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Askani E, Rospleszcz S, Lorbeer R, Wintergerst C, Müller-Peltzer K, Nattenmüller J, Hasic D, von Krüchten R, Kellner E, Reisert M, Rathmann W, Peters A, Schlett CL, Bamberg F, Storz C. MRI-based adrenal gland volume is associated with cardiovascular alterations in individuals without prior cardiovascular disease. Sci Rep 2024; 14:14664. [PMID: 38918570 PMCID: PMC11199666 DOI: 10.1038/s41598-024-65673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/24/2024] [Indexed: 06/27/2024] Open
Abstract
Aim of this study was to analyse the associations of cardiovascular health and adrenal gland volume as a rather new imaging biomarker of chronic hypothalamic-pituitary-adrenal (HPA) axis activation. The study population originates from the KORA population-based cross-sectional prospective cohort. 400 participants without known cardiovascular disease underwent a whole-body MRI. Manual segmentation of adrenal glands was performed on VIBE-Dixon gradient-echo sequence. MRI based evaluation of cardiac parameters was achieved semi-automatically. Cardiometabolic risk factors were obtained through standardized interviews and medical examination. Univariate and multivariate associations were derived. Bi-directional causal mediation analysis was performed. 351 participants were eligible for analysis (56 ± 9.1 years, male 58.7%). In multivariate analysis, significant associations were observed between adrenal gland volume and hypertension (outcome hypertension: Odds Ratio = 1.11, 95% CI [1.01, 1.21], p = 0.028), left ventricular remodelling index (LVRI) (outcome LVRI: β = 0.01, 95% CI [0.00, 0.02], p = 0.011), and left ventricular (LV) wall thickness (outcome LV wall thickness: β = 0.06, 95% CI [0.02, 0.09], p = 0.005). In bi-directional causal mediation analysis adrenal gland volume had a borderline significant mediating effect on the association between hypertension and LVRI (p = 0.052) as well as wall thickness (p = 0.054). MRI-based assessment of adrenal gland enlargement is associated with hypertension and LV remodelling. Adrenal gland volume may serve as an indirect cardiovascular imaging biomarker.
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Affiliation(s)
- Esther Askani
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Rospleszcz
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK E.V.), Munich, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilans-University Hospital, Munich, Germany
| | - Charlotte Wintergerst
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Müller-Peltzer
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dunja Hasic
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ricarda von Krüchten
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Wolfgang Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Site Neuherberg, Neuherberg, Germany
| | - Annette Peters
- Department of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK E.V.), Munich, Germany
- German Center for Diabetes Research (DZD), Partner Site Neuherberg, Neuherberg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Corinna Storz
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
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Xu Z, Li W, Wang J, Wang F, Sun B, Xiang S, Luo X, Meng Y, Wang X, Wang X, Song J, Zhang M, Xu D, Zhou X, Ju Z, Sun J, Han Y, Chen Y. Reference Ranges of Ventricular Morphology and Function in Healthy Chinese Adults: A Multicenter 3 T MRI Study. J Magn Reson Imaging 2024; 59:812-822. [PMID: 37530736 DOI: 10.1002/jmri.28903] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) reference ranges for ventricular morphology and function in the Chinese population are lacking. PURPOSE To establish the MRI reference ranges of left and right ventricular (LV and RV) morphology and function based on a large multicenter cohort. STUDY TYPE Prospective. POPULATION One thousand and twelve healthy Chinese Han adults. FIELD STRENGTH/SEQUENCE Balanced steady-state free procession cine sequence at 3.0 T. ASSESSMENT Biventricular end-diastolic, end-systolic, stroke volume, and ejection fraction (EDV, ESV, SV, and EF), LV mass (LVM), end-diastolic and end-systolic dimension (LVEDD and LVESD), anteroseptal wall thickness (AS), and posterolateral wall thickness (PL) were measured. Body surface area (BSA) and height were used to index biventricular parameters. Parameters were compared between age groups and sex. STATISTICAL TESTS Independent-samples t-tests or Mann-Whitney U test to compare mean values between sexes; ANOVA or Kruskal-Wallis test to compare mean values among age groups; linear regression to assess the relationships between cardiac parameters and age (correlation coefficient, r). A P value <0.05 was considered statistically significant. RESULTS The biventricular volumes, LVM, LVEDD, RVEDV/LVEDV ratio, LVESD, AS, and PL were significantly greater in males than in females, even after indexing to BSA or height, while LVEF and RVEF were significantly lower in males than in females. For both sexes, age was significantly negatively correlated with biventricular volumes (male and female: LVEDV [r = -0.491; r = -0.373], LVESV [r = -0.194; r = -0.184], RVEDV [r = -0.639; r = -0.506], RVESV [r = -0.270; r = -0.223]), with similar correlations after BSA normalization. LVEF (r = 0.043) and RVEF (r = 0.033) showed a significant correlation with age in females, but not in males (P = 0.889; P = 0.282). DATA CONCLUSION MRI reference ranges for biventricular morphology and function in Chinese adults are presented and show significant associations with age and sex. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ziqian Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Wang
