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Wang YRJ, Yang K, Wen Y, Wang P, Hu Y, Lai Y, Wang Y, Zhao K, Tang S, Zhang A, Zhan H, Lu M, Chen X, Yang S, Dong Z, Wang Y, Liu H, Zhao L, Huang L, Li Y, Wu L, Chen Z, Luo Y, Liu D, Zhao P, Lin K, Wu JC, Zhao S. Screening and diagnosis of cardiovascular disease using artificial intelligence-enabled cardiac magnetic resonance imaging. Nat Med 2024; 30:1471-1480. [PMID: 38740996 PMCID: PMC11108784 DOI: 10.1038/s41591-024-02971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
Cardiac magnetic resonance imaging (CMR) is the gold standard for cardiac function assessment and plays a crucial role in diagnosing cardiovascular disease (CVD). However, its widespread application has been limited by the heavy resource burden of CMR interpretation. Here, to address this challenge, we developed and validated computerized CMR interpretation for screening and diagnosis of 11 types of CVD in 9,719 patients. We propose a two-stage paradigm consisting of noninvasive cine-based CVD screening followed by cine and late gadolinium enhancement-based diagnosis. The screening and diagnostic models achieved high performance (area under the curve of 0.988 ± 0.3% and 0.991 ± 0.0%, respectively) in both internal and external datasets. Furthermore, the diagnostic model outperformed cardiologists in diagnosing pulmonary arterial hypertension, demonstrating the ability of artificial intelligence-enabled CMR to detect previously unidentified CMR features. This proof-of-concept study holds the potential to substantially advance the efficiency and scalability of CMR interpretation, thereby improving CVD screening and diagnosis.
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Affiliation(s)
| | - Kai Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Wen
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Pengcheng Wang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Yuepeng Hu
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Yongfan Lai
- School of Engineering, University of Science and Technology of China, Hefei, China
| | - Yufeng Wang
- Department of Computer Science, Stony Brook University, New York, NY, USA
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Siyi Tang
- School of Medicine, Stanford University, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Angela Zhang
- School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, School of Medicine (Division of Cardiology), Stanford University, Stanford, CA, USA
| | - Huayi Zhan
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuyu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujuan Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixiang Dong
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yining Wang
- Peking Union Medical College Hospital, Beijing, China
| | - Hui Liu
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Lei Zhao
- Beijing Anzhen Hospital, Beijing, China
| | | | - Yunling Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Zixian Chen
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Yi Luo
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dongbo Liu
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Pengbo Zhao
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA
| | - Keldon Lin
- Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
| | - Joseph C Wu
- School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, School of Medicine (Division of Cardiology), Stanford University, Stanford, CA, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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2
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Rahaghi FN, Nardelli P, Harder E, Singh I, Sanchez-Ferrero GV, Ross JC, San José Estépar R, Ash SY, Hunsaker AR, Maron BA, Leopold JA, Waxman AB, San José Estépar R, Washko GR. Quantification of Arterial and Venous Morphological Markers in Pulmonary Arterial Hypertension Using Computed Tomography. Chest 2021; 160:2220-2231. [PMID: 34270966 PMCID: PMC8692106 DOI: 10.1016/j.chest.2021.06.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/25/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Pulmonary hypertension is a heterogeneous disease, and a significant portion of patients at risk for it have CT imaging available. Advanced automated processing techniques could be leveraged for early detection, screening, and development of quantitative phenotypes. Pruning and vascular tortuosity have been previously described in pulmonary arterial hypertension (PAH), but the extent of these phenomena in arterial vs venous pulmonary vasculature and in exercise pulmonary hypertension (ePH) have not been described. Research Question What are the arterial and venous manifestations of pruning and vascular tortuosity using CT imaging in PAH, and do they also occur in ePH? Study Design and Methods A cohort of patients with PAH and ePH and control subjects with available CT angiograms were retrospectively identified to examine the differential arterial and venous presence of pruning and tortuosity in patients with precapillary pulmonary hypertension not confounded by lung or thromboembolic disease. The pulmonary vasculature was reconstructed, and an artificial intelligence method was used to separate arteries and veins and to compute arterial and venous vascular volumes and tortuosity. Results A total of 42 patients with PAH, 12 patients with ePH, and 37 control subjects were identified. There was relatively lower (median [interquartile range]) arterial small vessel volume in subjects with PAH (PAH 14.7 [11.7-16.5; P < .0001]) vs control subjects (16.9 [15.6-19.2]) and venous small vessel volume in subjects with PAH and ePH (PAH 8.0 [6.5-9.6; P < .0001]; ePH, 7.8 [7.5-11.4; P = .004]) vs control subjects (11.5 [10.6-12.2]). Higher large arterial volume, however, was only observed in the pulmonary arteries (PAH 17.1 [13.6-23.4; P < .0001] vs control subjects 11.4 [8.1-15.4]). Similarly, tortuosity was higher in the pulmonary arteries in the PAH group (PAH 3.5 [3.3-3.6; P = .0002] vs control 3.2 [3.2-3.3]). Interpretation Lower small distal pulmonary vascular volume, higher proximal arterial volume, and higher arterial tortuosity were observed in PAH. These can be quantified by using automated techniques from clinically acquired CT scans of patients with ePH and resting PAH.
