1
|
Kwon DH, Huang S, Turkmani M, Salam D, Al-Dieri D, Ming Wang TK, Kapadia SR, Krishnaswamy A, Gillinov M, Svensson LG, Grimm RA, Tang WW, Chen D, Nguyen CT, Wang X. Cardiac MRI-Enriched Phenomapping Classification and Differential Treatment Outcomes in Patients With Ischemic Cardiomyopathy. Circ Cardiovasc Imaging 2024; 17:e016006. [PMID: 38626097 PMCID: PMC11020053 DOI: 10.1161/circimaging.123.016006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/09/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Significant controversy continues to confound patient selection and referral for revascularization and mitral valve intervention in patients with ischemic cardiomyopathy (ICM). Cardiac magnetic resonance (CMR) enables comprehensive phenotyping with gold-standard tissue characterization and volumetric/functional measures. Therefore, we sought to determine the impact of CMR-enriched phenomapping patients with ICM to identify differential outcomes following surgical revascularization and surgical mitral valve intervention (sMVi). METHODS Consecutive patients with ICM referred for CMR between 2002 and 2017 were evaluated. Latent class analysis was performed to identify phenotypes enriched by comprehensive CMR assessment. The primary end point was death, heart transplant, or left ventricular assist device implantation. A multivariable Cox survival model was developed to determine the association of phenogroups with overall survival. Subgroup analysis was performed to assess the presence of differential response to post-magnetic resonance imaging procedural interventions. RESULTS A total of 787 patients were evaluated (63.0±11.2 years, 24.8% women), with 464 primary events. Subsequent surgical revascularization and sMVi occurred in 380 (48.3%) and 157 (19.9%) patients, respectively. Latent class analysis identified 3 distinct clusters of patients, which demonstrated significant differences in overall outcome (P<0.001). Latent class analysis identified differential survival benefit of revascularization in patients as well as patients who underwent revascularization with sMVi, based on phenogroup classification, with phenogroup 3 deriving the most survival benefit from revascularization and revascularization with sMVi (hazard ratio, 0.61 [0.43-0.88]; P=0.0081). CONCLUSIONS CMR-enriched unsupervised phenomapping identified distinct phenogroups, which were associated with significant differential survival benefit following surgical revascularization and sMVi in patients with ICM. Phenomapping provides a novel approach for patient selection, which may enable personalized therapeutic decision-making for patients with ICM.
Collapse
Affiliation(s)
- Deborah H. Kwon
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
- Department of Radiology, (D.H.K., T.K.M.W., R.A.G., C.T.N.), Cleveland Clinic, OH
| | - Shuaiqi Huang
- Quantitative Health Sciences (S.H., X.W.), Cleveland Clinic, OH
| | - Mustafa Turkmani
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Donna Salam
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Danah Al-Dieri
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Tom Kai Ming Wang
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
- Department of Radiology, (D.H.K., T.K.M.W., R.A.G., C.T.N.), Cleveland Clinic, OH
| | - Samir R. Kapadia
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Amar Krishnaswamy
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Marc Gillinov
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Lars G. Svensson
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Richard A. Grimm
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
- Department of Radiology, (D.H.K., T.K.M.W., R.A.G., C.T.N.), Cleveland Clinic, OH
| | - W.H. Wilson Tang
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - David Chen
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Christopher T. Nguyen
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
- Department of Radiology, (D.H.K., T.K.M.W., R.A.G., C.T.N.), Cleveland Clinic, OH
| | - Xiaofeng Wang
- Quantitative Health Sciences (S.H., X.W.), Cleveland Clinic, OH
| |
Collapse
|
2
|
Anthony CM, Wang TKM, Salam D, Obuchowski N, Turkmani M, Al-Deiri D, Popovic Z, Griffin B, Flamm S, Chen D, Nguyen C, Tang WW, Kwon D. Impact of Cardiac Magnetic Resonance Left Atrial Ejection Fraction in Advanced Ischemic Cardiomyopathy. JACC. ADVANCES 2024; 3:100796. [PMID: 38549681 PMCID: PMC10977265 DOI: 10.1016/j.jacadv.2023.100796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/22/2023] [Accepted: 08/16/2023] [Indexed: 06/29/2024]
Abstract
