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Sahashi Y, Vukadinovic M, Duffy G, Li D, Cheng S, Berman DS, Ouyang D, Kwan AC. Using Deep learning to Predict Cardiovascular Magnetic Resonance Findings from Echocardiography Videos. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.16.24305936. [PMID: 38699330 PMCID: PMC11065018 DOI: 10.1101/2024.04.16.24305936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Echocardiography is the most common modality for assessing cardiac structure and function. While cardiac magnetic resonance (CMR) imaging is less accessible, CMR can provide unique tissue characterization including late gadolinium enhancement (LGE), T1 and T2 mapping, and extracellular volume (ECV) which are associated with tissue fibrosis, infiltration, and inflammation. While deep learning has been shown to uncover findings not recognized by clinicians, it is unknown whether CMR-based tissue characteristics can be derived from echocardiography videos using deep learning. We hypothesized that deep learning applied to echocardiography could predict CMR-based measurements. Methods In a retrospective single-center study, adult patients with CMRs and echocardiography studies within 30 days were included. A video-based convolutional neural network was trained on echocardiography videos to predict CMR-derived labels including wall motion abnormality (WMA) presence, LGE presence, and abnormal T1, T2 or ECV across echocardiography views. The model performance was evaluated in a held-out test dataset not used for training. Results The study population included 1,453 adult patients (mean age 56±18 years, 42% female) with 2,556 paired echocardiography studies occurring on average 2 days after CMR (interquartile range 2 days prior to 6 days after). The model had high predictive capability for presence of WMA (AUC 0.873 [95%CI 0.816-0.922]), however, the model was unable to reliably detect the presence of LGE (AUC 0.699 [0.613-0.780]), native T1 (AUC 0.614 [0.500-0.715]), T2 0.553 [0.420-0.692], or ECV 0.564 [0.455-0.691]). Conclusions Deep learning applied to echocardiography accurately identified CMR-based WMA, but was unable to predict tissue characteristics, suggesting that signal for these tissue characteristics may not be present within ultrasound videos, and that the use of CMR for tissue characterization remains essential within cardiology. Clinical Perspective Tissue characterization of the heart muscle is useful for clinical diagnosis and prognosis by identifying myocardial fibrosis, inflammation, and infiltration, and can be measured using cardiac MRI. While echocardiography is highly accessible and provides excellent functional information, its ability to provide tissue characterization information is limited at this time. Our study using a deep learning approach to predict cardiac MRI-based tissue characteristics from echocardiography showed limited ability to do so, suggesting that alternative approaches, including non-deep learning methods should be considered in future research.
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Sveric KM, Ulbrich S, Dindane Z, Winkler A, Botan R, Mierke J, Trausch A, Heidrich F, Linke A. Improved assessment of left ventricular ejection fraction using artificial intelligence in echocardiography: A comparative analysis with cardiac magnetic resonance imaging. Int J Cardiol 2024; 394:131383. [PMID: 37757986 DOI: 10.1016/j.ijcard.2023.131383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) measurement in echocardiography (Echo) using the recommended modified biplane Simpson (MBS) method is operator-dependent and exhibits variability. We aimed to assess the accuracy of a novel fully automated (Auto) artificial intelligence (AI) in view selection and biplane LVEF calculation compared to MBS-Echo, with cardiac magnetic resonance imaging (CMR) as reference. METHODS Each of the 301 consecutive patients underwent CMR and Echo on the same day. LVEF was measured independently by Auto-Echo, MBS-Echo and CMR. Interobserver (n = 40) and test-retest (n = 14) analysis followed. RESULTS A total of 229 patients (76%) underwent complete analysis. Auto-Echo and MBS-Echo showed high correlations with CMR (R = 0.89 and 0.89) and with each other (R = 0.93). Auto underestimated LVEF (bias: 2.2%; limits of agreement [LOA]: -13.5 to 17.9%), while MBS overestimated it (bias: -2.2%; LOA: 18.6 to 14.1%). Despite comparable areas under the curves of Auto- and MBS-Echo (0.93 and 0.92), 46% (n = 70) of MBS-Echo misclassified LVEF by ≥5% units in patients with a reduced CMR-LVEF <51%. Although LVEF bias variability across different LV function ranges was significant (p < 0.001), Auto-Echo was closer to CMR for patients with reduced LVEF, wall motion abnormalities, and poor image quality than MBS-Echo. The interobserver correlation coefficient of Auto-Echo was excellent compared to MBS-Echo (1.00 vs. <0.91) for different readers. True test-retest variability was higher for MBS-Echo than for Auto-Echo (7.9% vs. 2.5%). CONCLUSION The tested AI has the potential to improve the clinical utility of Echo by reducing user-related variability, providing more accurate and reliable results than MBS.
