct patterns) and quantified with the full width at half-maximum method as percentage of the left ventricle. All-cause mortality and cardiovascular mortality were tracked for a minimum of 2 years. Results: Six hundred seventy-four patients with severe aortic stenosis (age, 75±14 years; 63% male; aortic valve area, 0.38±0.14 cm2/m2; mean gradient, 46±18 mm Hg; left ventricular ejection fraction, 61.0±16.7%) were included. Scar was present in 51% (18% infarct pattern, 33% noninfarct). Management was surgical AVR (n=399) or transcatheter AVR (n=275). During follow-up (median, 3.6 years), 145 patients (21.5%) died (52 after surgical AVR, 93 after transcatheter AVR). In multivariable analysis, the factors independently associated with all-cause mortality were age (hazard ratio [HR], 1.50; 95% CI, 1.11–2.04; P=0.009, scaled by epochs of 10 years), Society of Thoracic Surgeons score (HR, 1.12; 95% CI, 1.03–1.22; P=0.007), and scar presence (HR, 2.39; 95% CI, 1.40–4.05; P=0.001). Scar independently predicted all-cause (26.4% versus 12.9%; P<0.001) and cardiovascular (15.0% versus 4.8%; P<0.001) mortality, regardless of intervention (transcatheter AVR, P=0.002; surgical AVR, P=0.026 [all-cause mortality]). Every 1% increase in left ventricular myocardial scar burden was associated with 11% higher all-cause mortality hazard (HR, 1.11; 95% CI, 1.05–1.17; P<0.001) and 8% higher cardiovascular mortality hazard (HR, 1.08; 95% CI, 1.01–1.17; P<0.001). Conclusions: In patients with severe aortic stenosis, late gadolinium enhancement on cardiovascular magnetic resonance was independently associated with mortality; its presence was associated with a 2-fold higher late mortality.
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Affiliation(s)
- Tarique A Musa
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK (T.A.M., L.E.D., J.R.J.F., P.B., G.R.L., J.P.G.)
| | - Thomas A Treibel
- Barts Health National Health Service Trust and University College London, UK (T.A.T., G.C., S.P., J.C.M.)
| | | | - Gabriella Captur
- Barts Health National Health Service Trust and University College London, UK (T.A.T., G.C., S.P., J.C.M.)
| | - Anvesha Singh
- University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, UK (A.S., G.P.M.)
| | - Calvin Chin
- Centre for Cardiovascular Science, University of Edinburgh, UK (C.C., M.D.)
| | - Laura E Dobson
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK (T.A.M., L.E.D., J.R.J.F., P.B., G.R.L., J.P.G.)
| | - Silvia Pica
- Barts Health National Health Service Trust and University College London, UK (T.A.T., G.C., S.P., J.C.M.)
| | - Margaret Loudon
- University of Oxford Centre for Clinical Magnetic Resonance Research, UK (M.L., M.R., S.G.M.)
| | - Tamir Malley
- Imperial College London and Royal Brompton Hospital, UK (V.S.V., T.M., S.K.P.)
| | - Marzia Rigolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, UK (M.L., M.R., S.G.M.)
| | - James R J Foley
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK (T.A.M., L.E.D., J.R.J.F., P.B., G.R.L., J.P.G.)
| | - Petra Bijsterveld
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK (T.A.M., L.E.D., J.R.J.F., P.B., G.R.L., J.P.G.)
| | - Graham R Law
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK (T.A.M., L.E.D., J.R.J.F., P.B., G.R.L., J.P.G.).,School of Health and Social Care, University of Lincoln, UK (G.R.L.)
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, UK (C.C., M.D.)
| | - Saul G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, UK (M.L., M.R., S.G.M.)
| | - Gerry P McCann
- University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, UK (A.S., G.P.M.)
| | - Sanjay K Prasad
- Imperial College London and Royal Brompton Hospital, UK (V.S.V., T.M., S.K.P.)
| | - James C Moon
- Barts Health National Health Service Trust and University College London, UK (T.A.T., G.C., S.P., J.C.M.)
| | - John P Greenwood
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK (T.A.M., L.E.D., J.R.J.F., P.B., G.R.L., J.P.G.)
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8
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Rigolli M, Musa TA, Treibel TA, Loudon M, Vassiliou VS, Captur G, Singh A, Chin C, Bijsterveld P, Dobson LE, Pica S, Malley T, Foley JRJ, Law GR, Myerson SG. 515Right ventricular dysfunction detected by cardiovascular magnetic resonance is associated with late mortality in severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Rigolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - T A Musa
- University of Leeds, Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T A Treibel
- University College London, Barts Health National Health Service Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Loudon
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - V S Vassiliou
- Imperial College London, Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - G Captur
- University College London, Barts Health National Health Service Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Singh
- University of Leicester, National Institute for Health Research Leicester Biomedical Research Centre, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - C Chin
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - P Bijsterveld
- University of Leeds, Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - L E Dobson
- University of Leeds, Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Pica
- University College London, Barts Health National Health Service Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - T Malley
- Imperial College London, Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J R J Foley
- University of Leeds, Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - G R Law
- University of Lincoln, School of Health and Social Care, Lincoln, United Kingdom of Great Britain & Northern Ireland
| | - S G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
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9
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Everett R, Treibel T, Fukui M, Lee H, Rigolli M, Singh A, Bijsterveld P, Tastet L, Musa TA, Chin C, Captur G, Funk S, Clavel MA, Cavalcante J, Dweck M. 250Myocardial extracellular volume in patients with aortic stenosis undergoing valve intervention: a multicentre T1 mapping study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez120.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
| | - T Treibel
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fukui
- University of Pittsburgh, Pittsburgh, United States of America
| | - H Lee
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - M Rigolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - A Singh
- NIHR Biomedical Research Unit in Cardiovascular Disease, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - P Bijsterveld
- University of Leeds, Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - L Tastet
- Quebec Heart and Lung Institute, Quebec, Canada
| | - T A Musa
- University of Leeds, Leeds Institute for Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Chin
- National Heart Centre Singapore, Singapore, Singapore
| | - G Captur
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Funk
- Helios Clinic Berlin-Buch, Berlin, Germany
| | - M A Clavel
- Quebec Heart and Lung Institute, Quebec, Canada
| | - J Cavalcante
- University of Pittsburgh, Pittsburgh, United States of America
| | - M Dweck
- University of Edinburgh, Centre for Cardiovascular Sciences, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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10
