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Lewis CS, Joy G, Jensen P, Barraclough A, Franco N, Talaulikar D, Hawkes EA, El-Galaly TC, Villa D, Dickinson M, Seymour JF, Cheah CY. Primary gastric diffuse large B-cell lymphoma: A multicentre retrospective study. Br J Haematol 2024. [PMID: 38632873 DOI: 10.1111/bjh.19470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
Primary gastric diffuse large B-cell lymphoma (PG-DLBCL) accounts for the majority of extra-nodal DLBCL. Even so, literature is lacking on early, localised presentations. We studied a cohort of patients with stage I disease, diagnosed between 2006 and 2018, from six centres between Australia, Canada and Denmark. Our goal was to characterise outcomes, review treatment and investigate the role of interim positron emission tomography (iPET). Thirty-seven eligible patients were identified. The median duration of follow-up was 42.2 months. All received chemoimmunotherapy with 91.9% (n = 34) given rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP). 35.1% (n = 13) underwent consolidative radiotherapy. Eighteen patients were H. pylori positive and 11 had the documentation of H. pylori eradication therapy. The 4-year progression-free survival and overall survival of R-CHOP was 88% (95% CI: 71-95) and 91% (95% CI: 75-97) respectively. All patients who achieved a partial metabolic response or complete metabolic response on iPET went on to achieve complete response at the end of treatment. R-CHOP-based therapy with iPET assessment appears to offer favourable outcomes, with radiotherapy and H. pylori eradication therapy implemented on a case-by-case basis.
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Affiliation(s)
- Cameron S Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Greta Joy
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paw Jensen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Allison Barraclough
- Department of Haematology, Austin Health, Melbourne, Victoria, Australia
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Nunzio Franco
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Dipti Talaulikar
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Eliza A Hawkes
- Department of Haematology, Austin Health, Melbourne, Victoria, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tarec Christoffer El-Galaly
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Diego Villa
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Michael Dickinson
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Salguero BD, Agrawal A, Kaul V, Lo Cascio CM, Joy G, So M, Munagala R, Harkin T, Chaddha U. Airway stenting for liberation from positive pressure ventilation in patients with central airway obstruction presenting with acute respiratory failure. Respir Med 2024; 225:107599. [PMID: 38492817 DOI: 10.1016/j.rmed.2024.107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/05/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Central airway obstruction (CAO) can lead to acute respiratory failure (RF) necessitating positive pressure ventilation (PPV). The efficacy of airway stenting to aid liberation from PPV in patients with severe acute RF has been scarcely published. We present a systematic review and our recent experience. METHODS A systematic review of PubMed was performed, and a retrospective review of cases performed at our two institutions from 2018 to 2022 in adult patients who needed stent insertion for extrinsic or mixed CAO complicated by RF necessitating PPV. RESULTS Fifteen studies were identified with a total of 156 patients. The weighted mean of successful liberation from PPV post-stenting was 84.5% and the median survival was 127.9 days. Our retrospective series included a total of 24 patients. The most common etiology was malignant CAO (83%). The types of PPV used included high-flow nasal cannula (HFNC) (21%), non-invasive ventilation (NIV) (17%) and Invasive Mechanical Ventilation (62%). The overall rate of successful liberation from PPV was 79%, with 55% of HFNC and NIV cases being liberated immediately post-procedure. The median survival of the patients with MCAO that were successfully liberated from PPV was 74 days (n = 16, range 3-893 days), and for those with that failed to be liberated from PPV, it was 22 days (n = 4, range 9-26 days). CONCLUSION In patients presenting with acute RF from extrinsic or mixed morphology CAO requiring PPV, airway stenting can successfully liberate most from the PPV. This may allow patients to receive pathology-directed treatment and better end-of-life care.