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Affiliation(s)
- Krunoslav Michael Sveric
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, Dresden 01307, Germany.
| | - Stefan Ulbrich
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, Dresden 01307, Germany
| | - Zouhir Dindane
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, Dresden 01307, Germany
| | - Anna Winkler
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, Dresden 01307, Germany
| | - Roxana Botan
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, Dresden 01307, Germany
| | - Johannes Mierke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, Dresden 01307, Germany
| | - Anne Trausch
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, Dresden 01307, Germany
| | - Felix Heidrich
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, Dresden 01307, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, Dresden 01307, Germany
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Zhang Y, Zhu Y, Wang D, Xu L, Jiang W, Wang J, Sun X, Kang L, Song L. Cardiac index: A superior parameter of cardiac function than left ventricular ejection fraction in risk stratification of hypertrophic cardiomyopathy. Heart Rhythm 2023:S1547-5271(23)00212-6. [PMID: 36870381 DOI: 10.1016/j.hrthm.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND An appropriate indicator of cardiac function in the risk stratification of hypertrophic cardiomyopathy (HCM) patients is urgently needed. Cardiac index that reflects cardiac pumping function may be suitable. OBJECTIVE The purpose of this study was to investigate the clinical significance of reduced cardiac index in HCM patients. METHODS A total of 927 HCM patients were enrolled. The primary endpoint was cardiovascular death. The secondary endpoints were sudden cardiac death (SCD) and all-cause death. Combination models were constructed by adding reduced cardiac index and reduced left ventricular ejection fraction (LVEF) to the HCM risk-SCD model. Predictive accuracy was determined by C-statistics. RESULTS Reduced cardiac index was defined as cardiac index ≤2.42 L/min/m2. During median follow-up of 4.3 years, 51 patients reached the endpoint. Reduced cardiac index independently increased the risk of cardiovascular death (adjusted hazard ratio [aHR] 2.976; P = .007), SCD (aHR 6.385; P = .001), and all-cause death (aHR 2.428; P = .010). By adding reduced cardiac index to the HCM risk-SCD model, the model C-statistic increased from 0.691 to 0.762, with an integrated discrimination improvement of 0.021 (P = .018) and a net reclassification improvement of 0.560 (P = .007). The addition of reduced LVEF failed to improve the original model. Better predictive accuracy for all endpoints was also indicated in reduced cardiac index than in reduced LVEF. CONCLUSION Reduced cardiac index is an independent predictor of poor prognoses in HCM patients. Combining reduced cardiac index rather than reduced LVEF improved the HCM risk-SCD stratification strategy. The reduced cardiac index showed better predictive accuracy than reduced LVEF for all endpoints.
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Affiliation(s)
- Yu Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuming Zhu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Wang
- Cardiomyopathy Ward, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lianjun Xu
- Cardiomyopathy Ward, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen Jiang
- Cardiomyopathy Ward, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jizheng Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolu Sun
- Cardiomyopathy Ward, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Lianming Kang
- Cardiomyopathy Ward, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Lei Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Cardiomyopathy Ward, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Mabudian L, Jordan JH, Bottinor W, Hundley WG. Cardiac MRI assessment of anthracycline-induced cardiotoxicity. Front Cardiovasc Med 2022; 9:903719. [PMID: 36237899 PMCID: PMC9551168 DOI: 10.3389/fcvm.2022.903719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
The objective of this review article is to discuss how cardiovascular magnetic resonance (CMR) imaging measures left ventricular (LV) function, characterizes tissue, and identifies myocardial fibrosis in patients receiving anthracycline-based chemotherapy (Anth-bC). Specifically, CMR can measure LV ejection fraction (EF), volumes at end-diastole (LVEDV), and end-systole (LVESV), LV strain, and LV mass. Tissue characterization is accomplished through T1/T2-mapping, late gadolinium enhancement (LGE), and CMR perfusion imaging. Despite CMR’s accuracy and efficiency in collecting data about the myocardium, there are challenges that persist while monitoring a cardio-oncology patient undergoing Anth-bC, such as the presence of other cardiovascular risk factors and utility controversies. Furthermore, CMR can be a useful adjunct during cardiopulmonary exercise testing to pinpoint cardiovascular mediated exercise limitations, as well as to assess myocardial microcirculatory damage in patients undergoing Anth-bC.