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Chew PG, Dobson LE, Garg P, Fairbairn TA, Musa TA, Uddin A, Swoboda PP, Foley JR, Fent GJ, Brown LAE, Onciul S, Plein S, Blackman DJ, Greenwood JP. CMR quantitation of change in mitral regurgitation following transcatheter aortic valve replacement (TAVR): impact on left ventricular reverse remodeling and outcome. Int J Cardiovasc Imaging 2018; 35:161-170. [PMID: 30182320 PMCID: PMC6373302 DOI: 10.1007/s10554-018-1441-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022]
Abstract
Current echocardiographic data reporting the impact of concomitant mitral regurgitation (MR) on outcome in patients who undergo transcatheter aortic valve replacement (TAVR) are conflicting. Using cardiovascular magnetic resonance (CMR) imaging, this study aimed to assess the impact of MR severity on cardiac reverse remodeling and patient outcome. 85 patients undergoing TAVR with CMR pre- and 6 m post-TAVR were evaluated. The CMR protocol included cines for left (LV) and right ventricular (RV) volumes, flow assessment, and myocardial scar assessment by late gadolinium enhancement (LGE). Patients were dichotomised according to CMR severity of MR fraction at baseline (‘non-significant’ vs ‘significant’) and followed up for a median duration of 3 years. Forty-two (49%) patients had ‘significant MR’ at baseline; they had similar LV and RV size and function compared to the ‘non-significant MR’ group but had greater LV mass at baseline. In those with significant MR at baseline, 77% (n = 32) had a reduction in MR post-TAVR, moving them into the ‘non-significant’ category at 6-months, with an overall reduction in MR fraction from 34 to 17% (p < 0.001). Improvement in MR was not associated with more favourable cardiac reverse remodeling when compared with the ‘non-improvers’. Significant MR at baseline was not associated with increased mortality at follow-up. Significant MR is common in patients undergoing TAVR and improves in the majority post-procedure. Improvement in MR was not associated with more favourable LV reverse remodeling and baseline MR severity was not associated with mortality.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - James R Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Louise A E Brown
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Sebastian Onciul
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK.
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11
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Swoboda PP, Erhayiem B, Kan R, McDiarmid AK, Garg P, Musa TA, Dobson LE, Witte KK, Kearney MT, Barth JH, Ajjan R, Greenwood JP, Plein S. Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes. Cardiovasc Diabetol 2018; 17:35. [PMID: 29506523 PMCID: PMC5836381 DOI: 10.1186/s12933-018-0681-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/27/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We aimed to investigate in patients with type 2 diabetes whether aortic stiffness is: (i) associated with glycaemic control, (ii) associated with adverse outcomes and (iii) can be reversed on treatment with RAAS inhibition. METHODS Patients with type 2 diabetes (N = 94) and low vascular risk underwent assessment of cardiovascular risk and CMR assessment of ascending aortic distensibility (AAD), descending aortic distensibility (DAD) and aortic pulse wave velocity (PWV). Of these patients a subgroup with recent onset microalbuminuria (N = 25) were treated with renin-angiotensin-aldosterone system (RAAS) inhibition and imaging repeated after 1 year. All 94 patients were followed up for 2.4 years for major adverse cardiovascular disease (CVD) events including myocardial infarction detected on late gadolinium enhancement CMR. RESULTS Ascending aortic distensibility, DAD and PWV all had a significant association with age and 24 h systolic blood pressure but only AAD had a significant association with glycaemic control, measured as HbA1c (Beta - 0.016, P = 0.04). The association between HbA1c and AAD persisted even after correction for age and hypertension. CVD events occurred in 19/94 patients. AAD, but not DAD or PWV, was associated with CVD events (hazard ratio 0.49, 95% confidence interval 0.25-0.95, P = 0.01). On treatment with RAAS inhibition, AAD, but not DAD or PWV, showed significant improvement from 1.51 ± 1.15 to 1.97 ± 1.07 10-3 mmHg-1, P = 0.007. CONCLUSIONS Ascending aortic distensibility measured by CMR is independently associated with poor glycaemic control and adverse cardiovascular events. Furthermore it may be reversible on treatment with RAAS inhibition. AAD is a promising marker of cardiovascular risk in asymptomatic patients with type 2 diabetes and has potential use as a surrogate cardiovascular endpoint in studies of novel hypoglycaemic agents. Clinical trials registration https://clinicaltrials.gov/ct2/show/NCT01970319.
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Affiliation(s)
- Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Rachel Kan
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Adam K. McDiarmid
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Klaus K. Witte
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Mark T. Kearney
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Julian H. Barth
- Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, UK
| | - Ramzi Ajjan
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
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12
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Garg P, Broadbent DA, Swoboda PP, Foley JR, Fent GJ, Musa TA, Ripley DP, Erhayiem B, Dobson LE, McDiarmid AK, Haaf P, Kidambi A, Crandon S, Chew PG, van der Geest RJ, Greenwood JP, Plein S. Extra-cellular expansion in the normal, non-infarcted myocardium is associated with worsening of regional myocardial function after acute myocardial infarction. J Cardiovasc Magn Reson 2017; 19:73. [PMID: 28946878 PMCID: PMC5613621 DOI: 10.1186/s12968-017-0384-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/29/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Expansion of the myocardial extracellular volume (ECV) is a surrogate measure of focal/diffuse fibrosis and is an independent marker of prognosis in chronic heart disease. Changes in ECV may also occur after myocardial infarction, acutely because of oedema and in convalescence as part of ventricular remodelling. The objective of this study was to investigate changes in the pattern of distribution of regional (normal, infarcted and oedematous segments) and global left ventricular (LV) ECV using semi-automated methods early and late after reperfused ST-elevation myocardial infarction (STEMI). METHODS Fifty patients underwent cardiovascular magnetic resonance (CMR) imaging acutely (24 h-72 h) and at convalescence (3 months). The CMR protocol included: cines, T2-weighted (T2 W) imaging, pre-/post-contrast T1-maps and LGE-imaging. Using T2 W and LGE imaging on acute scans, 16-segments of the LV were categorised as normal, oedema and infarct. 800 segments (16 per-patient) were analysed for changes in ECV and wall thickening (WT). RESULTS From the acute studies, 325 (40.6%) segments were classified as normal, 246 (30.8%) segments as oedema and 229 (28.6%) segments as infarct. Segmental change in ECV between acute and follow-up studies (Δ ECV) was significantly different for normal, oedema and infarct segments (0.8 ± 6.5%, -1.78 ± 9%, -2.9 ± 10.9%, respectively; P < 0.001). Normal segments which demonstrated deterioration in wall thickening at follow-up showed significantly increased Δ ECV compared with normal segments with preserved wall thickening at follow up (1.82 ± 6.05% versus -0.10 ± 6.88%, P < 0.05). CONCLUSION Following reperfused STEMI, normal myocardium demonstrates subtle expansion of the extracellular volume at 3-month follow up. Segmental ECV expansion of normal myocardium is associated with worsening of contractile function.