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Affiliation(s)
- Bertin D Salguero
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Abhinav Agrawal
- Division of Pulmonary, Critical Care and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Viren Kaul
- Division of Pulmonary and Critical Care Medicine, Crouse Health/SUNY Upstate Medical University, Syracuse, USA
| | - Christian M Lo Cascio
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Greta Joy
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matsuo So
- Department of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Rohit Munagala
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Timothy Harkin
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Udit Chaddha
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Salguero BD, Salman S, Agrawal A, Lo Cascio CM, Joy G, Chaddha U. Evaluating the safety of intraprocedural chest tube removal during medical thoracoscopy. Respir Med 2024; 224:107560. [PMID: 38331227 DOI: 10.1016/j.rmed.2024.107560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Medical Thoracoscopy (MT) is a diagnostic procedure during which after accessing the pleural space the patient's negative-pressure inspiratory efforts draw atmospheric air into the pleural cavity, which creates a space to work in. At the end of the procedure this air must be evacuated via a chest tube, which is typically removed in the post-anesthesia care unit (PACU). We hypothesized that its removal intra-operatively is safe and may lead to lesser post-operative pain in comparison to its removal in the PACU. METHODS A retrospective review was conducted of all the MT with intraprocedural chest tube removal done between 2019 to 2023 in adult patients in a single center in New York, NY by interventional pulmonology. RESULTS A total of 100 MT cases were identified in which the chest tube was removed intra-operatively. Seventy-seven percent of cases were performed as outpatient and all these patients were discharged on the same day. Post procedure ex-vacuo pneumothorax was present in 42% of cases. Sixty-five percent of cases had some post-procedure subcutaneous emphysema, none reported any complaint of this being painful, and no intervention was needed to relieve the air. Seventy-three percent required no additional analgesia in PACU. Of the 27% that required any form of analgesia, 59% required no additional analgesia beyond the first 24 h. CONCLUSIONS Intraprocedural CT removal for MT is safe and may decrease utilization of additional analgesia post procedure. Further prospective studies are necessary to validate these conclusions.
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Affiliation(s)
- Bertin D Salguero
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Sidra Salman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Morningside and West, New York, NY, USA
| | - Abhinav Agrawal
- Division of Pulmonary, Critical Care and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Christian M Lo Cascio
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Greta Joy
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Udit Chaddha
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Joy G, Webber M, Kelly CI, Pierce I, Teh I, Schneider J, Nguyen C, Kellman P, Orini M, Lambiase P, Rudy Y, Captur G, Dall'armellina E, Moon JC, Lopes LR. Advanced microstructural substrate detection in pre-hypertrophic HCM and its relationship to arrhythmogenesis; a hybrid CMR-ECG-Imaging study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.253] [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
Hypertrophic cardiomyopathy is defined in three domains; clinically by unexplained hypertrophy, genetically by sarcomeric gene mutations and histologically by disarray, small vessel disease and fibrosis. Both ischaemia and myocyte disarray have been implicated in arrhythmogenesis and sudden cardiac death but whether disarray occurs before hypertrophy and its relationship to ischaemia is unknown.
Diffusion-tensor CMR, perfusion mapping & ECG Imaging (ECGI) can measure disarray, ischaemia and electrical aberrance respectively in vivo. We aimed to investigate these in genotype positive (G+) subjects without hypertrophy (LVH−) to identify further subclinical manifestations of gene expression and whether these relate to ventricular arrhythmia formation.
Methods
Diffusion-tensor CMR (3-Tesla) using a motion-compensated spin-echo sequence was acquired in 3 short-axis slices. Quantitative adenosine stress perfusion mapping was performed using standard clinical protocols. A novel ECGI vest, containing 256 unipolar electrodes acquired a 5-minute recording of body-surface potentials to quantify conduction and repolarisation dynamics intervals.
Results
ECGI/CMR was performed on 68 mutation carriers from 64 families and 24 age sex and ethnicity matched healthy controls. Of the mutation carriers, median age was 33 (24–41 years), 57% (39) were female, and 79% (54) were white. Mutations were 39 (57%) MYBPC3, 19 (28%) MYH7, 1 (1%) MYL2 and 9 (12%) were thin filament/non-sarcomeric mutations. There was no significant difference in ejection fraction or LV mass, however G+LVH− had a higher maximum wall thickness (9 (9–10) vs 8 (7–9) mm p=0.003).
Compared to healthy volunteers, G+LVH− individuals had more perfusion defects (18/64 (30%) vs 0, p=0.004), lower Fractional Anisotropy (FA) (suggestive of more disarray) (0.32±0.02 vs 0.34±0.02, p<0.0001) and more prolonged Activation–Recovery Intervals (ARI, a surrogate for action potential duration (259±40 vs 240±31 ms, p=0.03).
