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Dowsing B, Cash L, Webb E, Moon JC, Manisty CH, Bhuva AN. MRI provision for patients with cardiac implantable electronic devices: understanding the real-world administrative requirements of service delivery. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Patients with cardiac implantable electronic devices (CIEDs) should have access to Magnetic Resonance Imaging (MRI) but are less likely to be referred and hospitals lack provision. A major barrier to service delivery is the administrative demand required to obtain accurate CIED details prior to scheduling. We aimed to understand the administrative requirements of a high-volume Cardiac Device-MRI service to inform the design of an electronic referrals platform that can facilitate workflow.
Methods
Single centre retrospective audit of a high-volume Cardiac Device-MRI service in a tertiary unit in the UK. Six months of referrals were reviewed for patient and CIED details and barriers met. Referrals were stratified by source, indication, MR-Conditional labelling and referrer.
Results
Administrative barriers were reviewed for 116 patients with CIEDs referred for MRI (48% cardiac, 52% non-cardiac) between September 2020 and March 2021 (Table 1). Referrers were 47% cardiologists and 53% other specialties. Referral to scan time was 15 days (interquartile range, 8–32). There were no scan-related complications.
34% of referrals contained complete CIED details and 30% stated the MR labelling of the CIED. None incorrectly labelled a CIED as MR-Conditional, but 8% incorrectly labelled as non-MR Conditional. 7 additional days were required to obtain complete CIED details where not provided (involving information requests from two device clinics in 27%), 10% had delays over 2 weeks (maximum 145 days). 35% required 3 or more repeat discussions with referrers after initial referral. Obtaining CIED information for external referrals required 17 days (11–42), compared to 14 (6–35) days for internal referrals (p=0.25).
Patients with non-MR Conditional CIEDs required on average 14 days longer to obtain complete referral details than patients with MR-Conditional CIEDs. Even when referrers were aware of non-MR Conditional labelling and received information on risk, 41% required further discussion between patient and referrer regarding risks and benefits of MRI scanning. For cancer referrals, obtaining correct details took 1 day longer than other referrals (p=0.074) and required 2 extra emails to maintain provision within the national time-to-treatment target of 62 days. Missing data was similarly present in referrals from Cardiologists and non-Cardiologists (59% versus 61% respectively), but non-Cardiologists recorded more incorrect CIED details (8% vs 0%).
Conclusions
Referral for MRI in patients with CIEDs demands significant administrative input to obtain correct device information, leading to delays. These delays are greater for patients with non-MR conditional CIEDs, and data provided is often incorrect or incomplete. This may explain why some patients are not referred for MRI. An online referrals platform has been developed to streamline this process, initially deployed through a network of 60 centres registered in the UK.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work is supported by British Heart Foundation Innovations funding (HFHF_016).
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Affiliation(s)
- B Dowsing
- Barts Heart Centre, Greater London, United Kingdom
| | - L Cash
- Barts Heart Centre, Greater London, United Kingdom
| | - E Webb
- Barts Heart Centre, Greater London, United Kingdom
| | - J C Moon
- Barts Heart Centre, Greater London, United Kingdom
| | - C H Manisty
- Barts Heart Centre, Greater London, United Kingdom
| | - A N Bhuva
- Barts Heart Centre, Greater London, United Kingdom
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Bhuva AN, D'Silva A, Torlasco C, Nadarajan N, Jones S, Boubertakh R, Van Zalen J, Scully P, Knott K, Benedetti G, Augusto JB, Bastiaenen R, Lloyd G, Sharma S, Moon JC, Parker KH, Manisty CH, Hughes AD. Non-invasive assessment of ventriculo-arterial coupling using aortic wave intensity analysis combining central blood pressure and phase-contrast cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2021; 21:805-813. [PMID: 31501858 DOI: 10.1093/ehjci/jez227] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/01/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Wave intensity analysis (WIA) in the aorta offers important clinical and mechanistic insight into ventriculo-arterial coupling, but is difficult to measure non-invasively. We performed WIA by combining standard cardiovascular magnetic resonance (CMR) flow-velocity and non-invasive central blood pressure (cBP) waveforms. METHODS AND RESULTS Two hundred and six healthy volunteers (age range 21-73 years, 47% male) underwent sequential phase contrast CMR (Siemens Aera 1.5 T, 1.97 × 1.77 mm2, 9.2 ms temporal resolution) and supra-systolic oscillometric cBP measurement (200 Hz). Velocity (U) and central pressure (P) waveforms were aligned using the waveform foot, and local wave speed was calculated both from the PU-loop (c) and the sum of squares method (cSS). These were compared with CMR transit time derived aortic arch pulse wave velocity (PWVtt). Associations