- Department of Radiology, Anqing Municipal Hospital, Anqing, China
| | - Bin Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shifeng Xiang
- Department of Radiology, Handan Central Hospital, Handan, China
| | - Xiao Luo
- Department of Radiology, Maanshan People's Hospital, Maanshan, China
| | - Yanfeng Meng
- Department of Radiology, Taiyuan Central Hospital, Taiyuan, China
| | - Xiang Wang
- Department of Radiology, Wuhan Central Hospital, Wuhan, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Jinan, China
| | - Jianxun Song
- Department of Radiology, Shenzhen Baoan People's Hospital, Shenzhen, China
| | - Min Zhang
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Dinghu Xu
- Department of Radiology, Nanjing Jiangning Hospital, Nanjing, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Zhiguo Ju
- College of Medical Imaging, Shanghai University of Medicine & Health Science, Shanghai, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchi Han
- Cardiovascular Division, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Raisi-Estabragh Z, Kenawy AAM, Aung N, Cooper J, Munroe PB, Harvey NC, Petersen SE, Khanji MY. Variation in left ventricular cardiac magnetic resonance normal reference ranges: systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2021; 22:494-504. [PMID: 32460308 PMCID: PMC8081427 DOI: 10.1093/ehjci/jeaa089] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/09/2020] [Accepted: 04/09/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS To determine population-related and technical sources of variation in cardiac magnetic resonance (CMR) reference ranges for left ventricular (LV) quantification through a formal systematic review and meta-analysis. METHODS AND RESULTS This study is registered with the International Prospective Register of Systematic Reviews (CRD42019147161). Relevant studies were identified through electronic searches and assessed by two independent reviewers based on predefined criteria. Fifteen studies comprising 2132 women and 1890 men aged 20-91 years are included in the analysis. Pooled LV reference ranges calculated using random effects meta-analysis with inverse variance weighting revealed significant differences by age, sex, and ethnicity. Men had larger LV volumes and higher LV mass than women [LV end-diastolic volume (mean difference = 6.1 mL/m2, P-value = 0.014), LV end-systolic volume (MD = 4 mL/m2, P-value = 0.033), LV mass (mean difference = 12 g/m2, P-value = 7.8 × 10-9)]. Younger individuals had larger LV end-diastolic volumes than older ages (20-40 years vs. ≥65 years: women MD = 14.0 mL/m2, men MD = 14.7 mL/m2). East Asians (Chinese, Korean, Singaporean-Chinese, n = 514) had lower LV mass than Caucasians (women: MD = 6.4 g/m2, P-value = 0.016; men: MD = 9.8 g/m2, P-value = 6.7 × 10-5). Between-study heterogeneity was high for all LV parameters despite stratification by population-related factors. Sensitivity analyses identified differences in contouring methodology, magnet strength, and post-processing software as potential sources of heterogeneity. CONCLUSION There is significant variation between CMR normal reference ranges due to multiple population-related and technical factors. Whilst there is need for population-stratified reference ranges, limited sample sizes and technical heterogeneity precludes derivation of meaningful unified ranges from existing reports. Wider representation of different populations and standardization of image analysis is urgently needed to establish such reference distributions.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Asmaa A M Kenawy
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Patricia B Munroe
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit (MRCLEU), Tremona Rd, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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Rao NN, Stokes MB, Rajwani A, Ullah S, Williams K, King D, Macaulay E, Russell CH, Olakkengil S, Carroll RP, Faull RJ, Teo KS, McDonald SP, Worthley MI, Coates PT. Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients. Circulation 2019; 139:2809-2818. [DOI: 10.1161/circulationaha.118.038505] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Nitesh N. Rao
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Lyell McEwin Hospital, Northern Adelaide Local Health Network, Australia (N.N.R.)
| | - Michael B. Stokes
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
| | - Adil Rajwani
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
- Department of Cardiology, Royal Perth Hospital, Australia (A.R.)