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Affiliation(s)
- Pankaj Garg
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - David A. Broadbent
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter P. Swoboda
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - James R.J. Foley
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - David P. Ripley
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Bara Erhayiem
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Laura E. Dobson
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Adam K. McDiarmid
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Philip Haaf
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Ananth Kidambi
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Saul Crandon
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Pei G. Chew
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - R. J. van der Geest
- Division of Image Processing, Leiden University Medical Centre, Leiden, The Netherlands
| | - John P. Greenwood
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
| | - Sven Plein
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) & Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, LS2 9JT UK
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Swoboda PP, McDiarmid AK, Erhayiem B, Ripley DP, Dobson LE, Garg P, Musa TA, Witte KK, Kearney MT, Barth JH, Ajjan R, Greenwood JP, Plein S. Diabetes Mellitus, Microalbuminuria, and Subclinical Cardiac Disease: Identification and Monitoring of Individuals at Risk of Heart Failure. J Am Heart Assoc 2017; 6:JAHA.117.005539. [PMID: 28716801 PMCID: PMC5586286 DOI: 10.1161/jaha.117.005539] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients with type 2 diabetes mellitus and elevated urinary albumin:creatinine ratio (ACR) have increased risk of heart failure. We hypothesized this was because of cardiac tissue changes rather than silent coronary artery disease. METHODS AND RESULTS In a case-controlled observational study 130 subjects including 50 ACR+ve diabetes mellitus patients with persistent microalbuminuria (ACR >2.5 mg/mol in males and >3.5 mg/mol in females, ≥2 measurements, no previous renin-angiotensin-aldosterone therapy, 50 ACR-ve diabetes mellitus patients and 30 controls underwent cardiovascular magnetic resonance for investigation of myocardial fibrosis, ischemia and infarction, and echocardiography. Thirty ACR+ve patients underwent further testing after 1-year treatment with renin-angiotensin-aldosterone blockade. Cardiac extracellular volume fraction, a measure of diffuse fibrosis, was higher in diabetes mellitus patients than controls (26.1±3.4% and 23.3±3.0% P=0.0002) and in ACR+ve than ACR-ve diabetes mellitus patients (27.2±4.1% versus 25.1±2.9%, P=0.004). ACR+ve patients also had lower E' measured by echocardiography (8.2±1.9 cm/s versus 8.9±1.9 cm/s, P=0.04) and elevated high-sensitivity cardiac troponin T 18% versus 4% ≥14 ng/L (P=0.05). Rate of silent myocardial ischemia or infarction were not influenced by ACR status. Renin-angiotensin-aldosterone blockade was associated with increased left ventricular ejection fraction (59.3±7.8 to 61.5±8.7%, P=0.03) and decreased extracellular volume fraction (26.5±3.6 to 25.2±3.1, P=0.01) but no changes in diastolic function or high-sensitivity cardiac troponin T levels. CONCLUSIONS Asymptomatic diabetes mellitus patients with persistent microalbuminuria have markers of diffuse cardiac fibrosis including elevated extracellular volume fraction, high-sensitivity cardiac troponin T, and diastolic dysfunction, which may in part be reversible by renin-angiotensin-aldosterone blockade. Increased risk in these patients may be mediated by subclinical changes in tissue structure and function. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01970319.
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Affiliation(s)
- Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - David P Ripley
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Klaus K Witte
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Mark T Kearney
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Julian H Barth
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ramzi Ajjan
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
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Garg P, Broadbent DA, Swoboda PP, Foley JRJ, Fent GJ, Musa TA, Ripley DP, Erhayiem B, Dobson LE, McDiarmid AK, Haaf P, Kidambi A, van der Geest RJ, Greenwood JP, Plein S. Acute Infarct Extracellular Volume Mapping to Quantify Myocardial Area at Risk and Chronic Infarct Size on Cardiovascular Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2017; 10:e006182. [PMID: 28674085 DOI: 10.1161/circimaging.117.006182] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) imaging overestimates acute infarct size. The main aim of this study was to investigate whether acute extracellular volume (ECV) maps can reliably quantify myocardial area at risk (AAR) and final infarct size (IS). METHODS AND RESULTS Fifty patients underwent cardiovascular magnetic resonance imaging acutely (24-72 hours) and at convalescence (3 months). The cardiovascular magnetic resonance protocol included cines, T2-weighted imaging, native T1 maps, 15-minute post-contrast T1 maps, and LGE. Optimal AAR and IS ECV thresholds were derived in a validation group of 10 cases (160 segments). Eight hundred segments (16 per patient) were analyzed to quantify AAR/IS by ECV maps (ECV thresholds for AAR is 33% and IS is 46%), T2-weighted imaging, T1 maps, and acute LGE. Follow-up LGE imaging was used as the reference standard for final IS and viability assessment. The AAR derived from ECV maps (threshold of >33) demonstrated good agreement with T2-weighted imaging-derived AAR (bias, 0.18; 95% confidence interval [CI], -1.6 to 1.3) and AAR derived from native T1 maps (bias=1; 95% CI, -0.37 to 2.4). ECV demonstrated the best linear correlation to final IS at a threshold of >46% (R=0.96; 95% CI, 0.92-0.98; P<0.0001). ECV maps demonstrated better agreement with final IS than acute IS on LGE (ECV maps: bias, 1.9; 95% CI, 0.4-3.4 versus LGE imaging: bias, 10; 95% CI, 7.7-12.4). On multiple variable regression analysis, the number of nonviable segments was independently associated with IS by ECV maps (β=0.86; P<0.0001). CONCLUSIONS ECV maps can reliably quantify AAR and final IS in reperfused acute myocardial infarction. Acute ECV maps were superior to acute LGE in terms of agreement with final IS. IS quantified by ECV maps are independently associated with viability at follow-up.