In G+LVH−, patients with perfusion defects had more prolonged ARI (263 (248 vs 292) vs 246 (225–283) ms, p=0.03) and lower FA suggestive of more disarray (0.32±0.2 vs 0.31±0.1, p=0.04).
Conclusion
Ischaemia, myocyte disarray and electrical abnormalities occur even in the absence of hypertrophy in HCM. These abnormalities associate to form a complex a clinical phenotype.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): British Heart FoundationBarts Charity
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Affiliation(s)
- G Joy
- University College London , London , United Kingdom
| | - M Webber
- University College London , London , United Kingdom
| | - C I Kelly
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - I Pierce
- University College London , London , United Kingdom
| | - I Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - J Schneider
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - C Nguyen
- Massachusetts General Hospital , Massachusetts , United States of America
| | - P Kellman
- National Institutes of Health , Bethesda , United States of America
| | - M Orini
- University College London , London , United Kingdom
| | - P Lambiase
- University College London , London , United Kingdom
| | - Y Rudy
- Washington University in St Louis , Missouri , United States of America
| | - G Captur
- University College London , London , United Kingdom
| | - E Dall'armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - J C Moon
- University College London , London , United Kingdom
| | - L R Lopes
- University College London , London , United Kingdom
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Seraphim A, Knott K, Menacho K, Augusto J, Davies R, Joy G, Hui X, Treibel T, Cooper J, Petersen S, Fontana M, Hughes A, Moon J, Manisty C, Kellman P. Comparison of the prognostic value of stress and rest pulmonary transit time estimation using myocardial perfusion CMR. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.017] [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
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
Background
Pulmonary transit time (PTT) is a quantitative biomarker of cardiopulmonary status. Rest PTT was previously shown to predict outcomes in specific disease models, but clinical adoption is hindered but challenges in data acquisition. Whether evaluation of PTT during stress encodes incremental prognostic information has not been previously investigated as scale.
Objectives
To compare the prognostic value of stress and rest PTT derived from a fully automated, in-line method of estimation using perfusion CMR, in a large patient cohort.
Methods
A retrospective two-center study of patients referred clinically for adenosine stress myocardial perfusion assessment using CMR. Analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically, allowing the in-line estimation of both rest and stress PTT. Association with major adverse cardiovascular events (MACE) was evaluated. MACE was defined as a composite outcome of myocardial infarction, stroke, heart failure admission and ventricular tachycardia or appropriate ICD treatment (including ICD shock and/or anti-tachycardia pacing).
Results
985 patients (67% male, median age 62 years (IQR 52,71)) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR 54-69). Median stress PTT was shorter than rest PTT 6.2 (IQR 5.1, 7.7) seconds versus 7.7 (IQR, 6.4, 9.2) seconds. Stress and rest PTT were highly correlated (r = 0.69; p < 0.001). Stress PTT also correlated with LVEF (r=-0.37), stress MBF (r=-0.31), LVEDVi (r = 0.24), LA area index (r = 0.32) (p < 0.001 for all). Over a median follow-up period of 28.6 (IQR, 22.6 35,7) months, MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both rest and stress PTT, independently predicted MACE, but not all-cause mortality. For every 1xSD (2.39s) increase in rest PTT the adjusted hazard ratio (HR) for MACE was 1.43 (95% CI 1.10-1.85, p = 0.007). The hazard ratio for one standard deviation (2.64s) increase in stress PTT was 1.34 (95% CI 1.048-1.723; p = 0.020) after adjusting for age, LVEF, hypertension, diabetes, sex and presence of LGE
Conclusions
In this 2-center study of 985 patients, we deploy a fully automated method of PTT estimation using perfusion mapping with CMR and show that both stress and rest PTT are independently associated with adverse cardiovascular outcomes. In this patient cohort, there is no clear incremental prognostic value of stress PTT, over its evaluation during rest.