BACKGROUND The prognostic significance of cardiac magnetic resonance (CMR)-based left atrial ejection fraction (LAEF) is not well defined in the ischemic cardiomyopathy (ICM) cohort. OBJECTIVES The authors sought to assess the prognostic impact of LAEF, when adjusted for left ventricular remodeling, myocardial infarct size (MIS), left atrial volume index, and functional mitral regurgitation (FMR), on outcomes in patients with advanced ICM. METHODS ICM patients who underwent CMR were retrospectively evaluated (April 2001-December 2019). LAEF, left atrial volume index, MIS, left ventricular remodeling, and FMR were derived from CMR. The primary clinical endpoint was a composite of all-cause mortality and cardiac transplant. A baseline multivariable Cox proportional hazards regression model was constructed to assess prognostic power of LAEF. RESULTS There were 718 patients (416 primary events) evaluated, with a median duration of follow-up of 1,763 days (4.8 years) and a mean LAEF of 36% ± 15%. On multivariable analysis, higher LAEF was independently associated with reduced risk (HR: 0.24, 95% CI: 0.12-0.48, P < 0.001), even after adjusting for FMR and MIS. The highest adjusted risk was observed in patients with an LAEF <20% and an MIS of >30% (HR: 3.20, 95% CI: 1.73-5.93). The lowest risk was in patients within the comparator group with an LAEF of >50% and a MIS of <15% (HR: 1.07, 95% CI: 0.81-1.42). CONCLUSIONS Reduced LAEF is independently associated with increased mortality in ICM. Risk associated with declining LAEF is continuous and incremental to other risk factors for adverse outcomes in patients with ICM even after adjusting for MIS and FMR severity.
Collapse
Affiliation(s)
- Chris M. Anthony
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
- Monash Alfred Baker Centre for Cardiovascular Research, Melbourne, Australia
| | - Tom Kai Ming Wang
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donna Salam
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nancy Obuchowski
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mustafa Turkmani
- Internal Medicine, McLaren Oakland Program, Pontiac, Michigan, USA
| | - Danah Al-Deiri
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zoran Popovic
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Griffin
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott Flamm
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Chen
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher Nguyen
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wilson W.H. Tang
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah Kwon
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Bissolino A, Andreis A, Magnano M, Budano C, Saglietto A, Angelini F, Roagna E, Mattivi S, Peyracchia M, Errigo D, Golzio PG, Castagno D, Giustetto C, De Ferrari GM. Prognostic role of left atrial enlargement in patients with implantable cardioverter defibrillators for primary prevention. Acta Cardiol 2022; 77:45-50. [PMID: 33308049 DOI: 10.1080/00015385.2020.1856491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Left atrial volume index (LAVI) is a predictor of heart failure and adverse events, irrespective of left ventricular systolic function. The role of LAVI in the prediction of appropriate implantable cardioverter-defibrillator (ICD) therapies is currently unclear and was the focus of this study. METHODS Consecutive heart failure patients with ischaemic (ICM) or idiopathic (DCM) aetiology receiving ICD for primary prevention were included. The primary endpoint was the occurrence of appropriate ICD therapies (ATs): shocks or antitachycardia pacing (ATP). Inappropriate ICD shocks were also assessed as secondary endpoint. RESULTS Among 198 included patients, severe left atrial dilatation (SLAE = LAVI ≥ 60 ml/m2) was present in 54 (27%). SLAE patients had a higher prevalence of NYHA class ≥ III, severe mitral regurgitation and atrial fibrillation history. During a median follow-up of 45 months (IQR 25-68), ATs occurred more frequently in SLAE group (33% vs. 15%, p = .007) as well as appropriate shocks (24% vs. 10%, p = .014). At multivariate analysis SLAE was an independent predictor of ATs (OR 3.19, 95% CI 1.38-7.38, p = .007). Inappropriate shocks were associated with AF during implantation (p = .03), but not with SLAE (p = .009). CONCLUSION In DCM or ICM patients candidate to receive an ICD for primary prevention, a severely enlarged left atrium is a predictive factor for ATs (shocks or ATP). The risk of inappropriate shocks was increased in patients with atrial fibrillation, rather than SLAE.