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Affiliation(s)
- Pankaj Garg
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.).
| | - David A Broadbent
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Peter P Swoboda
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - James R J Foley
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Graham J Fent
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Tarique A Musa
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - David P Ripley
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Bara Erhayiem
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Laura E Dobson
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Adam K McDiarmid
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Philip Haaf
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Ananth Kidambi
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Rob J van der Geest
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - John P Greenwood
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
| | - Sven Plein
- From the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (P.G., D.A.B., P.P.S., J.R.J.F., G.J.F., T.A.M., D.P.R., B.E., L.E.D., A.K.M., P.H., A.K., J.P.G., S.P.); Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, United Kingdom (D.A.B.); and Division of Image Processing, Leiden University Medical Centre, The Netherlands (R.J.v.d.G.)
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Foley JRJ, Swoboda PP, Fent GJ, Garg P, Ripley DP, McDiarmid AK, Dobson LE, Musa TA, Plein S, Witte KK, Greenwood JP. 105 Differences in myocardial mechanics between ischaemic and non-ischaemic cardiomyopathy assessed by cmr: a sub-group analysis of the vindicate trial. Heart 2017. [DOI: 10.1136/heartjnl-2017-311726.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Swoboda PP, McDiarmid AK, Erhayiem B, Ripley DP, Dobson LE, Garg P, Musa TA, Witte KK, Kearney MT, Barth JH, Ajjan R, Greenwood JP, Plein S. 029 Diabetes, microalbuminuria and subclinical cardiac disease: identification and monitoring of individuals at risk of heart failure. Heart 2017. [DOI: 10.1136/heartjnl-2017-311399.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Bebb OJ, Swoboda PP, Haaf P, Foley J, Garg P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling. J Cardiovasc Magn Reson 2017; 19:22. [PMID: 28222749 PMCID: PMC5320804 DOI: 10.1186/s12968-017-0335-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. METHODS 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. RESULTS In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m2, p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. CONCLUSION TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB, especially as TAVR is now being extended to a younger, lower risk population.
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Affiliation(s)
- Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Timothy A. Fairbairn
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Owen J. Bebb
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Philip Haaf
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - James Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | | | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
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Swoboda PP, McDiarmid AK, Erhayiem B, Law GR, Garg P, Broadbent DA, Ripley DP, Musa TA, Dobson LE, Foley JR, Fent GJ, Page SP, Greenwood JP, Plein S. Effect of cellular and extracellular pathology assessed by T1 mapping on regional contractile function in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2017; 19:16. [PMID: 28215181 PMCID: PMC5317053 DOI: 10.1186/s12968-017-0334-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/27/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Regional contractile dysfunction is a frequent finding in hypertrophic cardiomyopathy (HCM). We aimed to investigate the contribution of different tissue characteristics in HCM to regional contractile dysfunction. METHODS We prospectively recruited 50 patients with HCM who underwent cardiovascular magnetic resonance (CMR) studies at 3.0 T including cine imaging, T1 mapping and late gadolinium enhancement (LGE) imaging. For each segment of the American Heart Association model segment thickness, native T1, extracellular volume (ECV), presence of LGE and regional strain (by feature tracking and tissue tagging) were assessed. The relationship of segmental function, hypertrophy and tissue characteristics were determined using a mixed effects model, with random intercept for each patient. RESULTS Individually segment thickness, native T1, ECV and the presence of LGE all had significant associations with regional strain. The first multivariable model (segment thickness, LGE and ECV) demonstrated that all strain parameters were associated with segment thickness (P < 0.001 for all) but not ECV. LGE (Beta 2.603, P = 0.024) had a significant association with circumferential strain measured by tissue tagging. In a second multivariable model (segment thickness, LGE and native T1) all strain parameters were associated with both segment thickness (P < 0.001 for all) and native T1 (P < 0.001 for all) but not LGE. CONCLUSION Impairment of contractile function in HCM is predominantly associated with the degree of hypertrophy and native T1 but not markers of extracellular fibrosis (ECV or LGE). These findings suggest that impairment of contractility in HCM is mediated by mechanisms other than extracellular expansion that include cellular changes in structure and function. The cellular mechanisms leading to increased native T1 and its prognostic significance remain to be established.