Figure 1. Stress and Rest Pulmonary Transit Time estimation using myocardial perfusion CMR
Figure 2. Event-free survival curves for major adverse cardiovascular events (Heart failure hospitalization, myocardial infarction, stroke and ventricular tachycardia/ICD treatment) according to mean rest PTT (8.05seconds) and mean stress PTT (6.7seconds). Log-rank for both p < 0.05
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Affiliation(s)
- A Seraphim
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Menacho
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Augusto
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - G Joy
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - X Hui
- National Institutes of Health, Bethesda, United States of America
| | - T Treibel
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Cooper
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Petersen
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Hughes
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
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Joy G, Artico J, Kurdi H, Lau C, Adam RD, Menacho KM, Pierce I, Captur G, Davies R, Schelbert EB, Fontana M, Kellman P, Treibel TA, Manisty C, Moon JC. Prospective case-control study of cardiovascular abnormalities six months following mild COVID-19 in healthcare workers. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC8344927 DOI: 10.1093/ehjci/jeab090.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Barts Charity UCLH Charity
OnBehalf
COVIDsortium
Background
Recent CMR studies have reported cardiac abnormalities after COVID-19 are common, even after mild, non-hospitalised illness with evidence of ongoing myocardial inflammation. Such a prevalence of chronic myocarditis after mild disease has prompted societal concerns in diverse domains, and suggests that screening should be considered post COVID-19, even in asymptomatic individuals. Cardiovascular magnetic resonance (CMR) has proven utility for diagnosis in patients with COVID-19 infection and elevated troponin from unclear causes by measuring cardiac structure, function, myocardial scar (late gadolinium enhancement) and oedema (T1 and T2 mapping).
Objectives
We aimed to determine the prevalence and extent of late cardiac and cardiovascular sequelae after mild non-hospitalised SARS-CoV-2 infection.
Methods
Participants were recruited from COVIDsortium, a three-hospital prospective study of 731 healthcare workers who underwent first wave weekly symptom, PCR and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post infection, 74 seropositive and 75 age-, sex-, ethnicity-matched seronegative controls were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated Cardiovascular Magnetic Resonance and blood biomarkers). Analysis was blinded, using objective AI analytics where available.
Results
149 subjects (mean age 37 years, range 18-63, 58% female) were recruited. Seropositive infections had been mild with case definition/non-case definition/asymptomatic disease in 45(61%), 18(24%) and 11(15%) with one person hospitalised (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass; atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterisation (T1, T2, ECV mapping, late gadolinium enhancement) or biomarkers (troponin, NT-proBNP). With abnormal defined by the 75 seronegatives (2 standard deviations from mean, e.g. EF < 54%, septal T1 > 1072ms, septal T2 > 52.4ms), individuals had abnormalities including reduced EF (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), LGE (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all NT-proBNP normal). These were distributed equally between seropositive and seronegative individuals.
Conclusions
Cardiovascular abnormalities are no more common in seropositive vs seronegative otherwise healthy, workforce representative individuals 6 months post mild SARS-CoV-2 infection. Our study provides societal reassurance for the cardiovascular health of working-aged individuals with convalescence from mild SARS-CoV-2. Screening asymptomatic individuals following mild diseases is not indicated.
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Affiliation(s)
- G Joy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Artico
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - H Kurdi
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C Lau
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - RD Adam
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - KM Menacho
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - I Pierce
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - G Captur
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- University College of London, London, United Kingdom of Great Britain & Northern Ireland
| | - EB Schelbert
- University of Pittsburgh, Pittsburgh, United States of America
| | - M Fontana
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - TA Treibel
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Joy G, Crane JD, Lau C, Augusto J, Brown LAE, Chowdhary A, Kotecha T, Plein S, Fontana M, Moon JC, Kellman P, Xue H, Cruickshank JK, Mcgowan BM, Manisty C. Impact of obesity on myocardial microvasculature assessed using fully-automated inline myocardial perfusion mapping CMR. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.296] [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: Public Institution(s). Main funding source(s): Guy"s and St Thomas" Charity University College London Hospitals Biomedical Research Centre
Background
Obesity and cardiovascular disease are associated, but the relationship is poorly understood. Myocardial perfusion, metabolic derangement and lipotoxicity appear adversely associated in many scenarios (myocardial injury, diastolic dysfunction, diabetes). Altered perfusion (by PET) predicts outcome, and it is hypothesised that perfusion derangement is part of causality for cardiac disease and adverse outcomes.
