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Lim D, Varadarajan V, Quinaglia T, Pezel T, Wu C, Noda C, Heckbert S, Bluemke D, Ambale-Venkatesh B, Lima J. Change in minimum indexed left atrial volume predicts incident heart failure: the multi-ethnic study of atherosclerosis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Purpose
Longitudinal change in the left atrium prior to the onset of heart failure has not been as well studied as left atrial (LA) dysfunction in pre-existing heart failure. This study used cardiac magnetic resonance (CMR) imaging to investigate the relationship between longitudinal change in LA volume and function and incident heart failure (HF), in a multi-ethnic population free of known cardiovascular disease at baseline.
Methods and Results
In the Multi-Ethnic Study of Atherosclerosis (MESA), 2470 participants (60±9 years, 47% males), free at baseline of clinically recognized cardiovascular disease, had LA volume, emptying fractions and peak longitudinal strain assessed with Multimodality Tissue Tracking (MTT; version 6.0 Toshiba, Japan) on CMR imaging at baseline (2000-02) and at follow-up 9.4±0.6 years later. Seventy three (3%) participants subsequently developed incident HF 7.1±2.1 years after the follow-up CMR exam. In cox regression models, an annualized change in all LA parameters were significantly associated with an increased risk of incident HF. An annual increase of 1ml/m2 in minimum indexed LA volumes (∆LAVimin) was most strongly associated with the risk of incident HF (Hazard Ratio(HR)=1.85, 95% confidence interval(CI) [1.49-2.29], P<0.001) and improved model reclassification and discrimination in predicting incident HF (c-statistic=0.80, 95%CI [0.75-0.86]; NRI=0.13, P=0.04; IDI=0.04, P=0.01; x2=6.52, P=0.69) adjusting for known risk factors (age, gender, systolic blood pressure, anti-hypertensive medication use, smoking status, diabetes mellitus, total cholesterol, previous atrial fibrillation) and baseline LA parameters.
Conclusion
In this multi-ethnic population free of clinical cardiovascular disease at baseline, ∆LAVimin was most strongly associated with, and incrementally predictive of incident HF, after adjusting for known risk factors and baseline LA measures.
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Toupin S, Pezel T, Hovasse T, Sanguineti F, Champagne S, Unterseeh T, Chitiboi T, Jacob A, Borgohain I, Sharma P, Garot P, Garot J. Incremental prognostic value of fully-automatic LVEF by stress CMR using machine learning. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2023. [DOI: 10.1016/j.acvdsp.2022.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Toupin S, Pezel T, Garot P, Sanguineti F, Kinnel M, Unterseeh T, Champagne S, Hovasse T, Garot J. Prognostic value of unrecognized myocardial infarction and silent ischemia detected by stress CMR in asymptomatic patients with prior cryptogenic ischemic stroke. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2023. [DOI: 10.1016/j.acvdsp.2022.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Pezel T, Dillinger JG, Trimaille A, Delmas C, Piliero N, Bouleti C, Pommier T, El Ouahidi A, Andrieu S, Lattuca B, Rossanaly Vasram R, Noirclerc N, Schurtz G, Roubille F, Fauvel C, Bochaton T, Aboyans V, Puymirat E, Vicaut E, Henry P. Prevalence of illicit drugs use and association with in-hospital major adverse events in patients hospitalised for acute cardiac events: The ADDICT-ICCU Trial. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2023. [DOI: 10.1016/j.acvdsp.2022.10.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Pezel T, Hovasse T, Garot P, Sanguineti F, Champagne S, Unterseeh T, Toupin S, Ah-Sing T, Faradji A, Nicol M, Hamzi L, Dillinger JG, Henry P, Bousson V, Garot J. Incremental prognostic value of stress CMR for cardiovascular risk stratification in patients with known chronic kidney disease. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2023. [DOI: 10.1016/j.acvdsp.2022.10.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gall E, Pezel T, Lattuca B, Puymirat E, Hauguel-Moreau M, Gretzinger A, Trimaille A, Léquipar A, Fauvel C, Charbonnel C, Zakine C, Bedossa M, Aboyans V, Deney A, Schurtz G, Bouleti C, Rossanaly Vasram R, Bochaton T, Dillinger JG, Henry P. Description of intensive cardiac care units (ICCU) in France in 2021: Insight from ADDICT-ICCU registry. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2023. [DOI: 10.1016/j.acvdsp.2022.10.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Pezel T, Lacotte J, Horvilleur J, Toupin S, Hovasse T, Unterseeh T, Sanguineti F, Ait Said M, Salerno F, Fiorina L, Manenti V, Zouaghi A, Faradji A, Nicol M, Ah-Sing T, Dillinger JG, Henry P, Bousson V, Garot P, Garot J. Safety, feasibility and prognostic value of stress perfusion CMR in patients with MR-conditional pacemaker. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2023. [DOI: 10.1016/j.acvdsp.2022.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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8
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Pezel T, Hovasse T, Toupin S, Sanguineti F, Garot P, Champagne S, Chitiboi T, Jacob A, Borgohain I, Sharma P, Unterseeh T, Garot J. Additional prognostic value of fully automatic global longitudinal strain using machine learning. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2023. [DOI: 10.1016/j.acvdsp.2022.10.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Lim D, Varadarajan V, Quinaglia T, Pezel T, Wu C, Noda C, Heckbert S, Bluemke D, Ambale-Venkatesh B, Lima J. Change in left atrial function and volume predicts heart failure with preserved and reduced ejection fraction: the multi-ethnic study of atherosclerosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
This study used cardiac magnetic resonance (CMR) imaging to investigate the relationship between longitudinal change in left atrial (LA) function and incident heart failure (HF), in a multi-ethnic population free of known cardiovascular disease at baseline.