Collapse
Affiliation(s)
- Arianna Bissolino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Massimo Magnano
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Edoardo Roagna
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Simone Mattivi
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Mattia Peyracchia
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Daniele Errigo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Pier Giorgio Golzio
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| |
Collapse
|
4
|
Rankin AJ, Zhu L, Mangion K, Rutherford E, Gillis KA, Lees JS, Woodward R, Patel RK, Berry C, Roditi G, Mark PB. Global longitudinal strain by feature-tracking cardiovascular magnetic resonance imaging predicts mortality in patients with end-stage kidney disease. Clin Kidney J 2021; 14:2187-2196. [PMID: 34804519 PMCID: PMC8598121 DOI: 10.1093/ckj/sfab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/11/2021] [Indexed: 11/12/2022] Open
Abstract
Background Patients with end-stage kidney disease (ESKD) are at increased risk of premature death, with cardiovascular disease being the predominant cause of death. We hypothesized that left ventricular global longitudinal strain (LV-GLS) measured by feature-tracking cardiovascular magnetic resonance imaging (CMRI) would be associated with all-cause mortality in patients with ESKD. Methods A pooled analysis of CMRI studies in patients with ESKD acquired within a single centre between 2002 and 2016 was carried out. CMR parameters including LV ejection fraction (LVEF), LV mass index, left atrial emptying fraction (LAEF) and LV-GLS were measured. We tested independent associations of CMR parameters with survival using a multivariable Cox model. Results Among 215 patients (mean age 54 years, 62% male), mortality was 53% over a median follow-up of 5 years. The median LVEF was 64.7% [interquartile range (IQR) 58.5-70.0] and the median LV-GLS was -15.3% (IQR -17.24 to -13.6). While 90% of patients had preserved LVEF (>50%), 58% of this group had abnormal LV-GLS (>-16%). On multivariable Cox regression, age {hazard ratio [HR] 1.04 [95% confidence interval (CI) 1.02-1.05]}, future renal transplant [HR 0.29 (95% CI 0.17-0.47)], LAEF [HR 0.98 (95% CI 0.96-1.00)] and LV-GLS [HR 1.08 (95% CI 1.01-1.16)] were independently associated with mortality. Conclusions In this cohort of patients with ESKD, LV-GLS on feature-tracking CMRI and LAEF was associated with all-cause mortality, independent of baseline clinical variables and future renal transplantation. This effect was present even when >90% of the cohort had normal LVEF. Using LV-GLS instead of LVEF to diagnose cardiac dysfunction in patients with ESKD could result in a major advance in our understanding of cardiovascular disease in ESKD.
Collapse
Affiliation(s)
- Alastair J Rankin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Luke Zhu
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Keith A Gillis
- Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rosie Woodward
- Clinical Research Imaging, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rajan K Patel
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
5
|
Krebs J, Mansi T, Delingette H, Lou B, Lima JAC, Tao S, Ciuffo LA, Norgard S, Butcher B, Lee WH, Chamera E, Dickfeld TM, Stillabower M, Marine JE, Weiss RG, Tomaselli GF, Halperin H, Wu KC, Ashikaga H. CinE caRdiac magneTic resonAnce to predIct veNTricular arrhYthmia (CERTAINTY). Sci Rep 2021; 11:22683. [PMID: 34811411 PMCID: PMC8608832 DOI: 10.1038/s41598-021-02111-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022] Open
Abstract
Better models to identify individuals at low risk of ventricular arrhythmia (VA) are needed for implantable cardioverter-defibrillator (ICD) candidates to mitigate the risk of ICD-related complications. We designed the CERTAINTY study (CinE caRdiac magneTic resonAnce to predIct veNTricular arrhYthmia) with deep learning for VA risk prediction from cine cardiac magnetic resonance (CMR). Using a training cohort of primary prevention ICD recipients (n = 350, 97 women, median age 59 years, 178 ischemic cardiomyopathy) who underwent CMR immediately prior to ICD implantation, we developed two neural networks: Cine Fingerprint Extractor and Risk Predictor. The former extracts cardiac structure and function features from cine CMR in a form of cine fingerprint in a fully unsupervised fashion, and the latter takes in the cine fingerprint and outputs disease outcomes as a cine risk score. Patients with VA (n = 96) had a significantly higher cine risk score than those without VA. Multivariate analysis showed that the cine risk score was significantly associated with VA after adjusting for clinical characteristics, cardiac structure and function including CMR-derived scar extent. These findings indicate that non-contrast, cine CMR inherently contains features to improve VA risk prediction in primary prevention ICD candidates. We solicit participation from multiple centers for external validation.