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Affiliation(s)
- Farbod N Rahaghi
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US.
| | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Eileen Harder
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Inderjit Singh
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | | | - James C Ross
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Rubén San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Samuel Y Ash
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Aaron B Waxman
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - George R Washko
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
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3
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GEORGE STEPHANIEM, PEARCE DANIELP, FREDERICKS LAQUANDA, MARCU CBOGDAN, MADDIPATI VEERANNA. RETROSPECTIVE COMPUTER-ASSISTED IMAGE ANALYSIS OF DOPPLER ECHOCARDIOGRAPHY IN PULMONARY HYPERTENSION PATIENTS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pulmonary hypertension (PH) is diagnosed invasively by right heart catheterization (RHC), which determines patient’s mean and systolic pulmonary artery pressure (mPAP, sPAP) and pulmonary vascular resistance (PVR). This study sought to identify non-invasive echocardiography parameters useful for screening PH. Patients ([Formula: see text]; 19 normotensive; 17 pre-capillary PH; 48 post-capillary PH) who had undergone transthoracic Doppler echocardiography and RHC within 60 days of each other were identified. Tricuspid regurgitant (TR) jet velocities, velocity spectral densities, average flow rates, and Fourier transforms (FFT) of velocity waveforms were calculated via an in-house MATLAB code. Correlations were found between the FFT magnitude at 0 Hz and sPAP and mPAP for normotensive patients; between the MATLAB-calculated TR jet and sPAP and PVR for all PH patients; and between the sum of FFT magnitudes [Formula: see text][Formula: see text]Hz and mPAP, sPAP, and PVR for post-capillary PH patients. Statistical difference was found between the FFT magnitudes at 2 Hz of pre- and post-capillary PH patients ([Formula: see text]). These results suggest non-invasive parameters with clinical utility for estimating RHC measurements and discriminating between PH types, offering a path forward for less invasive and more accessible PH screening protocol.