were examined using multivariable regression. The peak intensity of the initial compression wave, backward compression wave, and forward decompression wave were 69.5 ± 28, -6.6 ± 4.2, and 6.2 ± 2.5 × 104 W/m2/cycle2, respectively; reflection index was 0.10 ± 0.06. PWVtt correlated with c or cSS (r = 0.60 and 0.68, respectively, P < 0.01 for both). Increasing age decade and female sex were independently associated with decreased forward compression wave (-8.6 and -20.7 W/m2/cycle2, respectively, P < 0.01) and greater wave reflection index (0.02 and 0.03, respectively, P < 0.001). CONCLUSION This novel non-invasive technique permits straightforward measurement of wave intensity at scale. Local wave speed showed good agreement with PWVtt, and correlation was stronger using the cSS than the PU-loop. Ageing and female sex were associated with poorer ventriculo-arterial coupling in healthy individuals.
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Affiliation(s)
- Anish N Bhuva
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - A D'Silva
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - C Torlasco
- IRCCS, Istituto Auxologico Italiano, Via Ludovico Ariosto 13, 20145 Milan, Italy, Italy
| | - N Nadarajan
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK
| | - S Jones
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK
| | - R Boubertakh
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - J Van Zalen
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - P Scully
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - K Knott
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - G Benedetti
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - J B Augusto
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - Rachel Bastiaenen
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - G Lloyd
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - S Sharma
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - J C Moon
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - K H Parker
- Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - C H Manisty
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London WC1E 7HB, UK
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Bhuva AN, Moralee R, Moon JC, Manisty CH. Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change. Eur Radiol 2019; 30:1378-1384. [PMID: 31776746 PMCID: PMC7033076 DOI: 10.1007/s00330-019-06449-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/02/2019] [Accepted: 09/12/2019] [Indexed: 11/22/2022]
Abstract
Abstract More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this—newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.
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Affiliation(s)
- A N Bhuva
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK. .,Institute for Cardiovascular Science, University College London, London, UK.
| | - R Moralee
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - J C Moon
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
| | - C H Manisty
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
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Chong JH, Maxwell M, Smith T, Walker MJ, Crake T, Westwood M, Ghosh AK, Manisty CH. P680The clinical value of CMR in the management of Cardio-Oncology patients - a tertiary centre experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is increasing awareness of cardiotoxicity arising from cancer treatments. Early diagnosis and treatment is key, to ensure patients receive optimal oncological management. Cardiovascular magnetic resonance (CMR) offers gold standard measurement of cardiac function, alongside tissue characterisation and myocardial perfusion, thereby potentially providing additive value in the context of cardio-oncology.
Purpose
We sought to understand the clinical value of CMR in cardio-oncology at a tertiary cardio-oncology centre.
Methods
We retrospectively reviewed CMR scans requested in cardio-oncology patients at our institution within a ten-month period. We categorised clinical indications and assessed the impact on clinical management using previously-published criteria.
Results
102 CMR studies were requested in 93 cardio-oncology patients (mean age 56 (range 18 to 82), 49% male) between (March to December 2018). 41% of patients had haematological malignancies, 59% solid tumours.
15% of requests were for risk stratification prior to initiation of cancer therapy, 21% for screening for cardio-toxicity in patients currently receiving cardiotoxic agents (3% anthracyclines, 13% HER2 monoclonal antibodies, 4% fluoropyrimidines), 15% for investigation of patients with cardiac complications during cancer treatment, 35% assessment for late effects post cancer treatment, and 14% for cardiac malignancies/ infiltration.
The most common indications for CMR were monitoring of left ventricular ejection fraction (LVEF) in patients where quantification by echocardiography was non-diagnostic or significantly different between imaging studies (39%) and ischaemia assessment including for patients due to receive fluoropyrimidines (26%). Others were aetiology of LV dysfunction/cardiomyopathy (13%) and tissue characterisation (23%), including assessment for cardiac AL amyloid (11 patients), myocarditis (2), cardiac metastases (1), cardiac masses (6), and cardiac iron loading (1).