Collapse
Affiliation(s)
- Julian Krebs
- Digital Technology and Innovation Division, Siemens Healthineers, Princeton, NJ, USA
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, France
| | - Tommaso Mansi
- Digital Technology and Innovation Division, Siemens Healthineers, Princeton, NJ, USA
| | - Hervé Delingette
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, France
| | - Bin Lou
- Digital Technology and Innovation Division, Siemens Healthineers, Princeton, NJ, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susumu Tao
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | - Luisa A Ciuffo
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | - Sanaz Norgard
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | - Barbara Butcher
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | - Wei H Lee
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | - Ela Chamera
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | | | | | - Joseph E Marine
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | - Robert G Weiss
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | | | - Henry Halperin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | - Katherine C Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA
| | - Hiroshi Ashikaga
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA.
| |
Collapse
|
6
|
Ng MY, Poon J, Li A. Cardiac magnetic resonance left atrial volumes and function to predict appropriate device therapy and death. Int J Cardiovasc Imaging 2021; 37:2753-2754. [PMID: 33999353 DOI: 10.1007/s10554-021-02268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, SAR, China. .,Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Jessica Poon
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, SAR, China.,Department of Medicine, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong, SAR, China
| | - Andrew Li
- Department of Medicine, United Christian Hospital, Hong Kong, SAR, China
| |
Collapse
|
7
|
Gong IY, Yazdan-Ashoori P, Jimenez-Juan L, Tan NS, Angaran P, Chacko BR, Al-Mousawy S, Singh SM, Shalmon T, Folador L, Mangat I, Deva DP, Yan AT. Left atrial volume and function measured by cardiac magnetic resonance imaging as predictors of shocks and mortality in patients with implantable cardioverter-defibrillators. Int J Cardiovasc Imaging 2021; 37:2259-2267. [PMID: 33646496 DOI: 10.1007/s10554-021-02196-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
Left atrial (LA) volume and function (LA ejection fraction, LAEF) have demonstrated prognostic value in various cardiovascular diseases. We investigated the incremental value of LA volume and LAEF as measured by cardiovascular magnetic resonance imaging (CMR) for prediction of appropriate implantable cardioverter defibrillator (ICD) shock or all-cause mortality, in patients with ICD. We conducted a retrospective, multi-centre observational cohort study of patients who underwent CMR prior to primary or secondary prevention ICD implantation. A single, blinded reader measured maximum LA volume index (maxLAVi), minimum LA volume index (minLAVi), and LAEF. The primary outcome was a composite of independently adjudicated appropriate ICD shock or all-cause death. A total of 392 patients were enrolled. During a median follow-up time of 61 months, 140 (35.7%) experienced an appropriate ICD shock or died. Higher maxLAVi and minLAVi, and lower LAEF were associated with greater risk of appropriate ICD shock or death in univariate analysis. However, in multivariable analysis, LAEF (HR 0.92 per 10% higher, 95% CI 0.81-1.04, p = 0.17) and maxLAVi (HR 1.02 per 10 ml/m2 higher, 95% CI 0.93-1.12, p = 0.72) were not independent predictors of the primary outcome. In conclusion, LA volume and function measured by CMR were univariate but not independent predictors of appropriate ICD shocks or mortality. These findings do not support the routine assessment of LA volume and function to refine risk stratification to guide ICD implant. Larger studies with longer follow-up are required to further delineate the clinical implications of LA size and function.
Collapse
Affiliation(s)
- Inna Y Gong
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Laura Jimenez-Juan
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada.,Department of Medical Imaging, St Michael's Hospital, Toronto, Canada
| | - Nigel S Tan
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St Michael's Hospital, 30 Bond St, Toronto, M5B 1W8, Canada
| | - Paul Angaran
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St Michael's Hospital, 30 Bond St, Toronto, M5B 1W8, Canada
| | - Binita Riya Chacko
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Saif Al-Mousawy
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sheldon M Singh
- Department of Medicine, University of Toronto, Toronto, Canada.,Schulich Heart Center, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Tamar Shalmon
- Department of Medical Imaging, University of Toronto, Toronto, Canada.,Department of Medical Imaging, St Michael's Hospital, Toronto, Canada
| | - Luciano Folador
- Department of Medical Imaging, University of Toronto, Toronto, Canada.,Department of Medical Imaging, St Michael's Hospital, Toronto, Canada
| | - Iqwal Mangat
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St Michael's Hospital, 30 Bond St, Toronto, M5B 1W8, Canada
| | - Djeven P Deva
- Department of Medical Imaging, University of Toronto, Toronto, Canada.,Department of Medical Imaging, St Michael's Hospital, Toronto, Canada
| | - Andrew T Yan
- Department of Medicine, University of Toronto, Toronto, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, Canada. .,Division of Cardiology, St Michael's Hospital, 30 Bond St, Toronto, M5B 1W8, Canada. .,Department of Medical Imaging, St Michael's Hospital, Toronto, Canada.