| | - Shahid Ullah
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Australia and New Zealand Dialysis and Transplant Registry 1 (S.U., S.P.M.), South Australian Health and Medical Research Institute, Adelaide
| | - Kerry Williams
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
| | - David King
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Department of Vascular Surgery (D.K., E.M.), Central Adelaide Local Health Network, Australia
| | - Ewan Macaulay
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Department of Vascular Surgery (D.K., E.M.), Central Adelaide Local Health Network, Australia
| | - Christine H. Russell
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Santosh Olakkengil
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Robert P. Carroll
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Randall J. Faull
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Karen S.L. Teo
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
| | - Stephen P. McDonald
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Australia and New Zealand Dialysis and Transplant Registry 1 (S.U., S.P.M.), South Australian Health and Medical Research Institute, Adelaide
| | - Matthew I. Worthley
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
- Heart Health Theme (M.I.W.), South Australian Health and Medical Research Institute, Adelaide
| | - P. Toby Coates
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
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Ascending aortic blood flow velocity is increased in children with primary snoring/mild sleep-disordered breathing and associated with an increase in CD8
+
T cells expressing TNFα and IFNγ. Heart Vessels 2017; 33:537-548. [DOI: 10.1007/s00380-017-1090-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/17/2017] [Indexed: 12/18/2022]
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Morariu M, Bordi L, Opincariu D, Ratiu AM, Condrea S, Benedek A, Benedek T. New Developments in Magnetic Resonance Imaging of Myocardial Diseases – Technical Aspects and Clinical Applications. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractCardiac magnetic resonance imaging is an evolving imaging method that can be used in cardiovascular pathology evaluation. Technological developments have increased the clinical utility of cardiac magnetic resonance in the exploration of various cardiac abnormalities. The most important imaging techniques and their utility will be presented in this review, together with the advantages and limitations of cardiac magnetic resonance and with a brief presentation of common cardiac disorders that can be assessed by cardiac magnetic resonance including ischemic heart disease, cardiomyopathies and myocarditis.
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7
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Petersen SE, Aung N, Sanghvi MM, Zemrak F, Fung K, Paiva JM, Francis JM, Khanji MY, Lukaschuk E, Lee AM, Carapella V, Kim YJ, Leeson P, Piechnik SK, Neubauer S. Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort. J Cardiovasc Magn Reson 2017; 19:18. [PMID: 28178995 PMCID: PMC5304550 DOI: 10.1186/s12968-017-0327-9] [Citation(s) in RCA: 360] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is the gold standard method for the assessment of cardiac structure and function. Reference ranges permit differentiation between normal and pathological states. To date, this study is the largest to provide CMR specific reference ranges for left ventricular, right ventricular, left atrial and right atrial structure and function derived from truly healthy Caucasian adults aged 45-74. METHODS Five thousand sixty-five UK Biobank participants underwent CMR using steady-state free precession imaging at 1.5 Tesla. Manual analysis was performed for all four cardiac chambers. Participants with non-Caucasian ethnicity, known cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Remaining participants formed the healthy reference cohort; reference ranges were calculated and were stratified by gender and age (45-54, 55-64, 65-74). RESULTS After applying exclusion criteria, 804 (16.2%) participants were available for analysis. Left ventricular (LV) volumes were larger in males compared to females for absolute and indexed values. With advancing age, LV volumes were mostly smaller in both sexes. LV ejection fraction was significantly greater in females compared to males (mean ± standard deviation [SD] of 61 ± 5% vs 58 ± 5%) and remained static with age for both genders. In older age groups, LV mass was lower in men, but remained virtually unchanged in women. LV mass was significantly higher in males compared to females (mean ± SD of 53 ± 9 g/m2 vs 42 ± 7 g/m2). Right ventricular (RV) volumes were significantly larger in males compared to females for absolute and indexed values and were smaller with advancing age. RV ejection fraction was higher with increasing age in females only. Left atrial (LA) maximal volume and stroke volume were significantly larger in males compared to females for absolute values but not for indexed values. LA ejection fraction was similar for both sexes. Right atrial (RA) maximal volume was significantly larger in males for both absolute and indexed values, while RA ejection fraction was significantly higher in females. CONCLUSIONS We describe age- and sex-specific reference ranges for the left ventricle, right ventricle and atria in the largest validated normal Caucasian population.
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Affiliation(s)
- Steffen E Petersen
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Nay Aung
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Mihir M Sanghvi
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Filip Zemrak
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Jose Miguel Paiva
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Jane M Francis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Aaron M Lee
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Young Jin Kim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Paul Leeson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
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Moldenhauer LM, Cockshell MP, Frost L, Parham KA, Tvorogov D, Tan LY, Ebert LM, Tooley K, Worthley S, Lopez AF, Bonder CS. Interleukin-3 greatly expands non-adherent endothelial forming cells with pro-angiogenic properties. Stem Cell Res 2015; 14:380-95. [PMID: 25900163 DOI: 10.1016/j.scr.2015.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 03/25/2015] [Accepted: 04/01/2015] [Indexed: 12/19/2022] Open
Abstract
Circulating endothelial progenitor cells (EPCs) provide revascularisation for cardiovascular disease and the expansion of these cells opens up the possibility of their use as a cell therapy. Herein we show that interleukin-3 (IL3) strongly expands a population of human non-adherent endothelial forming cells (EXnaEFCs) with low immunogenicity as well as pro-angiogenic capabilities in vivo, making their therapeutic utilisation a realistic option. Non-adherent CD133(+) EFCs isolated from human umbilical cord blood and cultured under different conditions were maximally expanded by day 12 in the presence of IL3 at which time a 350-fold increase in cell number was obtained. Cell surface marker phenotyping confirmed expression of the hematopoietic progenitor cell markers CD133, CD117 and CD34, vascular cell markers VEGFR2 and CD31, dim expression of CD45 and absence of myeloid markers CD14 and CD11b. Functional experiments revealed that EXnaEFCs exhibited classical properties of endothelial cells (ECs), namely binding of Ulex europaeus lectin, up-take of acetylated-low density lipoprotein and contribution to EC tube formation in vitro. These EXnaEFCs demonstrated a pro-angiogenic phenotype within two independent in vivo rodent models. Firstly, a Matrigel plug assay showed increased vascularisation in mice. Secondly, a rat model of acute myocardial infarction demonstrated reduced heart damage as determined by lower levels of serum creatinine and a modest increase in heart functionality. Taken together, these studies show IL3 as a potent growth factor for human CD133(+) cell expansion with clear pro-angiogenic properties (in vitro and in vivo) and thus may provide clinical utility for humans in the future.