Methods and results
In the Multi-Ethnic Study of Atherosclerosis (MESA), 2470 participants (60±9 years, 47% males), free at baseline of clinically recognized cardiovascular disease, had LA volume and function assessed with CMR imaging at baseline (2000–02) and 9.4±0.6 years later. Seventy three (3%) participants developed incident HF over 7.1±2.1 years; of these, 39 participants had preserved ejection fraction (HFpEF) and 34 participants had reduced ejection fraction (HFrEF). An annual decrease of 1-SD unit in peak LA strain (ΔLASmax) was most strongly associated with the risk of HFpEF (subdistribution HR=2.56, 95% confidence interval (CI) [1.34–4.90], P=0.004) and improved model reclassification and discrimination in predicting HFpEF (c-statistic=0.84, 95% CI [0.79–0.90]; NRI=0.34, P=0.01; IDI=0.02, P=0.02; x2=4.25, P=0.89) adjusting for event-specific risk factors and baseline LA parameters. An annual decrease of 1ml/m2 of pre-atrial LA volume index (ΔLAVipreA) was most strongly associated with the risk of HFrEF (subdistribution HR=1.88, 95% CI [1.44–2.45], P<0.001) and improved model reclassification and discrimination in predicting HFrEF (c-statistic=0.81, 95% CI (0.72–0.90); NRI=0.31, P=0.03; IDI=0.01, P=0.50; x2=15.4, P=0.08), adjusting for event-specific risk factors and baseline LA measures (Table 1).
Conclusion
In this multi-ethnic population free of clinical cardiovascular disease at baseline, ΔLASmax and ΔLAVipreA were associated with, and incrementally predictive of HFpEF and HFrEF respectively, after adjusting for event-specific risk factors and baseline LA measures.
Disclaimer
The views expressed in this abstract are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Heart, Lung and Blood InstituteNational Center for Advancing Translational Sciences
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Pezel T, Sanguineti F, Garot P, Unterseeh T, Champagne S, Toupin S, Morisset S, Hovasse T, Ah-Sing T, Nicol M, Hamzi L, Dillinger JG, Henry P, Bousson V, Garot J. Machine-learning score using stress CMR for death prediction in patients with suspected or known CAD. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In patients with suspected or known coronary artery disease (CAD), traditional prognostic risk assessment is based upon a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables.
Purpose
To investigate the feasibility and accuracy of ML using stress CMR and clinical data to predict 10-year all-cause mortality in patients with suspected or known CAD, and compared its performance to existing clinical or CMR scores.
Methods
Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range: 5.0–8.0) included all consecutive patients referred for stress CMR. Twenty-three clinical and 11 stress CMR parameters were evaluated. Machine learning involved automated feature selection by random survival forest, model building with a multiple fractional polynomial algorithm, and 5 repetitions of 10-fold stratified cross-validation. The primary outcome was all-cause death based on the electronic National Death Registry. The external validation cohort of the ML score was performed in another center.
Results
Of 31,752 consecutive patients (mean age 63.7±12.1 years and 65.7% males), 2,679 (8.4%) died with 206,453 patient-years of follow-up. ML score (ranging 0 to 10 points) exhibited a higher area-under-the-curve compared with C-CMR-10-score, ESC-score, QRISK3-score, FRS and stress CMR data alone for prediction of 10-year all-cause mortality (ML: 0.76 vs. C-CMR-10-score: 0.68, ESC-score: 0.66, QRISK3-score: 0.64, FRS: 0.63, extent of inducible ischemia: 0.66, extent of LGE: 0.65, all p<0.001). The ML score exhibited also a good area-under-the-curve in the external cohort (AUC: 0.75).
Conclusions
The ML score including clinical and stress CMR data exhibited a higher prognostic value to predict 10-year death compared with all traditional clinical or CMR scores.
Funding Acknowledgement
Type of funding sources: None.
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Pezel T, Hovasse T, Lefevre T, Sanguineti F, Champagne S, Benamer H, Neylon A, Toupin S, Garot P, Chevalier B, Garot J. Incremental prognostic value of stress CMR in symptomatic patients with coronary stenosis on CCTA. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Noninvasive functional imaging is often performed in patients with obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA). However, the prognostic value of stress cardiovascular magnetic resonance (CMR) is unknown in patients with coronary stenosis of unknown significance on CCTA.
Purpose
To assess the prognostic value of stress CMR in symptomatic patients with obstructive CAD of unknown significance on CCTA.
Methods
Between 2008–2020, consecutive symptomatic patients without known CAD referred for CCTA were screened. Patients with obstructive CAD (at least 1 ≥50% stenosis on CCTA) were further referred for stress CMR and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction.