| |
Collapse
|
8
|
Becker MAJ, van der Lingen ALCJ, Wubben M, van de Ven PM, van Rossum AC, Cornel JH, Allaart CP, Germans T. Characteristics and prognostic value of right ventricular (dys)function in patients with non-ischaemic dilated cardiomyopathy assessed with cardiac magnetic resonance imaging. ESC Heart Fail 2021; 8:1055-1063. [PMID: 33560582 PMCID: PMC8006611 DOI: 10.1002/ehf2.13072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
Aims In non‐ischaemic dilated cardiomyopathy (DCM), concomitant right ventricular (RV) dysfunction is frequently observed. This study sought to determine the correlation of RV dysfunction with several cardiac magnetic resonance (CMR) imaging characteristics in patients with DCM, and the prognostic value of RV dysfunction on all‐cause mortality and ventricular arrhythmias (VA) was evaluated. Methods and results Consecutive patients with DCM and left ventricular (LV) dysfunction (ejection fraction < 50%) on CMR were included retrospectively. Left atrial (LA), LV, and RV volumes and function were quantified. RV systolic dysfunction was defined as RVEF<45%. The presence and pattern of late gadolinium enhancement (LGE) on CMR were assessed visually. Septal midwall LGE was defined as midmyocardial stripe‐like or patchy hyperenhancement in the septal segments, and the extent was quantified using the full width at half maximum method. Primary endpoint was a composite of all‐cause mortality and VA, including resuscitated cardiac arrest, sustained VA, and appropriate implantable cardioverter defibrillator therapy. Secondary endpoints were time to all‐cause mortality alone and time to VA alone. A total of 216 DCM patients were included (42% female, age 58 ± 14 years). Mean RVEF was 46 ± 12%, and RV dysfunction was present in 38%. RVEF was moderately correlated with LA dilation (LA minimal volume ρ = −0.38, P < 0.001) and strongly correlated with LA and LV dysfunction (LA emptying fraction r = 0.58, P < 0.001 and LVEF ρ = 0.52, P < 0.001). Septal midwall LGE was more often observed in patients with RV dysfunction compared with patients with preserved RV function (respectively 40% vs. 26%, P = 0.04). No correlation was found between RVEF and the extent of septal midwall LGE (ρ = −0.12, P = 0.34). During a median follow‐up of 2.2 years [IQR 1.6–2.8], 30 patients experienced the primary endpoint. RV dysfunction was significantly associated with shorter time to the composite primary endpoint (HR 3.19 [95% CI 1.49–6.84], P < 0.01) and to the secondary endpoint of VA alone (HR 6.48 [95% CI 1.83–22.98], P < 0.01). There was a trend towards increased mortality when RV dysfunction was present (HR 2.54 [95% CI 0.99–6.57], P = 0.05). Conclusions Right ventricular dysfunction was predominantly observed in patients with DCM with advanced heart failure and pronounced myocardial remodelling, defined as increased LV and LA dilation and dysfunction and the presence of septal midwall LGE on CMR. During follow‐up, RV dysfunction was associated with shorter time to all‐cause mortality and ventricular arrhythmic events.