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Affiliation(s)
- Lachlan M Moldenhauer
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia; Co-operative Research Centre for Biomarker Translation, La Trobe University, Melbourne, Victoria, Australia
| | - Michaelia P Cockshell
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia; Co-operative Research Centre for Biomarker Translation, La Trobe University, Melbourne, Victoria, Australia
| | - Lachlan Frost
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Kate A Parham
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia
| | - Denis Tvorogov
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia
| | - Lih Y Tan
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia
| | - Lisa M Ebert
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia
| | - Katie Tooley
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia; Co-operative Research Centre for Biomarker Translation, La Trobe University, Melbourne, Victoria, Australia
| | - Stephen Worthley
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Centre for Stem Cell Research, Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Angel F Lopez
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia; Co-operative Research Centre for Biomarker Translation, La Trobe University, Melbourne, Victoria, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Claudine S Bonder
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia; Co-operative Research Centre for Biomarker Translation, La Trobe University, Melbourne, Victoria, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Centre for Stem Cell Research, Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia.
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Left ventricle: fully automated segmentation based on spatiotemporal continuity and myocardium information in cine cardiac magnetic resonance imaging (LV-FAST). BIOMED RESEARCH INTERNATIONAL 2015; 2015:367583. [PMID: 25738153 PMCID: PMC4337041 DOI: 10.1155/2015/367583] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/04/2015] [Accepted: 01/12/2015] [Indexed: 12/29/2022]
Abstract
CMR quantification of LV chamber volumes typically and manually defines the basal-most LV, which adds processing time and user-dependence. This study developed an LV segmentation method that is fully automated based on the spatiotemporal continuity of the LV (LV-FAST). An iteratively decreasing threshold region growing approach was used first from the midventricle to the apex, until the LV area and shape discontinued, and then from midventricle to the base, until less than 50% of the myocardium circumference was observable. Region growth was constrained by LV spatiotemporal continuity to improve robustness of apical and basal segmentations. The LV-FAST method was compared with manual tracing on cardiac cine MRI data of 45 consecutive patients. Of the 45 patients, LV-FAST and manual selection identified the same apical slices at both ED and ES and the same basal slices at both ED and ES in 38, 38, 38, and 41 cases, respectively, and their measurements agreed within −1.6 ± 8.7 mL, −1.4 ± 7.8 mL, and 1.0 ± 5.8% for EDV, ESV, and EF, respectively. LV-FAST allowed LV volume-time course quantitatively measured within 3 seconds on a standard desktop computer, which is fast and accurate for processing the cine volumetric cardiac MRI data, and enables LV filling course quantification over the cardiac cycle.
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Dundon BK, Torpey K, Nelson AJ, Wong DT, Duncan RF, Meredith IT, Faull RJ, Worthley SG, Worthley MI. The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study. Int J Nephrol Renovasc Dis 2014; 7:337-45. [PMID: 25258554 PMCID: PMC4172192 DOI: 10.2147/ijnrd.s66390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim Arteriovenous fistula-formation remains critical for the provision of hemodialysis in end-stage renal failure patients. Its creation results in a significant increase in cardiac output, with resultant alterations in cardiac stroke volume, systemic blood flow, and vascular resistance. The impact of fistula-formation on cardiac and vascular structure and function has not yet been evaluated via “gold standard” imaging techniques in the modern era of end-stage renal failure care. Methods A total of 24 patients with stage 5 chronic kidney disease undergoing fistula-creation were studied in a single-arm pilot study. Cardiovascular magnetic resonance imaging was undertaken at baseline, and prior to and 6 months following fistula-creation. This gold standard imaging modality was used to evaluate, via standard brachial flow-mediated techniques, cardiac structure and function, aortic distensibility, and endothelial function. Results At follow up, left ventricular ejection fraction remained unchanged, while mean cardiac output increased by 25.0% (P<0.0001). Significant increases in left and right ventricular end-systolic volumes (21% [P=0.014] and 18% [P<0.01]), left and right atrial area (11% [P<0.01] and 9% [P<0.01]), and left ventricular mass were observed (12.7% increase) (P<0.01). Endothelial-dependent vasodilation was significantly decreased at follow up (9.0%±9% vs 3.0%±6%) (P=0.01). No significant change in aortic distensibility was identified. Conclusion In patients with end-stage renal failure, fistula-formation is associated with an increase in cardiac output, dilation of all cardiac chambers and deterioration in endothelial function.