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Affiliation(s)
- Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Adam K. McDiarmid
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham R. Law
- Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - David A. Broadbent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David P. Ripley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - James R. Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Stephen P. Page
- Inherited Cardiovascular Conditions Service, Leeds General Infirmary, Leeds, LS1 3EX UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Swoboda P, Ripley DP, McDiarmid AK, Erhayiem B, Garg P, Evans B, Malkin C, Blackman D, Plein S, Greenwood JP. Post-procedural myocardial infarction following surgical and trans-catheter aortic valve replacement - mechanistic insights from cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032045 DOI: 10.1186/1532-429x-18-s1-p337] [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: 12/01/2022] Open
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Swoboda PP, Erhayiem B, Foley J, Garg P, Haaf P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. Acute Reverse Remodelling After Transcatheter Aortic Valve Implantation: A Link Between Myocardial Fibrosis and Left Ventricular Mass Regression. Can J Cardiol 2016; 32:1411-1418. [DOI: 10.1016/j.cjca.2016.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022] Open
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Ripley DP, Nezafat M, Foley JR, Swoboda PP, Henningsson M, Vieira M, Musa TA, Dobson LE, Garg P, Erhayiem B, McDiarmid AK, Plein S, Botnar RM, Greenwood JP. Diagnostic accuracy of Dixon water fat suppression coronary artery magnetic resonance angiography at 3.0 Tesla. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032150 DOI: 10.1186/1532-429x-18-s1-q11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Garg P, Kidambi A, Swoboda PP, Foley JRJ, Musa TA, Ripley DP, Erhayiem B, Dobson LE, McDiarmid AK, Fent GJ, Haaf P, Greenwood JP, Plein S. The role of left ventricular deformation in the assessment of microvascular obstruction and intramyocardial haemorrhage. Int J Cardiovasc Imaging 2016; 33:361-370. [PMID: 27785677 PMCID: PMC5344946 DOI: 10.1007/s10554-016-1006-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/20/2016] [Indexed: 12/30/2022]
Abstract
In the setting of acute ST-elevation myocardial infarction (STEMI), it remains unclear which strain parameter most strongly correlates with microvascular obstruction (MVO) or intramyocardial haemorrhage (IMH). We aimed to investigate the association of MVO, IMH and convalescent left ventricular (LV) remodelling with strain parameters measured with cardiovascular magnetic resonance (CMR). Forty-three patients with reperfused STEMI and 10 age and gender matched healthy controls underwent CMR within 3-days and at 3-months following reperfused STEMI. Cine, T2-weighted, T2*-imaging and late gadolinium enhancement (LGE) imaging were performed. Infarct size, MVO and IMH were quantified. Peak global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS) and their strain rates were derived by feature tracking analysis of LV short-axis, 4-chamber and 2-chamber cines. All 43 patients and ten controls completed the baseline scan and 34 patients completed 3-month scans. In multivariate regression, GLS demonstrated the strongest association with MVO or IMH (beta = 0.53, p < 0.001). The optimal cut-off value for GLS was −13.7% for the detection of MVO or IMH (sensitivity 76% and specificity 77.8%). At follow up, 17% (n = 6) of patients had adverse LV remodeling (defined as an absolute increase of LV end-diastolic/end-systolic volumes >20%). Baseline GLS also demonstrated the strongest diagnostic performance in predicting adverse LV remodelling (AUC = 0.79; 95% CI 0.60–0.98; p = 0.03). Post-reperfused STEMI, baseline GLS was most closely associated with the presence of MVO or IMH. Baseline GLS was more strongly associated with adverse LV remodelling than other CMR parameters.
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Affiliation(s)
- Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James R J Foley
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - David P Ripley
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Philip Haaf
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Swoboda PP, McDiarmid AK, Erhayiem B, Haaf P, Kidambi A, Fent GJ, Dobson LE, Musa TA, Garg P, Law GR, Kearney MT, Barth JH, Ajjan R, Greenwood JP, Plein S. A Novel and Practical Screening Tool for the Detection of Silent Myocardial Infarction in Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2016; 101:3316-23. [PMID: 27300573 PMCID: PMC5377587 DOI: 10.1210/jc.2016-1318] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Silent myocardial infarction (MI) is a prevalent finding in patients with type 2 diabetes and is associated with significant mortality and morbidity. Late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) is the most validated technique for detection of silent MI, but is time-consuming, costly, and requires administration of intravenous contrast. We therefore planned to develop a simple and low-cost population screening tool to identify those at highest risk of silent MI validated against the CMR reference standard. METHODS A total of 100 asymptomatic patients with type 2 diabetes underwent electrocardiogram (ECG), echocardiography, biomarker assessment, and CMR at 3.0T including assessment of left ventricular ejection fraction and LGE. Global longitudinal strain from two- and four-chamber cines was measured using feature tracking. RESULTS A total of 17/100 patients with no history of cardiovascular disease had silent MI defined by LGE in an infarct pattern on CMR. Only four patients with silent MI had Q waves on ECG. Patients with silent MI were older (65 vs 60, P = .05), had lower E/A ratio (0.75 vs 0.89, P = .004), lower GLS (-15.2% vs -17.7%, P = .004), and higher amino-terminal pro brain natriuretic peptide (106 ng/L vs 52 ng/L, P = .003). A combined risk score derived from these four factors had an area under the receiver operating characteristic curve of 0.823 (0.734-0.892), P < .0001. A score of more than 3/5 had 82% sensitivity and 72% specificity for silent MI. CONCLUSIONS Using measures that can be derived in an outpatient clinic setting, we have developed a novel screening tool for the detection of silent MI in type 2 diabetes. The screening tool had significantly superior diagnostic accuracy than current ECG criteria for the detection of silent MI in asymptomatic patients.
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Affiliation(s)
- Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Philip Haaf
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Graham R Law
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Mark T Kearney
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Julian H Barth
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Ramzi Ajjan
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine (P.P.S., A.K.M., B.E., P.H., A.K., G.J.F., L.E.D., T.A.M., P.G., M.T.K., R.A., J.P.G., S.P.), University of Leeds, Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust (A.K., J.H.B.), Leeds, United Kingdom; Division of Epidemiology and Biostatistics (G.R.L.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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Swoboda PP, Erhayiem B, McDiarmid AK, Lancaster RE, Lyall GK, Dobson LE, Ripley DP, Musa TA, Garg P, Ferguson C, Greenwood JP, Plein S. Relationship between cardiac deformation parameters measured by cardiovascular magnetic resonance and aerobic fitness in endurance athletes. J Cardiovasc Magn Reson 2016; 18:48. [PMID: 27535657 PMCID: PMC4989526 DOI: 10.1186/s12968-016-0266-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/08/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Athletic training leads to remodelling of both left and right ventricles with increased myocardial mass and cavity dilatation. Whether changes in cardiac strain parameters occur in response to training is less well established. In this study we investigated the relationship in trained athletes between cardiovascular magnetic resonance (CMR) derived strain parameters of cardiac function and fitness. METHODS Thirty five endurance athletes and 35 age and sex matched controls underwent CMR at 3.0 T including cine imaging in multiple planes and tissue tagging by spatial modulation of magnetization (SPAMM). CMR data were analysed quantitatively reporting circumferential strain and torsion from tagged images and left and right ventricular longitudinal strain from feature tracking of cine images. Athletes performed a maximal ramp-incremental exercise test to determine the lactate threshold (LT) and maximal oxygen uptake (V̇O2max). RESULTS LV circumferential strain at all levels, LV twist and torsion, LV late diastolic longitudinal strain rate, RV peak longitudinal strain and RV early and late diastolic longitudinal strain rate were all lower in athletes than controls. On multivariable linear regression only LV torsion (beta = -0.37, P = 0.03) had a significant association with LT. Only RV longitudinal late diastolic strain rate (beta = -0.35, P = 0.03) had a significant association with V̇O2max. CONCLUSIONS This cohort of endurance athletes had lower LV circumferential strain, LV torsion and biventricular diastolic strain rates than controls. Increased LT, which is a major determinant of performance in endurance athletes, was associated with decreased LV torsion. Further work is needed to understand the mechanisms by which this occurs.