Results
Of 2,210 patients who completed CMR, 2,038 (46.5% male, mean age 69.8±12.2 years) completed follow-up (median 6.8 [IQR 5.9–9.2] years); 281 experienced a MACE (13.8%). Inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with MACE (HR: 4.51, [95% CI: 3.55–5.74]; and HR: 3.32, [95% CI: 2.55–4.32], respectively; p<0.001). In multivariable Cox regression, number of segments with >70% stenosis, with noncalcified plaques and number of vessels with obstructive CAD were prognosticators (p<0.001). The presence of inducible ischemia and LGE were independent predictors of MACE (HR: 3.97, [95% CI: 3.43–5.13]; HR: 2.30, [95% CI: 1.52–3.33]; p<0.001). After adjustment, stress CMR showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA (C-statistic improvement: 0.04; NRI=0.421; IDI=0.047).
Conclusions
In symptomatic patients with obstructive CAD of unknown significance on CCTA, stress CMR had incremental prognostic value to predict MACE.
Funding Acknowledgement
Type of funding sources: None.
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Pezel T, Bluemke D, Wu C, Lima J, Ambale Venkatesh B. Regional strain score as prognostic marker of cardiovascular events. from the Multi-Ethnic Study of Atherosclerosis (MESA). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) circumferential strain (Ecc) is an accurate indicator of regional myocardial function, particularly using the regional Ecc or layer-specific strain.
Purpose
To investigate the prognostic value of a regional strain score (RSS) for predicting the incident of heart failure (HF) and coronary heart disease (CHD) in a population without a history of cardiovascular disease at baseline.
Methods
In Multi-Ethnic Study of Atherosclerosis (MESA), 1,506 study participants (63.3±9.4 years, 54.6% men) underwent tagged magnetic resonance imaging for left ventricular circumferential strain (Ecc) analysis. Using −17% and −10% as Ecc cut-offs, each segment was rated from 0–2 points according to the Ecc value of each layer. The endo-Ecc, mid-Ecc, and epi-Ecc values from the 16-segment model were used to calculate three RSS: Endo-, Mid-, and Epi-RSS, respectively, which were defined as a percentage of good LV regional function. The Intramyocardial-RSS was the sum of these three RSS. Cox proportional models were used to evaluate the association between RSS and cardiovascular outcomes.
Results
After a median [IQR] follow-up of 15.9 [12.9–16.6] years, 122 hard CHD and 91 HF were observed. After adjustment, Mid-, Epi-, and Intramyocardial-RSS values <50% were independently associated with HF (HR 1.43; 95% CI [1.08–2.87], p=0.004; HR 1.80; 95% CI [1.12–3.07], p<0.001; and HR 2.01; 95% CI [1.19–3.20], p<0.001). After adjustment, Endo-, Mid-, Epi-, and Intramyocardial-RSS <50% were also independently associated with hard CHD (HR 1.31; 95% CI [1.03–1.51], p=0.04; HR 1.79; 95% CI [1.26–2.57], p<0.001; HR 2.03; 95% CI [1.45–3.40], p<0.001; and HR 2.28; 95% CI [1.51–3.53], p<0.001).
Conclusion
Layer-specific regional Ecc, assessed by RSS, provides a robust, independent predictive value for incident HF and hard CHD in asymptomatic participants without any cardiovascular disease at baseline.
Funding Acknowledgement
Type of funding sources: None.
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Pezel T, Dreyfus J, Mouhat B, Thebaut C, Audureau E, Bernard A, Lavie Badie Y, Bohbot Y, Fard D, Biere L, Le Ven F, Fauvel C, Donal E, Mansencal N, Coisne A. Efficacy of simulation-based training on transoesophageal echocardiography learning in a multicentre randomised controlled trial: SIMULATOR study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence on the impact of simulation-based training in transesophageal echocardiography (TEE) is scarce.
Purpose
We aimed to assess the efficacy of simulation-based versus traditional teaching on TEE knowledge and skills for cardiology residents.
Methods
Between November 2020 and November 2021, all consecutive cardiology residents inexperienced from TEE were randomised (1:1, n=324) through 42 French University Centers into two groups with or without simulation support (either a simulation group or a traditional group). The coprimary outcomes were the scores in the final theoretical and practical tests 3 months after the training. TEE duration and the feelings of residents were also assessed. An economic analysis was also performed.
Results
While the theoretical and practical test scores were similar between the two groups before the training (respectively P=0.80 and P=0.51), the residents in the simulation group displayed higher theoretical test and practical test scores after the training than those in the traditional group (respectively 47.2±15.6% vs. 38.3±19.8%, P<0.0001 and 74.5±17.7% vs. 59.0±25.1%, P<0.0001). Subgroups analyses showed that the efficacy of the simulation training was even greater when performed at the beginning of residency (P<0.0001). After the training, the duration to perform a complete TEE was significantly lower in the simulation group than in the traditional group (respectively 8.3±1.4 min vs. 9.4±1.2 min, P<0.0001). Finally, residents' feelings were better in the simulation group than in the traditional group across all components (P<0.0001). Compared to the traditional group, the average additional cost per resident of the simulation program was respectively €1,785, €942 or €662 for 20, 40 and 60 residents.
Conclusion
Simulation-based teaching on TEE showed a significant improvement in knowledge, skills, and feelings of cardiology residents as well as a reduction in the duration to complete the examination.
Funding Acknowledgement
Type of funding sources: None.
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Pezel T, Ambale Venkatesh B, De Vasconcellos H, Kato Y, Post WP, Wu C, Heckbert S, Bluemke D, Cohen-Solal A, Logeart D, Henry P, Lima J. Determinants of left atrioventricular coupling index: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Recent studies have described a novel left atrioventricular coupling index (LACI), which had a better prognostic value than individual left atrial (LA) or left ventricular (LV) parameters measured separately to predict cardiovascular events.