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Affiliation(s)
- Benjamin K Dundon
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia ; Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Kim Torpey
- Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Adam J Nelson
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Dennis Tl Wong
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Rae F Duncan
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Randall J Faull
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Stephen G Worthley
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Matthew I Worthley
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Dundon BK, Torpey DK, Nelson AJ, Wong DTL, Duncan RF, Meredith IT, Faull RJ, Worthley SG, Worthley MI. Beneficial cardiovascular remodeling following arterio-venous fistula ligation post-renal transplantation: a longitudinal magnetic resonance imaging study. Clin Transplant 2014; 28:916-25. [DOI: 10.1111/ctr.12402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin K. Dundon
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - David K. Torpey
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Adam J. Nelson
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Dennis T. L. Wong
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Rae F. Duncan
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Ian T. Meredith
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Randall J. Faull
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Stephen G. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
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Wong DTL, Leong DP, Weightman MJ, Richardson JD, Dundon BK, Psaltis PJ, Leung MCH, Meredith IT, Worthley MI, Worthley SG. Magnetic resonance-derived circumferential strain provides a superior and incremental assessment of improvement in contractile function in patients early after ST-segment elevation myocardial infarction. Eur Radiol 2014; 24:1219-28. [PMID: 24723232 DOI: 10.1007/s00330-014-3137-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/28/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND We evaluate whether circumferential strain derived from grid-tagged CMR is a better method for assessing improvement in segmental contractile function after STEMI compared to late gadolinium enhancement (LGE). METHODS STEMI patients post primary PCI underwent baseline CMR (day 3) and follow-up (day 90). Cine, grid-tagged and LGE images were acquired. Baseline LGE infarct hyperenhancement was categorised as ≤25 %, 26-50 %, 51-75 % and >75 % hyperenhancement. The segmental baseline circumferential strain (CS) and circumferential strain rate (CSR) were calculated from grid-tagged images. Segments demonstrating an improvement in wall motion of ≥1 grade compared to baseline were regarded as having improved segmental contractile-function. RESULTS Forty-five patients (aged 58 ± 12 years) and 179 infarct segments were analysed. A baseline CS cutoff of -5 % had sensitivity of 89 % and specificity of 70 % for detection of improvement in segmental-contractile-function. On receiver-operating characteristic analysis for predicting improvement in contractile function, AUC for baseline CS (0.82) compared favourably to LGE hyperenhancement (0.68), MVO (0.67) and baseline-CSR (0.74). On comparison of AUCs, baseline CS was superior to LGE hyperenhancement and MVO in predicting improvement in contractile function (P < 0.001). On multivariate-analysis, baseline CS was the independent predictor of improvement in segmental contractile function (P < 0.001). CONCLUSION Grid-tagged CMR-derived baseline CS is a superior predictor of improvement in segmental contractile function, providing incremental value when added to LGE hyperenhancement and MVO following STEMI. KEY POINTS Baseline CS predicts contractile function recovery better than LGE and MVO following STEMI. Baseline CS predicts contractile function recovery better than baseline CSR following STEMI. Baseline CS provides incremental value to LGE and MVO following STEMI.