Purpose
To assess the presence and pattern of myocardial microvascular dysfunction in patients with obesity (scheduled for bariatric surgery) using stress quantitative perfusion mapping.
Methods
38 subjects with obesity planned to undergo bariatric surgery and 38 age and sex matched healthy volunteers (no diabetes, no hypertension) underwent anthropometry, biochemistry and CMR at 1.5T (Siemens) with cine imaging, stress (adenosine 140-210 mcg/kg/min) and rest fully-automated quantitative perfusion mapping.
Results
Bariatric patients had a higher BMI (44 ± 6.4 vs 26.5 ± 4kg/m2 p = 0.001); 58%(22) were diabetic and 58%(22) had hypertension. Bariatric patients had higher absolute but lower indexed end-diastolic volumes, and overall higher ejection fractions (+5%) (see Table). Rest myocardial blood flow (MBF) in bariatric patients was the same (1.00 ± 0.3 vs 0.88 ± 0.24 p = 0.052), but stress perfusion results were significantly lower both for stress MBF (2.35 ± 0.69 vs 2.93 ± 0.76ml/g/min p = 0.001) and myocardial perfusion reserve (MPR 2.48 ± 0.82 vs 3.4 ± 0.81ml/g/min p = 0.0001). Although this was transmural, the endocardial stress MBF was particularly negatively affected in the bariatric cohort compared to controls (endocardial MBF 2.16 ± 0.65 vs 2.82 ± 0.73ml/g/min, p = 0.0001 vs epicardial MBF: 2.52 ± 0.76 vs 3.06 ± 0.79 p = 0.003), meaning there was an increased endo-epicardial stress MBF gradient in bariatric patients (0.87 ± 0.12 vs 0.92 ± 0.07 p = 0.03).
Conclusion
Compared to healthy controls, patients with obesity have abnormal myocardial stress perfusion with reduced global perfusion, perfusion reserve and an increased transmyocardial perfusion gradient.
Table - myocardial perfusion parameters Category Bariatric patients n = 38 Controls n = 38 p value Age (years) 48 ± 11 45 ± 13 0.25 n male (%) 12 (32%) 10 (36%) 0.32 LVEDV (ml) 168 ± 37 149 ± 31 0.017 LVEDVi (ml/m2) 70.4 ± 12.3 78.8 ± 12.1 0.004 LV Mass (g) 116 ± 31 99 ± 28 0.019 EF (%) 70 ± 8 65 ± 5 0.002 LVEDV - left ventricular end-diastolic volume, EF - ejection fraction
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Affiliation(s)
- G Joy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - JD Crane
- King"s College London, Department of Diabetes and Nutritional Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - C Lau
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Augusto
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - LAE Brown
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Chowdhary
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Kotecha
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, United States of America
| | - H Xue
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, United States of America
| | - JK Cruickshank
- King"s College London, Department of Diabetes and Nutritional Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - BM Mcgowan
- King"s College London, Department of Diabetes and Nutritional Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
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Seraphim A, Knott K, Beirne AM, Augusto J, Menacho K, Joy G, Artico J, Bhuva A, Torii R, Triebel T, Xue H, Moon J, Jones D, Kellman P, Manisty C. Use of quantitative myocardial perfusion mapping by CMR for characterisation of ischaemia in patients post coronary artery bypass graft surgery. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.295] [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
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
Background
Quantitative myocardial perfusion mapping using Cardiac Magnetic Resonance (CMR) imaging is used for evaluation of ischaemia in the context of native vessel coronary disease, but its diagnostic performance in patients with grafts is not well established. Perfusion defects are often detected in these patients, but whether these are a consequence of a technical limitation (delayed contrast arrival from graft conduits) or a true reflection of reduced myocardial blood flow is unclear.
Methods
39 patients undergoing stress perfusion CMR with previous coronary artery bypass graft (CABG) surgery, unobstructed left internal mammary artery (LIMA) grafts to the left anterior descending (LAD) artery on coronary angiography and no CMR evidence of prior LAD infarction were included. Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) were evaluated with quantitative perfusion mapping and the factors determining MBF in the LIMA-LAD territory (AHA segments 1,2,7,8,13,14), including the impact of delayed contrast arrival through the LIMA graft were evaluated.