Purpose
To identify the determinants of the LACI and its 10-year annual change (ΔLACI), measured by cardiovascular magnetic resonance (CMR), and to better understand the parameters governing this left atrioventricular coupling.
Methods
In the Multi-Ethnic Study of Atherosclerosis (MESA), 2,112 study participants, free of cardiovascular disease at baseline, had LACI assessed by CMR imaging at baseline (LACIBaseline, 2000–2002) and 10 years later (2010–2012). The LACI was defined as the ratio of LA to LV end-diastolic volumes. Linear regression analyses were performed to identify independent determinants of LACIBaseline or ΔLACI.
Results
In the 2,112 participants (58.8±9.1 years, 46.6% male), after adjustment for all covariates, age was independently associated with both LACIBaseline (R2=0.10, slope=0.16) and ΔLACI (R2=0.15, slope=0.008, both p<0.001). African Americans had the highest LACIBaseline value (18.0±7.7%). Although there was no difference in LACIBaseline between women and men (p=0.19), ΔLACI was higher in women than in men (1.0±1.1 vs. 0.8±1.0%/year, p<0.001). Diabetes and a higher BMI were independently associated with LACIBaseline (both p<0.001). LACIBaseline was independently associated with LV myocardial fibrosis markers (native T1: R2=0.11, slope = 0.09, p=0.038; and extra-cellular volume: R2=0.08, slope = 0.28, p=0.035) and NT-proBNP levels (R2=0.10, slope = −1.11, p<0.001) but was not associated with IL-6 or hsCRP.
Conclusions
Age, sex, ethnicity, diabetes, and BMI were independent determinants of LACI. LACI was independently associated with LV myocardial fibrosis markers and NT-proBNP levels.
Funding Acknowledgement
Type of funding sources: None.
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Pezel T, Toupin S, Sanguineti F, Kinnel M, Hovasse T, Unterseeh T, Champagne S, Garot P, Garot J. Incremental prognostic value of stress CMR for cardiovascular risk stratification after a cryptogenic ischemic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
One-third of ischemic strokes are “cryptogenic” without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest of CAD screening in patients with cryptogenic stroke is still debated.
Purpose
The aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke.
Methods
Between 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia.
Results
Of 542 patients (55.2% male, mean age 71.4±8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18% and 17% of patients, respectively. Using Kaplan-Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE (hazard ratio, HR: 8.43 [95% CI: 5.11–13.9]; HR: 7.87 [95% CI: 4.80–12.9]; respectively, p<0.001). In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE (HR: 8.08 [95% CI: 4.21–15.5]; HR: 6.65 [95% CI: 3.49–12.7]; respectively, p<0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI=0.428; IDI=0.048).
Conclusions
In patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors.
Funding Acknowledgement
Type of funding sources: None.
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Pezel T, Dillinger JG, Trimaille A, Delmas C, Piliero N, Bouleti C, Pommier T, El Ouahidi A, Andrieu S, Lattuca B, Rossanaly Vasram R, Fard D, Noirclerc N, Vicaut E, Henry P. Prevalence of illicit drugs use and association with in-hospital major adverse events in patients hospitalised for acute cardiac events: the ADDICT-ICCU Trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prevalence and short-term cardiovascular consequences of illicit drug use in patients admitted to the intensive cardiac care unit (ICCU) for acute cardiovascular events are not well established.
Purpose
The Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study was designed to assess prospectively the prevalence of illicit drugs use, and their association with the occurrence of in-hospital major adverse events (MAEs) in consecutive patients admitted to ICCUs for acute cardiovascular events.
Methods
From 7 to 22 April 2021, screening for illicit drug was performed by systematic urinary testing in a prospective study including all consecutive patients admitted to ICCU in 39 centres throughout France. The primary outcome was the prevalence of the illicit drugs detected. The secondary clinical outcome was in-hospital Major Adverse cardiac Events (MAEs) defined by death, resuscitated cardiac arrest or cardiogenic shock.
Results
Among 1,499 consecutive patients screened (age 63.3±14.9 years, 69.6% male), 161 (10.7%) had a positive test for illicit drugs (cannabis: 9.1%, opioids: 2.1%, cocaine: 1.7%, amphetamines: 0.7%, 3,4-methylenedioxymethamphetamine: 0.6%). Patients who used illicit drugs were young (33.0% at age <40 vs. 5.9% at age ≥60 years), and more frequently male (11.9% vs. 8.1%, p<0.001). Self-reported current use was 56.5% in patients with a positive test. After a median duration of hospitalisation of five days, there were 61 in-hospital MAEs (4.1%).
The detection of illicit drugs was associated with a higher rate of MAEs after adjustment for known predictors of severity (OR=8.84; 95% CI: 4.68–16.7, p<0.001) or after using a propensity score adjustment (OR=5.81; 95% CI: 4.14–8.14, p<0.001). After adjustment for age and sex, detection of cannabis or cocaine was significantly associated with MAEs (OR=3.53; 95% CI: 1.25–9.95, p<0.001; OR=5.12; 95% CI: 1.48–17.2, p=0.004 respectively). Multiple drug detection (28% of positive patients) was associated with a higher incidence of MAEs than single drug detection.