CMR findings had clinical impact in 61% of patients and assisted in adjudicating a new diagnosis in 29% of patients. 88% of patients were able to continue anthracycline/anti-HER2 therapies based on CMR findings of stable LVEF (93% of whose echocardiograms had suggested reductions). LVEF had reduced significantly in 12% of patients meaning chemotherapy was held/discontinued. 3 patients were recommended to receive non-fluoropyrimidine chemotherapy based on perfusion CMR (pCMR) findings, with one patient permitted to receive capecitabine following normal pCMR.
Conclusion
CMR provides a comprehensive assessment of myocardial structure and function with utility within the context of cardio-oncology for risk stratification pre-chemotherapy, screening for cardiotoxicity during treatment and investigation of cardiac complications of cancer treatment. The additional information derived from CMR generally provides reassurance enabling administration of optimal cancer therapies.
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Affiliation(s)
- J H Chong
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - M Maxwell
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - T Smith
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - M J Walker
- Hatter Cardiovascular Institute, London, United Kingdom
| | - T Crake
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - M Westwood
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - A K Ghosh
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - C H Manisty
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
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Bhuva A, Bai W, Lau C, Davies R, Yang Y, Bulluck H, Mcalindon E, Cole GD, Petersen SE, Greenwood JP, Bucciarelli-Ducci C, Hughes AD, Rueckert D, Moon JC, Manisty CH. 349Fully automated left ventricular analysis matches clinician precision: a multi-centre, multi-vendor, multi-field strength, multi-disease scan:rescan CMR study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez103.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Bhuva
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - W Bai
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Lau
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - Y Yang
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - H Bulluck
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - E Mcalindon
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - G D Cole
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A D Hughes
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - D Rueckert
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C H Manisty
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Jenkins A, Bhuva AN, Hughes AD, Manisty CH, Moon JC, Treibel TA. P432aortic stenosis. the role of aortoseptal angulation as a predictive factor for asymmetrical septal hypertrophy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Jenkins
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A N Bhuva
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A D Hughes
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C H Manisty
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - T A Treibel
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
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Bhuva A, D"silva A, Torlasco C, Jones S, Nadarajan N, Van Zalen J, Boubertakh R, Chaturvedi N, Lloyd G, Sharma S, Moon JC, Hughes AD, Manisty CH. 201Training for a first-time marathon reverses vascular ageing. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez128.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Bhuva
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - A D"silva
- St George"s University of London, Cardiology Clinical & Academic Group, London, United Kingdom of Great Britain & Northern Ireland
| | - C Torlasco
- San Luca Hospital of Milan, Milan, Italy
| | - S Jones
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - N Nadarajan
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Van Zalen
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R Boubertakh
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - N Chaturvedi
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - G Lloyd
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - S Sharma
- St George"s University of London, Cardiology Clinical & Academic Group, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A D Hughes
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - C H Manisty
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Abiodun AT, Tyebally S, Rosmini S, Seraphim A, Moon J, Manisty CH. P101A post-operative compressive conundrum. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez110.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A T Abiodun
- Barts Health NHS Trust, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - S Tyebally
- Barts Health NHS Trust, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - S Rosmini
- Barts Health NHS Trust, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Seraphim
- Barts Health NHS Trust, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- Barts Health NHS Trust, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - C H Manisty
- Barts Health NHS Trust, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