Results
In 28 out of 39 cases a myocardial perfusion defect was reported on visual assessment in LIMA-LAD myocardial territory, despite the presence of unobstructed LIMA graft and no LAD infarction. Chronic total occlusion (CTO) of the native LAD was an independent predictor of stress MBF (B=-0.36, p =0.027) and the strongest predictor of MPR (B=-0.55, p 0.005) within the LIMA-LAD myocardial territory after adjusting for age, left ventricular (LV) ejection fraction, and presence of diabetes. CTO of the native LAD was associated with a reduction in stress MBF in the basal myocardial segments (-0.57ml/g/min, p = 0.002) but had no effect on the MBF of apical segments (-0.31ml/g/min, p = 0.084). Increasing the maximum value for allowable arterial delay (TA) of contrast in the quantitative mapping algorithm resulted in a small increase in myocardial blood flow in the LIMA-LAD territory both at stress (0.07 ± 0.08ml/g/min, p < 0.001) and rest (0.06 ± 0.05ml/g/min, p < 0.001).
Conclusions
Perfusion defects detected in LIMA-LAD subtended territories are common despite graft patency. These defects are likely to represent genuine reduction in MBF, resulting from native LAD coronary occlusion. Prolonged contrast transit time associated with LIMA grafts results in small underestimation of MBF as measured by quantitative CMR perfusion mapping, but does not account for the degree of MBF reduction seen in these patients.
Figure 1. Study patient with unobstructed LIMA to LAD graft and evidence of inducible perfusion defect in LIMA-LAD territories. (A): First pass perfusion CMR imaging. (B): Perfusion mapping showing reduced stress MBF in mid antero-septum (0.85ml/g/min) compared to the apical septum (1.65ml/g/min). (C): Late gadolinium enhancement showing no evidence of previous infarction. (D,E): Coronary angiography demonstrating unobstructed LIMA graft (D) and anastomosis site (E).
Abstract Figure 1.
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Affiliation(s)
- A Seraphim
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - AM Beirne
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Augusto
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Menacho
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - G Joy
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Artico
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A Bhuva
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - R Torii
- University College London, Department of Mechanical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - T Triebel
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - J Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - D Jones
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - C Manisty
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
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Knott K, Seraphim A, Augusto JB, Camaioni C, Kotecha T, Xue H, Joy G, Bhuva AN, Manisty C, Brown LAE, Wong J, Fontana M, Kellman P, Plein S, Moon JC. Influences on myocardial perfusion in non-obstructive coronary disease: an observational quantitative perfusion mapping study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.297] [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
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by a Clinical Training Research Fellowship (K. Knott) from the British Heart Foundation and directly and indirectly from the Biomedical Research Centre at University College London Hospitals and Barts Heart Centre.
Background
Cardiovascular magnetic resonance (CMR) with automated inline perfusion mapping permits rapid fully automated non-invasive myocardial blood flow (MBF, ml/g/min). Understanding the microvascular component of MBF would help optimize epicardial coronary artery disease detection and potentially serve as an independent diagnostic / therapeutic target.
Purpose
To explore MBF influences at stress and rest in patients with unobstructed epicardial coronary arteries.
Methods
242 participants (mean age 56.9 years) from 5 European centers with unobstructed epicardial coronary arteries and no myocardial scar underwent adenosine vasodilator perfusion mapping at stress and rest. The factors influencing MBF were determined using univariate and multivariate linear regression analyses.
Results
Mean rest perfusion was 0.91+/-0.24ml/g/min. Rest perfusion was higher in females (0.97+/-0.22ml/g/min vs 0.83 +/- 0.24ml/g/min) and lower in patients on beta blockers. Mean stress MBF was 2.53+/-0.82ml/g/min. Factors independently associated with reduced stress MBF were increasing age, diabetes, increasing left ventricular mass (LVMi) and the use of beta blockers. The predicted stress MBF can be obtained from the equation MBF = 2.66–0.015(age-60)–0.013(LVMi-57)-0.405(diabetes)–0.365(beta blocker). This means stress MBF falls 10% over 19 years and that diabetes drops the MBF by the equivalent of being 27 years older. These changes are large: for example, a 70-year-old diabetic would have 30% lower stress MBF than a 35 year-old non-diabetic.