Conclusions
The prevalence of illicit drugs use in patients hospitalised in the ICCUs for acute cardiovascular events was 10.7% and was under-reported. Illicit drugs detection was independently associated with a higher occurrence of in-hospital MAEs.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fondation Coeur et Recherche
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Pezel T, Michos ED, Varadarajan V, Shabani M, Ambale Venkatesh B, Vaidya D, Kato Y, De Vasconcellos H, Heckbert S, Wu C, Post W, Bluemke D, Allison MA, Lima J. Prognostic value of a left atrioventricular coupling index (LACI) in pre- and post-menopausal women. from the multi-ethnic study of atherosclerosis (MESA). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Endogenous sex hormones associated with both the left atrial (LA) and left ventricular (LV) structures in peri-menopausal women, but the association of menopause status with left atrioventricular coupling is not well established.
Purpose
To assess the prognostic value of a left atrioventricular coupling index (LACI) in pre- and post-menopausal women without a history of cardiovascular disease (CVD) at baseline in the Multi-Ethnic Study of Atherosclerosis (MESA).
Methods
In women participating in the MESA study, the LACI was measured as the ratio of the left atrial (LA) end-diastolic volume to the left ventricular (LV) end-diastolic volume using cardiovascular magnetic resonance (CMR). Cox proportional hazard models were used to assess the association between the LACI and the outcomes of atrial fibrillation (AF), heart failure (HF), and hard CVD defined by myocardial infarction, resuscitated cardiac arrest, stroke, or coronary heart disease death.
Results
Among the 2,087 women participants (61±10 years), 485 cardiovascular events were observed during the mean follow-up period of 13.2±3.3 years. A higher LACI was independently associated with AF (HR 1.70; 95% CI [1.51–1.90]), HF (HR 1.62; [1.33–1.97]), and hard CVD (HR 1.30; [1.13–1.51], all p<0.001). Adjusted models with the LACI showed significant improvement in model discrimination and reclassification when compared to currently used standard models used to predict the incidence of AF (C-statistic=0.82 vs. 0.79; NRI=0.325; IDI=0.036), HF (C-statistic=0.84 vs. 0.81; NRI=0.571; IDI=0.023), hard CVD (C-statistic=0.78 vs. 0.76; NRI=0.229; IDI=0.012).
Conclusion
In a multi-ethnic population of pre- and post-menopausal women, the LACI is an independent predictor of HF, AF, and hard CVD. In both pre- and post-menopausal women, the LACI has an incremental prognostic value for predicting cardiovascular events over traditional risk factors and sex hormone levels.
ClinicalTrials: gov Identifier: NCT00005487
Funding Acknowledgement
Type of funding sources: None.
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Yoon S, Fischer C, Toupin S, Pezel T, Garot J, Wetzl J, Maier A, Giese D. Fully automatic AI-based valve motion parameter extraction on long axis CINE images - application on N=11000 patient datasets. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: Private company. Main funding source(s): Research support from Siemens Healthineers GmbH.
Background
Mitral valve (MV) motion parameters, assessable using CMR [1, 2], have been shown to help the diagnosis of cardiac dysfunction. To extract valve motion parameters, we propose a fully automatic AI-based prototype system that tracks annulus and apex landmarks by the registration network on time-resolved two- and four-chamber CMR cine views. Parameters such as displacements, velocities, mitral annular plane systolic excursion (MAPSE), or longitudinal shortening (LS) are automatically extracted and evaluated on a large CMR dataset (N=11000).
Methods
The system consists of two sequential neural networks with a processing step in between (Fig. 1a) [3]. Initially, a 2D UNet is applied to localize both MV annulus insertion points as well as the apex. Based on these points, the image processing step consists of rotating, cropping, and interpolating the images, allowing a standardized image impression for both long axis views. Finally, the registration network (VoxelMorph framework [4]) is applied to the processed series and tracks the MV annulus insertion points and apex over the cardiac cycle by the deformation fields obtained by the network. The system was trained on (N=166) multivendor, multi-field strength, ground-truth annotated datasets [5].
A total of 11000 datasets, acquired on a 1.5T scanner (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany) from January 2016 to September 2017 [6], were used for parameter extraction. 200 of these datasets were additionally annotated semi-automatically for the performance evaluation of the system.
Five motion parameters were automatically derived by the system that are defined as follows (Fig. 1b): (1) The atrioventricular plane displacement (AVPD) as the distance of the plane spanned by the MV annulus points relative to the first frame, (2) the atrioventricular plane velocity (AVPV) as the discrete temporal derivate of the AVPD, (3) the diameter of the annulus as the maximum distance between the MV annulus points, (4) the lateral/inferior and septal/superior MAPSE, as the maximum MV points’ excursion, and (5) the LS as the percentage size difference of the distance between the mid valvular point and the apex point at end-systole and end-diastole.
Results
The accuracy of the system resulted in deviations on the annotated dataset of 1.02 ± 0.87 mm, 0.01 ± 0.02 mm/s, 1.54 ± 1.21 mm, 2.30 ± 1.35 mm, 2.1 ± 1.8 mm for AVPD, AVPV, diameter, MAPSE, and LS respectively. Initial statistics on all datasets (Fig. 2) revealed a mean lateral/inferior, septal/superior MAPSE and LS of 8.7 ± 2.7 mm, 10.5 ± 3.2 mm and 16.3 ± 4.2 % for two-chamber and 9.6 ± 2.6 mm, 8.7 ± 2.6 mm and 15.5 ± 3.9 % for four-chamber views, respectively.