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Affiliation(s)
- Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Adam K. McDiarmid
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Rosalind E. Lancaster
- Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Gemma K. Lyall
- Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - David P. Ripley
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Carrie Ferguson
- Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
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McDiarmid AK, Swoboda PP, Erhayiem B, Lancaster RE, Lyall GK, Broadbent DA, Dobson LE, Musa TA, Ripley DP, Garg P, Greenwood JP, Ferguson C, Plein S. Athletic Cardiac Adaptation in Males Is a Consequence of Elevated Myocyte Mass. Circ Cardiovasc Imaging 2016; 9:e003579. [PMID: 27033835 PMCID: PMC4841180 DOI: 10.1161/circimaging.115.003579] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [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: 06/03/2015] [Accepted: 02/10/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cardiac remodeling occurs in response to regular athletic training, and the degree of remodeling is associated with fitness. Understanding the myocardial structural changes in athlete's heart is important to develop tools that differentiate athletic from cardiomyopathic change. We hypothesized that athletic left ventricular hypertrophy is a consequence of increased myocardial cellular rather than extracellular mass as measured by cardiovascular magnetic resonance. METHODS AND RESULTS Forty-five males (30 athletes and 15 sedentary age-matched healthy controls) underwent comprehensive cardiovascular magnetic resonance studies, including native and postcontrast T1 mapping for extracellular volume calculation. In addition, the 30 athletes performed a maximal exercise test to assess aerobic capacity and anaerobic threshold. Participants were grouped by athleticism: untrained, low performance, and high performance (O2max <60 or>60 mL/kg per min, respectively). In athletes, indexed cellular mass was greater in high- than low-performance athletes 60.7±7.5 versus 48.6±6.3 g/m(2); P<0.001), whereas extracellular mass was constant (16.3±2.2 versus 15.3±2.2 g/m(2); P=0.20). Indexed left ventricular end-diastolic volume and mass correlated with O2max (r=0.45, P=0.01; r=0.55, P=0.002) and differed significantly by group (P=0.01; P<0.001, respectively). Extracellular volume had an inverse correlation with O2max (r=-0.53, P=0.003 and left ventricular mass index (r=-0.44, P=0.02). CONCLUSIONS Increasing left ventricular mass in athlete's heart occurs because of an expansion of the cellular compartment while the extracellular volume becomes relatively smaller: a difference which becomes more marked as left ventricular mass increases. Athletic remodeling, both on a macroscopic and cellular level, is associated with the degree of an individual's fitness. Cardiovascular magnetic resonance ECV quantification may have a future role in differentiating athlete's heart from change secondary to cardiomyopathy.
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Affiliation(s)
- Adam K McDiarmid
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Peter P Swoboda
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Bara Erhayiem
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Rosalind E Lancaster
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Gemma K Lyall
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - David A Broadbent
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Laura E Dobson
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Tarique A Musa
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - David P Ripley
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Pankaj Garg
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - John P Greenwood
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Carrie Ferguson
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Sven Plein
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
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Dobson L, Musa TA, Akhlaque U, Fairbairn TA, Bebb OJ, Swoboda PP, Haaf P, Foley J, Garg P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. 39 The Impact of New Left Bundle Branch Block Following Trans-Catheter Aortic Valve Impantation. Is There a TAVI LBBB-induced Cardiomyopathy? Insights from Cardiovascular Magnetic Resonance Imaging. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Foley JRJ, Dobson LE, Musa TA, Fairbairn TA, Uddin A, Swoboda PP, Garg P, Fent G, Haaf P, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. 42 Gender Differences in Response to Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis Assessed by Feature Tracking. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dobson L, Musa TA, Uddin A, Fairbairn TA, Swoboda PP, Ripley DP, Erhayiem B, McDiarmid AK, Garg P, Evans B, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. 38 Myocardial Infarction following Surgical and Trans-Catheter Aortic Valve Replacement – Is Peri-Procedural Revascularisation for TAVI Necessary? Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.38] [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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Dobson LE, Fairbairn TA, Musa TA, Uddin A, Mundie CA, Swoboda PP, Ripley DP, McDiarmid AK, Erhayiem B, Garg P, Malkin CJ, Blackman DJ, Sharples LD, Plein S, Greenwood JP. Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling after aortic valve replacement: A cardiovascular magnetic resonance study. Am Heart J 2016; 175:101-11. [PMID: 27179729 DOI: 10.1016/j.ahj.2016.02.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/10/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiac adaptation to aortic stenosis (AS) appears to differ according to sex, but reverse remodeling after aortic valve replacement has not been extensively described. The aim of the study was to determine using cardiac magnetic resonance imaging whether any sex-related differences exist in AS in terms of left ventricular (LV) remodeling, myocardial fibrosis, and reverse remodeling after valve replacement. METHODS One hundred patients (men, n = 60) with severe AS undergoing either transcatheter or surgical aortic valve replacement underwent cardiac magnetic resonance scans at baseline and 6 months after valve replacement. RESULTS Despite similar baseline comorbidity and severity of AS, women had a lower indexed LV mass than did men (65.3 ± 18.4 vs 81.5 ± 21.3 g/m(2), P < .001) and a smaller indexed LV end-diastolic volume (87.3 ± 17.5 vs 101.2 ± 28.6 mL/m(2), P = .002) with a similar LV ejection fraction (58.6% ± 10.2% vs 54.8% ± 12.9%, P = .178). Total myocardial fibrosis mass was similar between sexes (2.3 ± 4.1 vs 1.3 ± 1.1 g, P = .714), albeit with a differing distribution according to sex. After aortic valve replacement, men had more absolute LV mass regression than did women (18.3 ± 10.6 vs 12.7 ± 8.8 g/m(2), P = .007). When expressed as a percentage reduction of baseline indexed LV mass, mass regression was similar between the sexes (men 21.7% ± 10.1% vs women 18.4% ± 11.0%, P = .121). There was no sex-related difference in postprocedural LV ejection fraction or aortic regurgitation. Sex was not found to be a predictor of LV reverse remodeling on multiple regression analysis. CONCLUSIONS There are significant differences in the way that male and female hearts adapt to AS. Six months after aortic valve replacement, there are no sex-related differences in reverse remodeling, but superior reverse remodeling in men as a result of their more adverse remodeling profile at baseline.