Conclusions
In the absence of obstructive epicardial coronary disease, stress MBF falls with age, diabetes, increased LV mass and beta-blockers. These data may help develop normal reference ranges, input to other modelling (eg CT FFR), and they advance perfusion mapping as a measure of microvascular function.
Abstract Figure. Summary of the determinants of perfusion
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Affiliation(s)
- K Knott
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Seraphim
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JB Augusto
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Camaioni
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - T Kotecha
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - G Joy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - AN Bhuva
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - LAE Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Wong
- Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- University College London, London, United Kingdom of Great Britain & Northern Ireland
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Zamora JM, Joy G, Mattman A, Ur E. Treating hyperthyroidism in the critically ill patient with rectal methimazole. Clin Endocrinol (Oxf) 2020; 92:485-487. [PMID: 31943250 DOI: 10.1111/cen.14159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jacob M Zamora
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Greta Joy
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andre Mattman
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Ehud Ur
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
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Joy G, Gaughan AP, Wharf I, Shriver DF, Dougherty JP. Single-crystal Raman evidence for and x-ray analysis of the distorted square-pyramidal pentachlorothallate and pentachloroindate complexes in bis(tetraethylammonium) pentachlorothallate and bis(tetraethylammonium) pentachloroindate. Inorg Chem 2002. [DOI: 10.1021/ic50150a011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Joy G, Logan PM. Residents' corner. Answer to case of the month #55. Intrathoracic extramedullary hematopoiesis secondary to idiopathic myelofibrosis. Can Assoc Radiol J 1998; 49:200-2. [PMID: 9640289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- G Joy
- Department of Diagnostic Imaging, Queen Elizabeth II Health Sciences Centre, Halifax, NS
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Leigh DA, Joy G. Treatment of familial staphylococcal infection--comparison of mupirocin nasal ointment and chlorhexidine/neomycin (Naseptin) cream in eradication of nasal carriage. J Antimicrob Chemother 1993; 31:909-17. [PMID: 8360128 DOI: 10.1093/jac/31.6.909] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Twenty-six families with recurrent staphylococcal infections were treated with either mupirocin nasal ointment (group M) or chlorhexidine neomycin (Naseptin) cream (group N) to the anterior nares, each combined with chlorhexidine soap for washing and chlorhexidine powder applied to other possible carriage sites. Patients receiving mupirocin following failure with chlorhexidine/neomycin (group M/N) were also treated. Treatment was given for seven days to 99 patients, 32 index (infected) patients and 67 family members. Follow-up swabs were collected by a study nurse 8, 14, 28, and 91 days after starting treatment. The carriage of Staphylococcus aureus in the anterior nares was 67%, in the axillae 22%, in the groin 23%, and perianal 19%. The carriage rates in the index patients was higher than family members, in all sites. The eradication of S. aureus from the nasal carriage site after therapy at 8 days was 95% in group M, 85% in group M/N and 61% in group N. Recolonization during the follow-up period was much less in those treated with mupirocin: 57% of patients in group M and 42% in group M/N were not carriers at 91 days, whereas 89% of patients group N were again colonized. Assessment clinically and in terms of prevention of further infective lesions showed that there was a higher response to mupirocin than to chlorhexidine/neomycin. Mupirocin nasal is a successful therapy for removing nasal carriage of S. aureus and has a prolonged effect on recolonization.
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Affiliation(s)
- D A Leigh
- Department of Microbiology, Wycombe General Hospital, Bucks, UK
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Joy G, Gaughan AP, Wharf I, Shriver DF, Dougherty JP. Single-Crystal Raman Evidence for and X-Ray Analysis of the Distorted Square-Pyramidal Pentachlorothallate and Pentachloroindate Complexes in [(C(2)H(5))(4)N](2)[TlCl(5)] and [(C(2)H(5))(4)N](2)[InCl(5)]. Inorg Chem 1975; 14:3138. [PMID: 22462476 DOI: 10.1021/ic50154a601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Joy G, Patzakis MJ, Harvey JP. Precise evaluation of the reduction of severe ankle fractures. J Bone Joint Surg Am 1974; 56:979-93. [PMID: 4211159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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