Conclusions
The results demonstrate the versatility of the proposed system for automatic extraction of various MV motion parameters. The proposed system enables automatic extraction of clinically relevant parameters and can improve the automation of MV-based analyses. System overview & Parameter of interestsAnalysis of the extracted parameters
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Fauvel C, Trimaille A, Weizman O, Pezel T, Mika D, Waldmann V, Cohen A, Bonnet G. Cardiovascular manifestations secondary to COVID-19: A narrative review. Respir Med Res 2022; 81:100904. [PMID: 35525097 PMCID: PMC9065692 DOI: 10.1016/j.resmer.2022.100904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly, becoming a major threat to global health. In addition to having required the adaptation of healthcare workers for almost 2 years, it has been much talked about, both in the media and among the scientific community. Beyond lung damage and respiratory symptoms, the involvement of the cardiovascular system largely explains COVID-19 morbimortality. In this review, we emphasize that cardiovascular involvement is common and is associated with a worse prognosis, and that earlier detection by physicians should lead to better management. First, direct cardiac involvement will be discussed, in the form of COVID-19 myocarditis, then secondary cardiac involvement, such as myocardial injury, myocardial infarction and arrhythmias, will be considered. Finally, worsening of previous cardiovascular disease as a result of COVID-19 will be examined, as well as long-term COVID-19 effects and cardiovascular complications of COVID-19 vaccines.
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Pezel T, Michos E, Varadarajan V, Shabani M, Ambale Venkatesh B, Vaidya D, Kato Y, De Vasconcellos H, Heckbert S, Wu C, Post WENDY, Bluemke D, Allison M, Lima J. Prognostic value of left atrioventricular coupling index (LACI) in pre- and post-menopausal women : from the multi-ethnic study of atherosclerosis (MESA). Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: None.
BACKGROUND
Although endogenous sex hormones influence both left atrial (LA) and left ventricular (LV) structure in peri-menopausal women, no study has ever evaluated the interaction between sex hormones levels and the left atrioventricular coupling.
PURPOSE
This study aimed to assess the prognostic value of a left atrioventricular coupling index (LACI) in pre- and post-menopausal women without history of CVD at baseline.
METHODS
In all women participating in the Multi-Ethnic Study of Atherosclerosis (MESA) with baseline cardiovascular magnetic resonance (CMR) study, LACI was measured as the ratio of the LA end-diastolic volume divided by the LV end-diastolic volume. Cox proportional hazard models were used to assess the association between LACI and the outcomes of atrial fibrillation (AF), heart failure (HF), coronary heart disease (CHD) death, and hard CVD defined by myocardial infarction, resuscitated cardiac arrest, stroke, or CHD death. In multivariable analyses, the associations between LACI and the time-to-event were evaluated, adjusting for demographics, traditional cardiovascular risk factors, menopausal status and sex hormone levels.
RESULTS
Among the 2,087 women (61.2 ± 10.1 years), 485 cardiovascular events were observed during mean follow-up period of 13.2 ± 3.3 years. Greater LACI was independently associated with AF (HR 1.70; 95% CI [1.51-1.90]), HF (HR 1.62; 95% CI [1.33-1.97]), CHD death (HR 1.36; 95% CI [1.10-1.68]), and hard CVD (1.30; 95% CI [1.13-1.51], all p < 0.001). Adjusted models with LACI showed significant improvement in model discrimination and reclassification compared to currently used standard models to predict the incidences of AF (C-statistic: 0.82 vs. 0.79; NRI = 0.325; IDI = 0.036), HF (C-statistic: 0.84 vs. 0.81; NRI = 0.571; IDI = 0.023), CHD death (C-statistic: 0.87 vs. 0.85; NRI = 0.506; IDI = 0.012), and hard CVD (C-statistic: 0.78 vs. 0.76; NRI = 0.229; IDI = 0.012). The prognostic value of LACI was homogeneous in both pre- and post-menopausal women with a better discrimination and reclassification compared to individual LA or LV parameters.
CONCLUSIONS
In a multi-ethnic population of pre- and post-menopausal women, LACI is an independent predictor of HF, AF, CHD death and hard CVD. In both pre- and post-menopausal women, LACI has an incremental prognostic value to predict cardiovascular events over traditional risk factors and sex hormone levels.
ClinicalTrials.gov Identifier: NCT00005487 Abstract Figure. Kaplan-Meier curves by LACI terciles Abstract Figure. Kaplan-Meier curves by LACI and Menop.
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Pezel T, Sanguineti F, Garot P, Unterseeh T, Champagne S, Toupin S, Morisset S, Hovasse T, Garot J. Machine-learning score using stress CMR for death prediction in patients with suspected or known CAD. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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.
BACKGROUND
In patients with suspected or known coronary artery disease (CAD), traditional prognostic risk assessment is based upon a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables.
PURPOSE
To investigate the feasibility and accuracy of ML using stress CMR and clinical data to predict 10-year all-cause mortality in patients with suspected or known CAD, and compared its performance to existing clinical or CMR scores.
METHODS
Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range: 5.0-8.0) included all consecutive patients referred for stress CMR. Twenty-three clinical and 11 stress CMR parameters were evaluated. Machine learning involved automated feature selection by random survival forest, model building with a multiple fractional polynomial algorithm, and 5 repetitions of 10-fold stratified cross-validation. The primary outcome was all-cause death based on the electronic National Death Registry.