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Affiliation(s)
- Dennis T L Wong
- Discipline of Medicine, University of Adelaide, Adelaide, Australia,
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Bertaso AG, Richardson JD, Wong DT, Cunnington MS, Nelson AJ, Tayeb H, Williams K, Chew DP, Worthley MI, Teo KS, Worthley SG. Prognostic value of adenosine stress perfusion cardiac MRI with late gadolinium enhancement in an intermediate cardiovascular risk population. Int J Cardiol 2013; 167:2055-60. [DOI: 10.1016/j.ijcard.2012.05.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 02/09/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022]
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Richardson JD, Bertaso AG, Frost L, Psaltis PJ, Carbone A, Koschade B, Wong DT, Nelson AJ, Paton S, Williams K, Azarisman S, Worthley MI, Teo KS, Gronthos S, Zannettino ACW, Worthley SG. Cardiac magnetic resonance, transthoracic and transoesophageal echocardiography: a comparison of in vivo assessment of ventricular function in rats. Lab Anim 2013; 47:291-300. [PMID: 23836849 DOI: 10.1177/0023677213494373] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In vivo assessment of ventricular function in rodents has largely been restricted to transthoracic echocardiography (TTE). However 1.5 T cardiac magnetic resonance (CMR) and transoesophageal echocardiography (TOE) have emerged as possible alternatives. Yet, to date, no study has systematically assessed these three imaging modalities in determining ejection fraction (EF) in rats. Twenty rats underwent imaging four weeks after surgically-induced myocardial infarction. CMR was performed on a 1.5 T scanner, TTE was conducted using a 9.2 MHz transducer and TOE was performed with a 10 MHz intracardiac echo catheter. Correlation between the three techniques for EF determination and analysis reproducibility was assessed. Moderate-strong correlation was observed between the three modalities; the greatest between CMR and TOE (intraclass correlation coefficient (ICC) = 0.89), followed by TOE and TTE (ICC = 0.70) and CMR and TTE (ICC = 0.63). Intra- and inter-observer variations were excellent with CMR (ICC = 0.99 and 0.98 respectively), very good with TTE (0.90 and 0.89) and TOE (0.87 and 0.84). Each modality is a viable option for evaluating ventricular function in rats, however the high image quality and excellent reproducibility of CMR offers distinct advantages even at 1.5 T with conventional coils and software.
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Affiliation(s)
- J D Richardson
- Cardiovascular Research Centre, Royal Adelaide Hospital and Department of Medicine, University of Adelaide, South Australia, Australia
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Wong DT, Leung MC, Das R, Liew GY, Teo KS, Chew DP, Meredith IT, Worthley MI, Worthley SG. Intracoronary ECG during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction predicts microvascular obstruction and infarct size. Int J Cardiol 2013; 165:61-6. [DOI: 10.1016/j.ijcard.2011.07.078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 06/23/2011] [Accepted: 07/25/2011] [Indexed: 11/24/2022]
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Wong DTL, Weightman MJ, Baumert M, Tayeb H, Richardson JD, Puri R, Bertaso AG, Roberts-Thomson KC, Sanders P, Worthley MI, Worthley SG. Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging. Eur Radiol 2012; 22:1651-8. [PMID: 22752521 DOI: 10.1007/s00330-012-2417-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 01/04/2012] [Accepted: 01/12/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). METHODS Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'border-zone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). RESULTS We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 ± 4.6 vs -5.9 ± 7.4, P < 0.001) and CSR (-86.4 ± 33.3 vs -73.5 ± 51.4, P < 0.001) severity compared with infarct regions. Patients with 'border-zone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03). CONCLUSION Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. KEY POINTS • Grid-tagged cardiac magnetic resonance (CMR) offers new insights into myocardial mechanical function. • Grid-tagged CMR identified different characteristics in 'border-zone' and 'adjacent' peri-infarct myocardial regions. • Reduced very-low-frequency (VLF) power is associated with arrhythmic and mortality risk. • The presence of 'border-zone' peri-infarct region correlated with reduced VLF power.
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Affiliation(s)
- Dennis T L Wong
- Cardiovascular Research Centre, Royal Adelaide Hospital and Discipline of Medicine, University of Adelaide, Adelaide, South Australia
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Wong DTL, Leung MCH, Das R, Puri R, Liew GYH, Teo KSL, Chew DP, Meredith IT, Worthley MI, Worthley SG. Intracoronary ECG ST-segment recovery during primary percutaneous intervention for ST-segment myocardial infarction: insights from a cardiac MRI study. Catheter Cardiovasc Interv 2012; 80:746-53. [PMID: 22422674 DOI: 10.1002/ccd.23455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 10/25/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND ST-segment-resolution (STR) on surface electrocardiogram (ECG) is a good surrogate for myocardial reperfusion in patients with acute ST-segment-elevation-myocardial-infarction (STEMI). We sort to determine the optimal criteria of measuring STR on intracoronary-ECG (IC-ECG) for prediction of myocardial injury evaluated by cardiac MRI (CMR). METHODS Measurements of IC-ECG ST-segments were performed at baseline, immediately after (early) and 15 min (late) after achieving TIMI-3 flow during primary-PCI. The degree of ST-segment-shift from baseline noted upon the IC-ECG was divided into four groups: (group 1) ST-segment-resolution >1 mm, (group 2) <30% resolution, (group 3) >50% resolution, (group 4) >70% resolution at both early and late time points. Patients had CMR at days 3 and 90 postprimary-PCI. RESULTS Fifty two patients (aged 60 ± 11 years; 43 males) were evaluated. Early intracoronary-ECG ST-segment resolution (early IC-STR >1 mm) correlated with smaller scar mass (P = 0.003), nonviable myocardial mass (P < 0.001), and microvascular obstruction (MVO) (P = 0.004) on CMR at day 3. Ejection fraction (EF) was also better at day 3 (P = 0.026) and 90 (P = 0.039). Patients with poor early IC-STR (IC-STR <30%) conversely is associated with larger scar mass (P = 0.017), nonviable myocardial mass (P = 0.01), and MVO (P = 0.021) at day 3. This was also associated with worse EF at day 90 (P = 0.044). Neither group 3 or 4, or the late measurements of late IC-STR correlated with CMR markers of myocardial injury. CONCLUSION The degree of early IC-STR (defined by IC-STR > 1 mm or <30%) successfully predicts myocardial damage following primary-PCI for an acute STEMI. Further studies are required to investigate its potential utility.