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Foley JRJ, Garg P, Musa TA, Dobson LE, Swoboda PP, Fent GJ, Haaf P, Plein S, Greenwood JP. 11 Left ventricular end diastolic filling pressure predicted by left atrial strain measured by feature tracking. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Garg P, Hassell ME, Ripley DP, Dobson LE, Swoboda P, Musa TA, Erhayiem B, Haaf P, Greenwood JP, Nijveldt R, Westenberg JJ, van der Geest RJ, Plein S. Reliability and reproducibility of trans-valvular flow measurement by 4D flow magnetic resonance imaging in acute myocardial infarct patients: two centre study. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032305 DOI: 10.1186/1532-429x-18-s1-p36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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McDiarmid AK, Higgins DM, Broadbent DA, Ripley DP, Swoboda PP, Kidambi A, Erhayiem B, Musa TA, Dobson LE, Garg P, Greenwood JP, Plein S. Split dose versus single bolus gadolinium administration in ecv calculation at 3 tesla cmr. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328617 DOI: 10.1186/1532-429x-17-s1-p257] [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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Musa TA, Uddin A, Fairbairn TA, Dobson LE, Kidambi A, Ripley DP, Swoboda PP, McDiarmid AK, Erhayiem B, Garg P, Steadman CD, McCann GP, Plein S, Greenwood JP. Right ventricular function following Surgical Aortic Valve Replacement (SAVR). J Cardiovasc Magn Reson 2015. [PMCID: PMC4328260 DOI: 10.1186/1532-429x-17-s1-p177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Musa TA, Dobson LE, Uddin A, Fairbairn TA, Kidambi A, Ripley DP, Swoboda PP, Erhayiem B, Garg P, McDiarmid AK, Plein S, Greenwood JP. Left atrial remodelling following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). J Cardiovasc Magn Reson 2015. [PMCID: PMC4328939 DOI: 10.1186/1532-429x-17-s1-p182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Swoboda PP, Kidambi A, Gierula J, McDiarmid AK, Erhayiem B, Dobson LE, Musa TA, Ripley DP, Garg P, Witte KK, Greenwood JP, Plein S. The prognostic value of cardiovascular magnetic resonance in aborted sudden cardiac death. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328188 DOI: 10.1186/1532-429x-17-s1-o31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Swoboda PP, McDiarmid AK, Erhayiem B, Dobson LE, Musa TA, Ripley DP, Garg P, Ajjan R, Greenwood JP, Plein S. Cardiovascular magnetic resonance assessment of ventricular morphology to investigate the mechanisms of heart failure associated with type 2 diabetes. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328542 DOI: 10.1186/1532-429x-17-s1-o82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Dobson LE, Musa TA, Fairbairn TA, Uddin A, Blackman DJ, Ripley DP, Swoboda PP, McDiarmid AK, Erhayiem B, Garg P, Plein S, Greenwood JP. Left ventricular mass regression may occur very early following transcatheter aortic valve implantation for severe aortic stenosis. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328315 DOI: 10.1186/1532-429x-17-s1-p341] [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: 11/20/2022] Open
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Dobson LE, Musa TA, Fairbairn TA, Uddin A, Blackman DJ, Ripley DP, Swoboda PP, McDiarmid AK, Erhayiem B, Garg P, Plein S, Greenwood JP. CMR assessment of longitudinal left ventricular function following transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328201 DOI: 10.1186/1532-429x-17-s1-p180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Blackman DJ, Ripley DP, McDiarmid AK, Swoboda PP, Erhayiem B, Garg P, Plein S, Greenwood JP. Gender influences left ventricular remodelling in the setting of aortic stenosis but does not appear to impact on reverse remodelling following transcatheter aortic valve implantation. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328163 DOI: 10.1186/1532-429x-17-s1-p332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Garg P, Kidambi A, Dobson LE, Musa TA, Ripley DP, McDiarmid AK, Erhayiem B, Swoboda PP, Greenwood JP, Plein S. Assessment of interventricular systolic relationship and infarct location in acute myocardial infarction. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328861 DOI: 10.1186/1532-429x-17-s1-p21] [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: 11/24/2022] Open
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Kidambi A, Motwani M, Uddin A, Ripley DP, McDiarmid AK, Swoboda PP, Broadbent DA, Musa TA, Erhayiem B, Leader J, Greenwood JP, Plein S. Myocardial extracellular volume estimation by CMR predicts functional recovery following acute myocardial infarction. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328631 DOI: 10.1186/1532-429x-17-s1-q63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Erhayiem B, McDiarmid AK, Swoboda PP, Kidambi A, Ripley DP, Musa TA, Dobson LE, Garg P, Andrews J, Greenwood JP, Buch MH, Plein S. Newly diagnosed, treatment-naive patients with rheumatoid arthritis have early abnormalities of vascular and myocardial function. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328691 DOI: 10.1186/1532-429x-17-s1-p285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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McDiarmid AK, Broadbent DA, Higgins DM, Swoboda PP, Kidambi A, Ripley DP, Erhayiem B, Musa TA, Dobson LE, Greenwood JP, Plein S. The effect of changes to MOLLI scheme on T1 mapping and extra cellular volume calculation in healthy volunteers with 3 tesla cardiovascular magnetic resonance imaging. Quant Imaging Med Surg 2015; 5:503-10. [PMID: 26435913 DOI: 10.3978/j.issn.2223-4292.2015.04.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Diffuse myocardial fibrosis may be quantified with magnetic resonance (MR) by calculating extracellular volume (ECV) fraction from native and post-contrast T1 values. The ideal modified look-locker inversion recovery (MOLLI) sequence for deriving T1 values has not been determined. This study aims to establish if systematic differences exist between suggested MOLLI schemes. METHODS Twelve phantom gels were studied with inversion recovery spin echo MR at 3.0 tesla to determine reference T1. Gels were then scanned with six MOLLI sequences (3s)3b(3s)5b; 4b(3s)3b(3s)2b; 5b(3s)3b with flip angles of both 35° and 50° at a range of heart rates (HRs). In 10 healthy volunteers MOLLI studies were performed on two separate occasions. Mid ventricular native and post contrast T1 was measured and ECV (%) calculated. RESULTS In phantoms, the co-efficient of variability at simulated HR [40-100] with a flip angle of 35° ranged from 6.77 to 9.55, and at 50° from 7.71 to 11.10. T1 was under-estimated by all MOLLI acquisitions. Error was greatest with longer T1, and increased as HR increased. The 10 volunteers had normal MR studies. Native T1 time was similar for all acquisitions but highest with the 5b(3s)3b 35° scheme (1,189.1±33.46 ms). Interstudy reproducibility was similar for all MOLLIs. CONCLUSIONS The 5b(3s)3b MOLLI scheme agreed best with reference T1, without statistical difference between the six schemes. The shorter breath-hold time of 5b(3s)3b scheme may be preferable in clinical studies and warrants further investigation.