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Affiliation(s)
- STEPHANIE M. GEORGE
- Department of Engineering, East Carolina University, 225 Slay Building, Mail Stop 117, Greenville, North Carolina 27858, USA
| | - DANIEL P. PEARCE
- Department of Engineering, East Carolina University, 1000 E. Fifth Street, Greenville, North Carolina 27858, USA
| | - LAQUANDA FREDERICKS
- Department of Biological and Biomedical Sciences, North Carolina Central University, 1801 Fayetteville Street, Durham, North Carolina 27707, USA
| | - C. BOGDAN MARCU
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, North Carolina 27858, USA
| | - VEERANNA MADDIPATI
- Department of Internal Medicine Pulmonary, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, North Carolina 27858, USA
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4
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Alabed S, Garg P, Johns CS, Alandejani F, Shahin Y, Dwivedi K, Zafar H, Wild JM, Kiely DG, Swift AJ. Cardiac Magnetic Resonance in Pulmonary Hypertension-an Update. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020; 13:30. [PMID: 33184585 PMCID: PMC7648000 DOI: 10.1007/s12410-020-09550-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW This article reviews advances over the past 3 years in cardiac magnetic resonance (CMR) imaging in pulmonary hypertension (PH). We aim to bring the reader up-to-date with CMR applications in diagnosis, prognosis, 4D flow, strain analysis, T1 mapping, machine learning and ongoing research. RECENT FINDINGS CMR volumetric and functional metrics are now established as valuable prognostic markers in PH. This imaging modality is increasingly used to assess treatment response and improves risk stratification when incorporated into PH risk scores. Emerging techniques such as myocardial T1 mapping may play a role in the follow-up of selected patients. Myocardial strain may be used as an early marker for right and left ventricular dysfunction and a predictor for mortality. Machine learning has offered a glimpse into future possibilities. Ongoing research of new PH therapies is increasingly using CMR as a clinical endpoint. SUMMARY The last 3 years have seen several large studies establishing CMR as a valuable diagnostic and prognostic tool in patients with PH, with CMR increasingly considered as an endpoint in clinical trials of PH therapies. Machine learning approaches to improve automation and accuracy of CMR metrics and identify imaging features of PH is an area of active research interest with promising clinical utility.
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Affiliation(s)
- Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
| | - Christopher S. Johns
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
| | - Yousef Shahin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Hamza Zafar
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
| | - James M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
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5
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Abstract
Pulmonary arterial hypertension (PAH) is rare and, if untreated, has a median survival of 2-3 years. Pulmonary arterial hypertension may be idiopathic (IPAH) but is frequently associated with other conditions. Despite increased awareness, therapeutic advances, and improved outcomes, the time from symptom onset to diagnosis remains unchanged. The commonest symptoms of PAH (breathlessness and fatigue) are non-specific and clinical signs are usually subtle, frequently preventing early diagnosis where therapies may be more effective. The failure to improve the time to diagnosis largely reflects an inability to identify patients at increased risk of PAH using current approaches. To date, strategies to improve the time to diagnosis have focused on screening patients with a high prevalence [systemic sclerosis (10%), patients with portal hypertension assessed for liver transplantation (2-6%), carriers of mutations of the gene encoding bone morphogenetic protein receptor type II, and first-degree relatives of patients with heritable PAH]. In systemic sclerosis, screening algorithms have demonstrated that patients can be identified earlier, however, current approaches are resource intensive. Until, recently, it has not been considered possible to screen populations for rare conditions such as IPAH (prevalence 5-15/million/year). However, there is interest in the use of artificial intelligence approaches in medicine and the application of diagnostic algorithms to large healthcare data sets, to identify patients at risk of rare conditions. In this article, we review current approaches and challenges in screening for PAH and explore novel population-based approaches to improve detection.
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Affiliation(s)
- David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, UK
- Insigneo Institute for in silico Medicine, Sheffield, S1 3JD, UK
| | - Allan Lawrie
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, UK
- Insigneo Institute for in silico Medicine, Sheffield, S1 3JD, UK
| | - Marc Humbert
- Univ. Paris–Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
- AP-HP, Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
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6
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Johns CS, Kiely DG, Rajaram S, Hill C, Thomas S, Karunasaagarar K, Garg P, Hamilton N, Solanki R, Capener DA, Elliot C, Sabroe I, Charalamopopoulos A, Condliffe R, Wild JM, Swift AJ. Diagnosis of Pulmonary Hypertension with Cardiac MRI: Derivation and Validation of Regression Models. Radiology 2019; 290:61-68. [PMID: 30351254 PMCID: PMC6314564 DOI: 10.1148/radiol.2018180603] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/30/2018] [Accepted: 09/05/2018] [Indexed: 01/04/2023]
Abstract