RESULTS
Of 31,752 consecutive patients (mean age 63.7 ± 12.1 years and 65.7% males), 2,679 (8.4%) died with 206,453 patient-years of follow-up. ML score (ranging 0 to 10 points) exhibited a higher area-under-the-curve compared with C-CMR-10-score, ESC-score, QRISK3-score, FRS and stress CMR data alone for prediction of 10-year all-cause mortality (ML: 0.76 vs. C-CMR-10-score: 0.68, ESC-score: 0.66, QRISK3-score: 0.64, FRS: 0.63, extent of inducible ischemia: 0.66, extent of LGE: 0.65, all p < 0.001).
CONCLUSIONS
The ML score including clinical and stress CMR data exhibited a higher prognostic value to predict 10-year death compared with all traditional clinical or CMR scores. Abstract Figure. Random survival Forest: ML score Abstract Figure. Prognostic Value of ML score
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Pezel T, Unterseeh T, Hovasse T, Asselin A, Lefevre T, Chevalier B, Neylon A, Benamer H, Champagne S, Sanguineti S, Toupin S, Garot P, Garot J. Phenotypic clustering of patients with newly diagnosed coronary artery disease using cardiovascular magnetic resonance and coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Epidemiological characteristics and prognostic profiles of patients with newly diagnosed coronary artery disease (CAD) are heterogeneous. Thus, providing individualized cardiovascular (CV) risk stratification and tailored prevention is crucial.
PURPOSE
Phenotypic unsupervised clustering integrating clinical, coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) data was used to unveil pathophysiological differences between subgroups of patients with newly diagnosed CAD.
METHODS
Between 2008 and 2020, consecutive patients with newly diagnosed obstructive CAD on CCTA and further referred for vasodilator stress CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. A cluster analysis was performed on clinical, CCTA and CMR variables, and associations between phenogroups and outcomes were assessed.
RESULTS
Of 2,210 patients who underwent CMR, 2,015 (46% male, mean 70 ± 12 years) completed follow-up (median 6.8[IQR 5.9-9.2] years); 277 experienced a MACE (13.7%). Three mutually exclusive and clinically distinct phenogroups (PG) were identified based upon unsupervised hierarchical clustering of principal components: [PG1] CAD in elderly patients with few traditional risk factors; [PG2] women with metabolic syndrome, calcified plaques on CCTA and preserved left ventricular ejection fraction (LVEF); and [PG3] younger male smokers with proximal noncalcified plaques on CCTA, myocardial scar and reduced LVEF. Using survival analysis, the occurrence of MACE, cardiovascular mortality and all-cause mortality (all p < 0.001) differed among the three PG, PG3 having the worse prognosis. In each PG, inducible ischemia was associated with MACE (PG1, HR = 3.09, 95%CI, 1.70-5.62; PG2, HR = 3.62, 95%CI, 2.31-5.70; PG3, HR = 3.55, 95%CI, 2.30-5.49; all p < 0.001).
CONCLUSIONS
Cluster analysis of clinical, CCTA and CMR variables identified 3 phenogroups of patients with newly diagnosed CAD that were associated with distinct clinical and prognostic profiles. Inducible ischemia assessed by stress CMR remained associated with the occurrence of MACE within each phenogroup. Abstract Figure. Cluster analysis: Biplot representation Abstract Figure. Kaplan Meier curves by Phenogroups
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Pezel T, Ambale Venkatesh B, De Vasconcellos H, Kato Y, Post W, Wu C, Heckbert S, Bluemke D, Logeart D, Henry P, Lima J. Determinants of left atrioventricular coupling index as a prognostic marker of cardiovascular events from the multi-ethnic atherosclerosis study (MESA). Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: None.
BACKGROUND
Recent studies have emphasized the incremental prognostic value of a novel left atrioventricular coupling index (LACI) and its 10-year annual change (ΔLACI) to predict cardiovascular events. However, no study has investigated the potential determinants of this index.
PURPOSE
To identify the determinants of LACI and ΔLACI, measured by cardiovascular magnetic resonance (CMR), and to better understand the parameters governing this left atrioventricular coupling in the Multi-Ethnic Study of Atherosclerosis (MESA).
METHODS
In the MESA, 2,112 study participants, free of cardiovascular disease at baseline, had LACI assessed by CMR imaging at baseline (LACIBaseline, Exam 1, 2000–2002) and 10 years later (Exam 5, 2010–2012). The LACI was defined as the ratio of left atrium to left ventricular (LV) end-diastolic volumes. Multivariable linear regression analyses were performed, adjusting for traditional risk factors and LV structure, to identify independent determinants of LACIBaseline or ΔLACI.
RESULTS
In the 2,112 participants (mean age 58.8 ± 9.1 years and 46.6% male), after adjustment for all covariates, age was independently associated with both LACIBaseline (R2 = 0.10) and ΔLACI (R2 = 0.15, both p < 0.001). Although there was no difference in LACIBaseline between women and men (p = 0.19), ΔLACI was higher in women than in men (1.0 ± 1.1 vs. 0.8 ± 1.0 %/year, p < 0.001). African Americans had the highest LACIBaseline value (18.0 ± 7.7%) while Chinese Americans had the lowest (13.8 ± 6.4%, p < 0.001). Diabetes and a higher body mass index were independently associated with LACIBaseline (coefficients B: 1.75 and 0.24, respectively, both p < 0.001). LACIBaseline was independently associated with LV myocardial fibrosis markers (native T1: R2 = 0.11, p = 0.038; and extra-cellular volume [ECV]: R2 = 0.08, p = 0.035) and NT-proBNP levels (R2 = 0.10, p < 0.001) but was not associated with inflammation biomarkers.