Collapse
Affiliation(s)
- Marthe A J Becker
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.,Department of Cardiology, Northwest Clinics Alkmaar, Alkmaar, The Netherlands
| | - Anne-Lotte C J van der Lingen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Marc Wubben
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Jan H Cornel
- Department of Cardiology, Northwest Clinics Alkmaar, Alkmaar, The Netherlands.,Department of Cardiology, Radboud University Medical Center, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Tjeerd Germans
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.,Department of Cardiology, Northwest Clinics Alkmaar, Alkmaar, The Netherlands
| |
Collapse
|
9
|
Ferreira J, Gonçalves V, Marques-Alves P, Martins R, Monteiro S, Teixeira R, Gonçalves L. Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm. Cardiovasc Ultrasound 2021; 19:1. [PMID: 33388070 PMCID: PMC7778823 DOI: 10.1186/s12947-020-00231-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/07/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. While other risk factors in severe AS are well documented, little is known about the prognostic value of left atrial (LA) function in AS. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up. METHODS We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated LA reservoir, conduit and pump function by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up. RESULTS A total of 408 patients were included in the analysis, with a median follow-up time of 45 months (interquartile range 54 months). 57.9% of patients underwent AVR and 44.9% of patients registered the primary outcome during follow-up. Left atrial emptying fraction (LAEF) was the best LA functional parameter and the best overall parameter in discriminating primary outcome (AUC 0.845, 95%CI 0.81-0.88, P < 0.001). After adjustment for clinical, demographic and echocardiographic variables, cumulative survival of patients with LAEF < 37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (HR 13.91, 95%CI 6.20-31.19, P < 0.001 and HR 3.40, 95%CI 1.57-7.37, P = 0.002, respectively). After adjustment for AVR, excess risk of LAEF < 37% and LAEF 37 to 53% relative to LAEF ≥54% remained significant (HR 11.71, 95%CI 5.20-26.40, P < 0.001 and HR 3.59, 95%CI 1.65-7.78, P = 0.001, respectively). CONCLUSIONS In patients with a first diagnosis of severe AS, LA function, evaluated by means of volumetric assessment, is an independent predictor of all-cause mortality and a more potent predictor of death compared to classical severity parameters. These data can be useful to identify high-risk patients who might benefit of AVR.
Collapse
Affiliation(s)
- João Ferreira
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Valdirene Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561, Coimbra, Portugal.,Departamento Cardio-torácico, Clínica Girassol, Luanda, Angola
| | - Patrícia Marques-Alves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561, Coimbra, Portugal.,Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Rui Martins
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Sílvia Monteiro
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Rogério Teixeira
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561, Coimbra, Portugal.,Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.,iCBR, Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561, Coimbra, Portugal.,Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.,iCBR, Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal
| |
Collapse
|
10
|
Wu KC, Wongvibulsin S, Tao S, Ashikaga H, Stillabower M, Dickfeld TM, Marine JE, Weiss RG, Tomaselli GF, Zeger SL. Baseline and Dynamic Risk Predictors of Appropriate Implantable Cardioverter Defibrillator Therapy. J Am Heart Assoc 2020; 9:e017002. [PMID: 33023350 PMCID: PMC7763383 DOI: 10.1161/jaha.120.017002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Current approaches fail to separate patients at high versus low risk for ventricular arrhythmias owing to overreliance on a snapshot left ventricular ejection fraction measure. We used statistical machine learning to identify important cardiac imaging and time-varying risk predictors. Methods and Results Three hundred eighty-two cardiomyopathy patients (left ventricular ejection fraction ≤35%) underwent cardiac magnetic resonance before primary prevention implantable cardioverter defibrillator insertion. The primary end point was appropriate implantable cardioverter defibrillator discharge or sudden death. Patient characteristics; serum biomarkers of inflammation, neurohormonal status, and injury; and cardiac magnetic resonance-measured left ventricle and left atrial indices and myocardial scar burden were assessed at baseline. Time-varying covariates comprised interval heart failure hospitalizations and left ventricular ejection fractions. A random forest statistical method for survival, longitudinal, and multivariable outcomes incorporating baseline and time-varying variables was compared with (1) Seattle Heart Failure model scores and (2) random forest survival and Cox regression models incorporating baseline characteristics with and without imaging variables. Age averaged 57±13 years with 28% women, 66% white, 51% ischemic, and follow-up time of 5.9±2.3 years. The primary end point (n=75) occurred at 3.3±2.4 years. Random forest statistical method for survival, longitudinal, and multivariable outcomes with baseline and time-varying predictors had the highest area under the receiver operating curve, median 0.88 (95% CI, 0.75-0.96). Top predictors comprised heart failure hospitalization, left ventricle scar, left ventricle and left atrial volumes, left atrial function, and interleukin-6 level; heart failure accounted for 67% of the variation explained by the prediction, imaging 27%, and interleukin-6 2%. Serial left ventricular ejection fraction was not a significant predictor. Conclusions Hospitalization for heart failure and baseline cardiac metrics substantially improve ventricular arrhythmic risk prediction.