Purpose To derive and test multiparametric cardiac MRI models for the diagnosis of pulmonary hypertension (PH). Materials and Methods Images and patient data from consecutive patients suspected of having PH who underwent cardiac MRI and right-sided heart catheterization (RHC) between 2012 and 2016 were retrospectively reviewed. Of 2437 MR images identified, 603 fit the inclusion criteria. The mean patient age was 61 years (range, 18-88 years; mean age of women, 60 years [range, 18-84 years]; mean age of men, 62 years [range, 22-88 years]). In the first 300 patients (derivation cohort), cardiac MRI metrics that showed correlation with mean pulmonary arterial pressure (mPAP) were used to create a regression algorithm. The performance of the model was assessed in the 303-patient validation cohort by using receiver operating characteristic (ROC) and χ2 analysis. Results In the derivation cohort, cardiac MRI mPAP model 1 (right ventricle and black blood) was defined as follows: -179 + loge interventricular septal angle × 42.7 + log10 ventricular mass index (right ventricular mass/left ventricular mass) × 7.57 + black blood slow flow score × 3.39. In the validation cohort, cardiac MRI mPAP model 1 had strong agreement with RHC-measured mPAP, an intraclass coefficient of 0.78, and high diagnostic accuracy (area under the ROC curve = 0.95; 95% confidence interval [CI]: 0.93, 0.98). The threshold of at least 25 mm Hg had a sensitivity of 93% (95% CI: 89%, 96%), specificity of 79% (95% CI: 65%, 89%), positive predictive value of 96% (95% CI: 93%, 98%), and negative predictive value of 67% (95% CI: 53%, 78%) in the validation cohort. A second model, cardiac MRI mPAP model 2 (right ventricle pulmonary artery), which excludes the black blood flow score, had equivalent diagnostic accuracy (ROC difference: P = .24). Conclusion Multiparametric cardiac MRI models have high diagnostic accuracy in patients suspected of having pulmonary hypertension. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Colletti in this issue.
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Affiliation(s)
- Christopher S. Johns
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - David G. Kiely
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Smitha Rajaram
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Catherine Hill
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Steven Thomas
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Kavitasagary Karunasaagarar
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Pankaj Garg
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Neil Hamilton
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Roshni Solanki
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - David A. Capener
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Charles Elliot
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Ian Sabroe
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Athanasios Charalamopopoulos
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Robin Condliffe
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - James M. Wild
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
| | - Andrew J. Swift
- From the Academic Department of Radiology, University of Sheffield,
Floor C, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, England
(C.S.J., P.G., R.S., D.A.C., J.M.W., A.J.S.); and Sheffield Pulmonary Vascular
Disease Unit (D.G.K., S.R., N.H., C.E., I.S., A.C., R.C.) and Department of
Radiology (C.S.J., C.H., S.T., K.K., A.J.S.), Sheffield Teaching Hospitals,
Sheffield, England
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7
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Zhang Q, Liu H, Yang J. Regulation of TGF-β1 on PI3KC3 and its role in hypertension-induced vascular injuries. Exp Ther Med 2018; 17:1717-1727. [PMID: 30783440 PMCID: PMC6364233 DOI: 10.3892/etm.2018.7128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/26/2018] [Indexed: 12/26/2022] Open
Abstract
The aim of the present study was to investigate the expression and role of transforming growth factor (TGF)-β1/phosphatidylinositol 3-kinase catalytic subunit type 3 (PI3KC3) in the peripheral blood in patients with hypertension. A total of 28 patients with primary hypertension and 20 healthy control subjects were included. Peripheral blood samples were collected. The mRNA and protein expression levels were detected by reverse transcription-quantitative polymerase chain reaction and western blot analysis, respectively. Cell counting kit-8 assay, Transwell chamber assay and flow cytometry were performed to detect the cell proliferation, migration ability and cellular apoptosis, respectively. Laser scanning confocal microscopy was used to detect the intracellular autophagosomes. The expression of TGF-β1 was significantly elevated, whereas the expression of PI3KC3 was significantly downregulated in the patients with hypertension compared with controls. There was negative correlation between the TGF-β1 and PI3KC3 expression. Following treatment with TGF-β1, the protein expression of PI3KC3 was significantly decreased in human umbilical vein endothelial cells (HUVECs), and the autophagic activity was significantly decreased. Furthermore, following the treatment of TGF-β1 the proliferation of HUVECs was significantly reduced in the HUVECs, the hypoxia-induced apoptosis rates were significantly elevated and the number of penetrating cells were significantly declined (indicating declined migration ability). However, the overexpression of PI3KC3 significantly ameliorated the proliferation, migration ability and hypoxia tolerance of TGF-β1-treated HUVECs. In conclusion, the present results indicated that TGF-β1 expression was elevated in the peripheral blood in hypertensive patients and negatively correlated with the PI3KC3 expression; and that TGF-β1 regulates the PI3KC3 signaling pathway to inhibit the autophagic activity of vascular endothelial cells, and regulate the cell proliferation, migration and anti-apoptosis ability, thus aggregating the endothelial cell injuries in hypertension. The results of the current study revealed a novel mechanism of TGF-β1 in the regulation of endothelial cell injury in hypertension, which may provide a potential target for disease therapy.