CONCLUSIONS
In a multi-ethnic population, age, sex, ethnicity, diabetes, and a higher body mass index were independent determinants of LACI. LACI was independently associated with LV myocardial fibrosis markers and NT-proBNP levels but not associated with inflammation biomarkers.
ClinicalTrials.gov Identifier: NCT00005487 Abstract Figure. Relationship between LACI and Age Abstract Figure. Relationship between LACI and Gender
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Pezel T, Ambale Venkatesh B, Quinaglia T, Heckbert S, Kato Y, De Vasconcellos H, Wu C, Post W, Henry P, Bluemke D, Lima J. Change in left atrioventricular coupling index to predict incident atrial fibrillation: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [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.
BACKGROUND
Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF).
PURPOSE
To investigate the prognostic value of a left atrioventricular coupling index (LACI) and average annualized change in LACI measured by cardiac MRI to predict incident AF in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA).
METHODS
In a secondary analysis of the prospective Multi-Ethnic Study of Atherosclerosis (MESA) study, 1,911 study participants, free of clinically recognized AF and cardiovascular disease at baseline, had LACI assessed with cardiac MRI at baseline (Exam 1, 2000-2002), and ten years later (Exam 5, 2010-2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average annualized change in LACI (ΔLACI) with incident AF.
RESULTS
Among the 1,911 participants (mean age 59 ± 9 years and 907 men), 87 incident AF events occurred over 3.9 ± 0.9 years following the second imaging (Exam 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (HR 1.69, 95% CI[1.46-1.96] and HR 1.71, 95% CI[1.50-1.94], respectively; both p<.001). Adjusted models for LACI and ΔLACI showed improvement in model discrimination compared to currently used AF risk score (CHARGE-AF score) model (AUC: 0.78 vs. 0.74, and AUC: 0.80 vs. 0.74, both p<.001); and to the final model including individual LA or LV parameters for predicting AF incidence (AUC: 0.78 vs. 0.76, and AUC: 0.80 vs. 0.78, both p<.001).
CONCLUSIONS
Atrioventricular coupling (LACI) and coupling change (ΔLACI) were strong predictors for AF in a multi-ethnic population. Both had incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination compared to the CHARGE-AF score and to individual LA or LV parameters.
ClinicalTrials.gov Identifier: NCT00005487 Abstract Figure. Kaplan-Meier curves by change in LACI Abstract Figure. Kaplan-Meier curves by ΔLACI and LACI
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Pezel T, Bluemke D, Wu C, Lima J, Ambale Venkatesh B. Layer-specific regional circumferential strain as prognostic marker of cardiovascular events. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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.
BACKGROUND
Left ventricular (LV) circumferential strain (Ecc) is an accurate indicator of regional myocardial function. Recent studies have emphasized the potential superiority of regional Ecc, particularly using the layer-specific strain. To date, no studies have assessed the prognostic value of layer-specific regional Ecc in the general population.
PURPOSE
This study aimed to investigate the prognostic value of the layer-specific regional Ecc for predicting the incident of heart failure (HF) and coronary heart disease (CHD) in a population without a history of cardiovascular disease at baseline.
METHODS
Data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent tagged magnetic resonance imaging for strain determination were analyzed. Using −17% and −10% as Ecc cut-offs, each segment was rated from 0–2 points according to the Ecc value of each layer. The endo-Ecc, mid-Ecc, and epi-Ecc values from the 16-segment model were used to calculate three indexes: Endo-MyoHealth, Mid-MyoHealth, and Epi-MyoHealth, respectively, which were defined as a percentage of good LV regional function. The Intramyocardial-MyoHealth index was the sum of these three MyoHealth indexes. Cox proportional hazard models were used to evaluate the association between each MyoHealth index and incident HF and hard CHD.
RESULTS
Among the 1,506 participants (63.3 ± 9.4 years, 54.6% men), 122 cases of hard CHD and 91 cases of HF were observed (median [IQR] follow-up 15.9 [12.9-16.6] years). After adjustment, Mid-, Epi-, and Intramyocardial-MyoHealth index values <50% were independently associated with HF (adjusted HR 1.43; 95% CI [1.08-2.87], p = 0.004; HR 1.80; 95% CI [1.12-3.07], p < 0.001; and HR 2.01; 95% CI [1.19-3.20], p < 0.001). After adjustment, Endo-, Mid-, Epi-, and Intramyocardial-MyoHealth <50% were also independently associated with hard CHD (adjusted HR 1.31; 95% CI [1.03-1.51], p = 0.04; HR 1.79; 95% CI [1.26-2.57], p < 0.001; HR 2.03; 95% CI [1.45-3.40], p < 0.001; and HR 2.28; 95% CI [1.51-3.53], p < 0.001).
CONCLUSIONS
Layer-specific regional Ecc, assessed via MyoHealth indexes, provides a robust, independent predictive value for incident HF and hard CHD in asymptomatic participants without any history of previous clinical cardiovascular disease.
Unique identifier Clinical.gov : NCT00005487. Abstract Figure. Abstract Figure. Kaplan Meier curves
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