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Affiliation(s)
- Dennis T L Wong
- Cardiovascular Research Centre, Royal Adelaide Hospital Department of Cardiology and Discipline of Medicine, University of Adelaide, Adelaide, South Australia
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Cardiac magnetic resonance derived late microvascular obstruction assessment post ST-segment elevation myocardial infarction is the best predictor of left ventricular function: a comparison of angiographic and cardiac magnetic resonance derived measurements. Int J Cardiovasc Imaging 2012; 28:1971-81. [PMID: 22310980 DOI: 10.1007/s10554-012-0021-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 01/17/2012] [Indexed: 12/12/2022]
Abstract
Microvascular obstruction (MVO) is a strong independent predictor of left ventricular remodelling and mortality following ST-segment elevation myocardial infarction (STEMI). Microvascular obstruction can be identified at angiography or with gadolinium-enhanced cardiac MRI (CMR). First-pass perfusion CMR also allows a novel quantitative evaluation of myocardial blood flow (MBF) that might provide superior predictive data in the assessment of MVO. We sought to compare angiographic and CMR derived methodologies in the assessment of MVO to determine the optimal methodology that best predicts the surrogate outcome marker of left ventricular function post STEMI. Following primary-PCI angiographic assessment of 'no-reflow' with TIMI myocardial perfusion grade (TMPG) and myocardial blush grade (MBG) were documented. Assessment of CMR derived MVO was assessed on day 3, with MVO on first-pass perfusion imaging termed 'early MVO' and on late gadolinium enhancement, 'late MVO'. Furthermore on the same day 3 CMR scan, myocardial blood flow in the infarct region was quantified at adenosine stress and rest utilizing standard perfusion imaging sequences. Assessment of remodelling, structure and function was undertaken via standard CMR imaging assessment on day 90 post-STEMI and was used as the surrogate marker for long term clinical outcome. Forty patients (age 59 ± 12 years, 84% males) were appraised. Late MVO had the strongest correlation with LVEF at 90 days compared to the CMR parameters of early MVO, stress infarct region MBF and rest infarct region MBF (r = -0.754, r = -0.588, r = 0.595 and r = 0.345 respectively). Of the angiographic parameters used to assess MVO, TMPG had the strongest relationship with MVO when assessed via CMR. Myocardial blush grade however showed no relationship to CMR derived assessment of MVO. On multivariate analysis, of all angiographic and CMR variables, late MVO was the strongest predictor of LVEF at 90 days (p = 0.004). Cardiac magnetic resonance imaging derived assessment of microvascular obstruction on late gadolinium enhancement strongly predicts left ventricular function following STEMI at 90 days.
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LAWLEY C, WAINWRIGHT C, SEGELOV E, LYNCH J, BEITH J, MCCROHON J. Pilot study evaluating the role of cardiac magnetic resonance imaging in monitoring adjuvant trastuzumab therapy for breast cancer. Asia Pac J Clin Oncol 2012; 8:95-100. [DOI: 10.1111/j.1743-7563.2011.01462.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wong DTL, Leung MCH, Das R, Liew GYH, Williams K, Dundon BK, Molaee P, Teo KSL, Meredith IT, Worthley MI, Worthley SG. Diagnostic accuracy of adenosine stress cardiovascular magnetic resonance following acute ST-segment elevation myocardial infarction post primary angioplasty. J Cardiovasc Magn Reson 2011; 13:62. [PMID: 22017888 PMCID: PMC3228752 DOI: 10.1186/1532-429x-13-62] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 10/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine stress cardiovascular magnetic resonance (CMR) has been proven an effective tool in detection of reversible ischemia. Limited evidence is available regarding its accuracy in the setting of acute coronary syndromes, particularly in evaluating the significance of non-culprit vessel ischaemia. Adenosine stress CMR and recent advances in semi-quantitative image analysis may prove effective in this area. We sought to determine the diagnostic accuracy of semi-quantitative versus visual assessment of adenosine stress CMR in detecting ischemia in non-culprit territory vessels early after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). METHODS Patients were prospectively enrolled in a CMR imaging protocol with rest and adenosine stress perfusion, viability and cardiac functional assessment 3 days after successful primary-PCI for STEMI. Three short axis slices each divided into 6 segments on first pass adenosine perfusion were visually and semi-quantitatively analysed. Diagnostic accuracy of both methods was compared with non-culprit territory vessels utilising quantitative coronary angiography (QCA) with significant stenosis defined as ≥ 70%. RESULTS Fifty patients (age 59 ± 12 years) admitted with STEMI were evaluated. All subjects tolerated the adenosine stress CMR imaging protocol with no significant complications. The cohort consisted of 41% anterior and 59% non anterior infarctions. There were a total of 100 non-culprit territory vessels, identified on QCA. The diagnostic accuracy of semi-quantitative analysis was 96% with sensitivity of 99%, specificity of 67%, positive predictive value (PPV) of 97% and negative predictive value (NPV) of 86%. Visual analysis had a diagnostic accuracy of 93% with sensitivity of 96%, specificity of 50%, PPV of 97% and NPV of 43%. CONCLUSION Adenosine stress CMR allows accurate detection of non-culprit territory stenosis in patients successfully treated with primary-PCI post STEMI. Semi-quantitative analysis may be required for improved accuracy. Larger studies are however required to demonstrate that early detection of non-culprit vessel ischemia in the post STEMI setting provides a meaningful test to guide clinical decision making and ultimately improved patient outcomes.