Collapse
Affiliation(s)
- Katherine C Wu
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Shannon Wongvibulsin
- Department of Biomedical Engineering and School of Medicine Johns Hopkins University Baltimore MD
| | - Susumu Tao
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Hiroshi Ashikaga
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD.,Department of Biomedical Engineering and School of Medicine Johns Hopkins University Baltimore MD
| | | | - Timm M Dickfeld
- Department of Medicine University of Maryland Medical Systems Baltimore MD
| | - Joseph E Marine
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Robert G Weiss
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD.,The Russell H. Morgan Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore MD
| | | | - Scott L Zeger
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD
| |
Collapse
|
11
|
Yue T, Chen B, Wu L, Xu J, Pu J. Prognostic Value of Late Gadolinium Enhancement in Predicting Life‐Threatening Arrhythmias in Heart Failure Patients With Implantable Cardioverter‐Defibrillators: A Systematic Review and Meta‐Analysis. J Magn Reson Imaging 2019; 51:1422-1439. [DOI: 10.1002/jmri.26982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ting Yue
- Department of Radiology, Ren Ji HospitalShanghai Jiao Tong University School of Medicine Shanghai China
| | - Bing‐Hua Chen
- Department of Radiology, Ren Ji HospitalShanghai Jiao Tong University School of Medicine Shanghai China
| | - Lian‐Ming Wu
- Department of Radiology, Ren Ji HospitalShanghai Jiao Tong University School of Medicine Shanghai China
| | - Jian‐Rong Xu
- Department of Radiology, Ren Ji HospitalShanghai Jiao Tong University School of Medicine Shanghai China
| | - Jun Pu
- Department of Cardiology, Ren Ji HospitalShanghai Jiao Tong University School of Medicine Shanghai China
| |
Collapse
|
12
|
Lydell CP, Mikami Y, Homer K, Peng M, Cornhill A, Rajagopalan A, Arasaratnam P, Cowan K, Roberts A, Sumner C, Heydari B, Howarth AG, Exner D, White JA. Left Atrial Function Using Cardiovascular Magnetic Resonance Imaging Independently Predicts Life-Threatening Arrhythmias in Patients Referred to Receive a Primary Prevention Implantable Cardioverter Defibrillator. Can J Cardiol 2019; 35:1149-1157. [PMID: 31472813 DOI: 10.1016/j.cjca.2019.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/19/2019] [Accepted: 04/10/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In this study we aimed to investigate left atrial (LA) function, measured from routine cine cardiovascular magnetic resonance imaging, to determine its value for the prediction of sudden cardiac death (SCD) or appropriate implantable cardioverter defibrillator (ICD) shock in patients who received primary prevention ICD implantation. METHODS We studied 203 patients with ischemic or idiopathic nonischemic dilated cardiomyopathy who underwent cardiovascular magnetic resonance imaging before primary prevention ICD implantation. LA volumes were measured at end-diastole and end-systole from 4- and 2-chamber cine images, and LA emptying function (LAEF) calculated. Patients were followed for the primary composite end point of SCD or appropriate ICD shock. RESULTS Mean age was 61 ± 12 years with a mean left ventricular ejection fraction of 24 ± 7%. The mean LAEF was 27 ± 15% (range, 0.9%-73%). At a median follow-up of 1639 days, 35 patients (17%) experienced the primary composite outcome. LAEF was strongly associated with the primary outcome (P = 0.001); patients with an LAEF ≤ 30% experienced a cumulative event rate of 26.1% vs 5.7% (hazard ratio, 5.5; P < 0.001) in patients above this cutoff. This finding was maintained in multivariable analysis (hazard ratio, 4.7; P = 0.002) and was consistently shown in the ischemic and nonischemic dilated cardiomyopathy subgroups. CONCLUSIONS LAEF is a simple, powerful, and independent predictor of SCD in patients being referred for primary prevention ICD implantation.
Collapse
Affiliation(s)
- Carmen P Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Kai Homer
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Mingkai Peng
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aidan Cornhill
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Archa Rajagopalan
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Punitha Arasaratnam
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Karen Cowan
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Roberts
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire Sumner
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek Exner
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
13
|
Left Atrial Function and Sudden Cardiac Death. Can J Cardiol 2019; 35:1091-1093. [DOI: 10.1016/j.cjca.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/20/2022] Open
|