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Bhuva A, Treibel TA, De Marvao A, Biffi C, Dawes T, Doumou G, Bai W, Oktay O, Jones S, Davies R, Chaturvedi N, Rueckert D, Hughes A, Moon JC, Manisty CH. P5470Septal hypertrophy in aortic stenosis and its regression after valve replacement is more plastic in males than females: insights from 3D machine learning approach. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Bhuva
- University College London, Institute of Cardiovasular Science, London, United Kingdom
| | - T A Treibel
- University College London, Institute of Cardiovasular Science, London, United Kingdom
| | - A De Marvao
- Imperial College London, MRC London Institute of Medical Sciences, London, United Kingdom
| | - C Biffi
- Imperial College London, MRC London Institute of Medical Sciences, London, United Kingdom
| | - T Dawes
- Imperial College London, MRC London Institute of Medical Sciences, London, United Kingdom
| | - G Doumou
- Imperial College London, MRC London Institute of Medical Sciences, London, United Kingdom
| | - W Bai
- Imperial College London, Department of Computer Science, London, United Kingdom
| | - O Oktay
- Imperial College London, Department of Computer Science, London, United Kingdom
| | - S Jones
- University College London, Institute of Cardiovasular Science, London, United Kingdom
| | - R Davies
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - N Chaturvedi
- University College London, Institute of Cardiovasular Science, London, United Kingdom
| | - D Rueckert
- Imperial College London, Department of Computer Science, London, United Kingdom
| | - A Hughes
- University College London, Institute of Cardiovasular Science, London, United Kingdom
| | - J C Moon
- University College London, Institute of Cardiovasular Science, London, United Kingdom
| | - C H Manisty
- University College London, Institute of Cardiovasular Science, London, United Kingdom
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Dhutia NM, Zolgharni M, Willson K, Cole G, Nowbar AN, Dawson D, Zielke S, Whelan C, Newton J, Mayet J, Manisty CH, Francis DP. Guidance for accurate and consistent tissue Doppler velocity measurement: comparison of echocardiographic methods using a simple vendor-independent method for local validation. Eur Heart J Cardiovasc Imaging 2014; 15:817-27. [DOI: 10.1093/ehjci/jeu040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pabari PA, Moraldo M, Hughes AD, Mayet J, Kyriacou A, Francis DP, Manisty CH. 003 Validating markers of mechanical dyssynchrony by experimental manipulation of interventricular timings: what is needed to make them a reasonable prospect for cardiac resynchronisation therapy selection? Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.3] [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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Manisty CH, Unsworth B, Baruah R, Pabari P, Whinnett ZI, Mayet J, Francis DP. 100 Pressure vs flow as a guide for pacemaker optimisation? The acute haemodynamic effects of changes to atrioventricular delay. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.100] [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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Raphael CE, Whinnett ZI, Davies JE, Fontana M, Ferenczi EA, Manisty CH, Mayet J, Francis DP. Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure. Heart 2008; 95:56-62. [DOI: 10.1136/hrt.2007.134973] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Whinnett ZI, Davies JER, Willson K, Manisty CH, Chow AW, Foale RA, Davies DW, Hughes AD, Mayet J, Francis DP. Haemodynamic effects of changes in atrioventricular and interventricular delay in cardiac resynchronisation therapy show a consistent pattern: analysis of shape, magnitude and relative importance of atrioventricular and interventricular delay. Heart 2006; 92:1628-34. [PMID: 16709698 PMCID: PMC1861257 DOI: 10.1136/hrt.2005.080721] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess the haemodynamic effect of simultaneously adjusting atrioventricular (AV) and interventricular (VV) delays. METHOD 35 different combinations of AV and VV delay were tested by using digital photoplethysmography (Finometer) with repeated alternations to measure relative change in systolic blood pressure (SBP(rel)) in 15 patients with cardiac resynchronisation devices for heart failure. RESULTS Changing AV delay had a larger effect than changing VV delay (range of SBP(rel) 21 v 4.2 mm Hg, p < 0.001). Each had a curvilinear effect. The curve of response to AV delay fitted extremely closely to a parabola (average R2 = 0.99, average residual variance 0.8 mm Hg2). The response to VV delay was significantly less curved (quadratic coefficient 67 v 1194 mm Hg/s2, p = 0.003) and therefore, although the residual variance was equally small (0.8 mm Hg2), the R2 value was 0.7. Reproducibility at two months was good, with the SD of the difference between two measurements of SBP(rel) being 2.5 mm Hg for AV delay (2% of mean systolic blood pressure) and 1.5 mm Hg for VV delay (1% of mean systolic blood pressure). CONCLUSIONS Changing AV and VV delays results in a curvilinear acute blood pressure response. This shape fits very closely to a parabola, which may be valuable information in developing a streamlined clinical protocol. VV delay adjustment provides an additional, albeit smaller, haemodynamic benefit to AV optimisation.
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Affiliation(s)
- Z I Whinnett
- International Centre for Circulatory Health, St Mary's Hospital and Imperial College London, London, UK.
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