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Affiliation(s)
- Dennis TL Wong
- Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Michael CH Leung
- Monash Cardiovascular Research Centre, Department of Medicine (MMC), MonashUniversity, and MonashHeart, Melbourne, Australia
| | - Rajiv Das
- Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Gary YH Liew
- Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Kerry Williams
- Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Benjamin K Dundon
- Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Payman Molaee
- Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Karen SL Teo
- Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, Department of Medicine (MMC), MonashUniversity, and MonashHeart, Melbourne, Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital & Department of Medicine, University of Adelaide, Adelaide, Australia
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Duncan RF, Dundon BK, Nelson AJ, Pemberton J, Williams K, Worthley MI, Zaman A, Thomas H, Worthley SG. A Study of the 16-Segment Regional Wall Motion Scoring Index and Biplane Simpson's Rule for the Calculation of Left Ventricular Ejection Fraction: A Comparison with Cardiac Magnetic Resonance Imaging. Echocardiography 2011; 28:597-604. [DOI: 10.1111/j.1540-8175.2011.01394.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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van der Zwaan HB, Helbing WA, Boersma E, Geleijnse ML, McGhie JS, Soliman OI, Roos-Hesselink JW, Meijboom FJ. Usefulness of real-time three-dimensional echocardiography to identify right ventricular dysfunction in patients with congenital heart disease. Am J Cardiol 2010; 106:843-50. [PMID: 20816126 DOI: 10.1016/j.amjcard.2010.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 05/03/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
Because right ventricular (RV) dysfunction predicts a poor outcome in patients with congenital heart disease (CHD), regular monitoring of RV function is indicated. To date, cardiac magnetic resonance (CMR) imaging has been the reference method. A more practical, more accessible, and accurate tool would be preferred. We defined normality regarding RV systolic function using healthy controls and tested the ability of real-time 3-dimensional echocardiographic (RT3DE) findings to identify patients with CHD with RV dysfunction. The cutoff values for the RV volumes and ejection fraction (EF) were derived from the CMR imaging findings from 41 healthy controls (mean age 27 +/- 8 years, 56% men). In 100 patients with varying CHDs (mean age 27 +/- 11 years, 65% men), both RT3DE data sets (iE33) and short-axis CMR imaging (1.5 T) were obtained within 2 hours. The RT3DE and CMR RV volumes and EF were calculated using commercially available software. Receiver operating characteristic curves were created to obtain the sensitivity and specificity of the RT3DE data to identify RV dysfunction. Applying the cutoff values derived from the healthy controls using the CMR data of patients with CHD, we identified 23 patients with an enlarged indexed end-diastolic volume, 29 patients with an enlarged indexed end-systolic volume, and 21 patients with an impaired RVEF. The best cutoff values predicting RV dysfunction using the RT3DE findings were identified (indexed end-diastolic volume >105 ml/m(2), indexed end-systolic volume >54 ml/m(2), and EF <43%). The RT3DE findings revealed 23 patients with impaired RVEF, with 95% sensitivity, 89% specificity, and a negative predictive value of 99%. In conclusion, real-time 3-dimensional echocardiography is a very sensitive tool to identify RV dysfunction in patients with CHD and could be applied clinically to rule out RV dysfunction or to indicate additional quantitative analysis of RV function.
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Psaltis PJ, Carbone A, Nelson A, Lau DH, Manavis J, Finnie J, Teo KS, Mackenzie L, Sanders P, Gronthos S, Zannettino AC, Worthley SG. An Ovine Model of Toxic, Nonischemic Cardiomyopathy—Assessment by Cardiac Magnetic Resonance Imaging. J Card Fail 2008; 14:785-95. [DOI: 10.1016/j.cardfail.2008.06.449] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Revised: 06/17/2008] [Accepted: 06/30/2008] [Indexed: 11/29/2022]
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