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Affiliation(s)
- Qin Zhang
- Department of Cardiology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong 277101, P.R. China
| | - Hu Liu
- Department of Cardiology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong 277101, P.R. China
| | - Jun Yang
- Department of Cardiology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong 277101, P.R. China
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8
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Johns CS, Wild JM, Rajaram S, Tubman E, Capener D, Elliot C, Condliffe R, Charalampopoulos A, Kiely DG, Swift AJ. Identifying At-Risk Patients with Combined Pre- and Postcapillary Pulmonary Hypertension Using Interventricular Septal Angle at Cardiac MRI. Radiology 2018; 289:61-68. [PMID: 29969067 PMCID: PMC6190488 DOI: 10.1148/radiol.2018180120] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 12/21/2022]
Abstract
Purpose To assess interventricular septal (IVS) angle in the identification of combined pre- and postcapillary pulmonary hypertension (Cpc-PH) in patients with pulmonary hypertension (PH) due to left-sided heart disease. Materials and Methods In this retrospective study, consecutive, incident patients suspected of having PH underwent same-day right-sided heart catheterization (RHC) and MRI at a PH referral center between April 2012 and April 2017. The diagnostic accuracy of the IVS angle to identify Cpc-PH in patients with pulmonary arterial wedge pressure (PAWP) greater than 15 mmHg was assessed by using receiver operator characteristic curves, sensitivity, specificity, and negative and positive predictive values. IVS angle also was assessed as a predictor of all-cause mortality by using Cox uni- and multivariable proportional hazards regression. Results A total of 708 patients underwent same-day MRI and RHC, and 171 patients had PAWP greater than 15 mmHg. Mean age was 70 years (range, 21-90 years) (women: mean age, 69 years; range, 21-88 years) (men: mean age, 71 years; range, 43-90 years). Systolic IVS angle correlated with diastolic pulmonary gradient (DPG) (r = 0.739, P < .001). Receiver operating characteristic curve analysis showed septal angle enabled identification of Cpc-PH (DPG ≥ 7), with an area under the receiver operating characteristic curve of 0.911 (P < .001). A 160° threshold, derived from the first half of patients with raised PAWP, enabled identification of a DPG of at least 7 mmHg with 67% sensitivity and 93% specificity (P < .001) in the second cohort of patients with raised PAWP. IVS angle was predictive of all-cause mortality (standardized univariable hazard ratio, 1.615; P < .01). Conclusion The systolic interventricular septal angle is elevated in patients with combined pre- and postcapillary pulmonary hypertension and enables one to predict those patients who have PH due to left-sided heart disease who have an increased risk of death. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Christopher S. Johns
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
| | - James M. Wild
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
| | - Smitha Rajaram
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
| | - Euan Tubman
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
| | - David Capener
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
| | - Charlie Elliot
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
| | - Robin Condliffe
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
| | - Athanasios Charalampopoulos
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
| | - David G. Kiely
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
| | - Andrew J. Swift
- From the Academic Department of Radiology, Academic Unit of
Radiology, Department of Infection, Immunity & Cardiovascular Disease,
Magnetic Resonance Imaging Unit, University of Sheffield, Royal Hallamshire
Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, England (C.S.J., J.M.W., E.T.,
D.C., A.J.S.); Sheffield Pulmonary Vascular Disease Institute (C.E., R.C., A.C.,
D.G.K.) and Department of Radiology (S.R.), Sheffield Teaching Hospitals,
Sheffield, England; and Insigneo Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (A.J.S.)
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