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Affiliation(s)
- Adam K McDiarmid
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - David A Broadbent
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - David M Higgins
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - Peter P Swoboda
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - Ananth Kidambi
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - David P Ripley
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - Bara Erhayiem
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - Tarique A Musa
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - Laura E Dobson
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - John P Greenwood
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
| | - Sven Plein
- 1 Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ; 2 Philips Healthcare, Philips Centre, Guildford Business Park, Guildford, UK
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Dobson LE, Musa TA, Greenwood JP. Aortic valve replacement and the right ventricle--the plot thickens. J Thorac Cardiovasc Surg 2015; 150:742-3. [PMID: 26319472 DOI: 10.1016/j.jtcvs.2015.05.027] [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] [Received: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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Kidambi A, Motwani M, Uddin A, Ripley DP, McDiarmid AK, Swoboda PP, Broadbent DA, Musa TA, Erhayiem B, Leader J, Greenwood JP, Plein S. 125 Myocardial Extracellular Volume Estimation by Cardiovascular Magnetic Resonance Predicts Functional Recovery Following Acute Myocardial Infarction. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.125] [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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Ripley DP, McDiarmid AK, Kidambi A, Uddin A, Swoboda PP, Musa TA, Erhayiem B, Bainbridge GJ, Greenwood JP, Plein S, Higgins DM. Patient adaptive maximal resolution magnetic resonance myocardial stress perfusion imaging. J Magn Reson Imaging 2015; 42:946-53. [PMID: 25857628 DOI: 10.1002/jmri.24846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/18/2014] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To demonstrate the feasibility of an automatic adaptive acquisition sequence. Magnetic resonance perfusion pulse sequences often leave potential acquisition time unused in patients with lower heart-rates (HR) and smaller body size. MATERIALS AND METHODS A perfusion technique was developed that automatically adapts to HR and field-of-view by maximizing in-plane spatial resolution while maintaining temporal resolution every cardiac cycle. Patients (n = 10) and volunteers (n = 10) were scanned with both a standard resolution and adaptive method. Image quality was scored, signal-to-noise ratio (SNR) calculated, and width of dark-rim artifact (DRA) measured. RESULTS The acquired spatial resolution of the adaptive sequence (1.92 × 1.92 mm(2) ± 0.34) was higher than the standard resolution (2.42 × 2.42 mm(2) ) (P < 0.0001). Mean DRA width was reduced using the adaptive pulse sequence (1.94 ± 0.60 mm vs. 2.82 ± 0.65 mm, P < 0.0001). The signal-to-noise ratio (SNR) was higher with the standard pulse sequence (6.7 ± 2.2 vs. 3.8 ± 1.8, P < 0.0001). There was no difference in image quality score between sequences in either volunteers (1.1 ± 0.31 vs. 1.0 ± 0.0, P = 0.34) or patients (1.3 ± 0.48 vs. 1.3 ± 0.48, P = 1.0). CONCLUSION Optimizing the use of available imaging time during first-pass perfusion with a magnetic resonance imaging pulse sequence that adapts image acquisition duration to HR and patient size is feasible. Acquired in-plane spatial resolution is improved, the DRA is reduced, and while SNR is reduced with the adaptive sequence consistent with the lower voxel size used, image quality is maintained.
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Affiliation(s)
- David P Ripley
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Gavin J Bainbridge
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Center (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Garg P, Foley JRJ, Kidambi A, Ripley DP, Dobson LE, Swoboda PP, Musa TA, McDiarmid AK, Erhayiem B, Greenwood JP, Plein S. 14 Feature tracking versus manual methods of assessment of left atrial mechanics in acute myocardial infarction: a pilot study: Abstract 14 Table 1. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Musa TA, Uddin A, Fairbairn TA, Dobson LE, Steadman C, Kidambi A, Motwani M, Ripley DP, McDiarmid AK, Swoboda P, Erhayiem B, Garg P, Sourbron S, Plein S, McCann G, Greenwood JP. 21 Left atrial remodelling following treatment of symptomatic severe aortic stenosis. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Garg P, Kidambi A, Ripley DP, Dobson LE, Swoboda PP, Musa TA, McDiarmid AK, Erhayiem B, Haaf P, Greenwood JP, Plein S. 15 Predictors of right ventricular remodelling in reperfused inferior myocardial infarctions: cmr voxel feature tracking based feasibility study. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Garg P, Kidambi A, Ripley DP, Dobson LE, Swoboda PP, Musa TA, McDiarmid AK, Erhayiem B, Greenwood JP, Plein S. 16 Relationship of mitral annular plane systolic excursion and intra-myocardial haemorrhage in reperfused st-elevation myocardial infarction. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.16] [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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