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Affiliation(s)
- Leila Mabudian
- Division of Cardiology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, United States
| | - Jennifer H. Jordan
- Division of Cardiology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, United States
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States
| | - Wendy Bottinor
- Division of Cardiology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, United States
| | - W. Gregory Hundley
- Division of Cardiology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, United States
- *Correspondence: W. Gregory Hundley,
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Elmadi J, Satish Kumar L, Pugalenthi LS, Ahmad M, Reddy S, Barkhane Z. Cardiovascular Magnetic Resonance Imaging: A Prospective Modality in the Diagnosis and Prognostication of Heart Failure. Cureus 2022; 14:e23840. [PMID: 35530891 PMCID: PMC9072284 DOI: 10.7759/cureus.23840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) is a clinical syndrome resulting from structural cardiac remodeling and altered function that impairs tissue perfusion. This article aimed to highlight the current diagnostic and prognostic value of cardiac magnetic resonance (CMR) in the management of HF and prospective future applications. Reviewed are the physics associated with CMR, its use in ischemic and non-ischemic causes of HF, and its role in quantifying left ventricular ejection fraction. It also emphasized that CMR allows for noninvasive morphologic and functional assessment, tissue characterization, blood flow, and perfusion evaluation in patients with suspected or diagnosed HF. CMR has become a crucial instrument for the diagnosis, prognosis, and therapy planning in patients with HF and cardiomyopathy due to its accuracy in quantifying cardiac volumes and ejection fraction (considered the gold standard) as well as native and post-contrast myocardial tissue characterization.
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Cicco S. Diet as cornerstone of cardiovascular prevention: the key role of coffee consumption. Eur J Prev Cardiol 2022; 29:979-981. [PMID: 35148374 DOI: 10.1093/eurjpc/zwac030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sebastiano Cicco
- Department of Biomedical Sciences and Human Oncology (DIMO), Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro Medical School.,Unit of Internal Medicine "Guido Baccelli", AUOC Policlinico di Bari, piazza G. Cesare, 11-I-70124, Bari, Italy
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Dattani A, Prasad R. Isolated Left Ventricular Apical Hypoplasia. Card Fail Rev 2022; 7:e21. [PMID: 35024171 PMCID: PMC8728883 DOI: 10.15420/cfr.2021.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester Leicester, UK
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Manole S, Budurea C, Pop S, Iliescu AM, Ciortea CA, Iancu SD, Popa L, Coman M, Szabó L, Coman V, Bálint Z. Correlation between Volumes Determined by Echocardiography and Cardiac MRI in Controls and Atrial Fibrillation Patients. Life (Basel) 2021; 11:life11121362. [PMID: 34947893 PMCID: PMC8707690 DOI: 10.3390/life11121362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/21/2022] Open
Abstract
Aims: We aimed to compare cardiac volumes measured with echocardiography (echo) and cardiac magnetic resonance imaging (MRI) in a mixed cohort of healthy controls (controls) and patients with atrial fibrillation (AF). Materials and methods: In total, 123 subjects were included in our study; 99 full datasets were analyzed. All the participants underwent clinical evaluation, EKG, echo, and cardiac MRI acquisition. Participants with full clinical data were grouped into 63 AF patients and 36 controls for calculation of left atrial volume (LA Vol) and 51 AF patients and 30 controls for calculation of left ventricular end-diastolic volume (LV EDV), end-systolic volume (ESV), and LV ejection fraction (LV EF). Results: No significant differences in LA Vol were observed (p > 0.05) when measured by either echo or MRI. However, echo provided significantly lower values for left ventricular volume (p < 0.0001). The echo LA Vol of all the subjects correlated well with that measured by MRI (Spearmen correlation coefficient r = 0.83, p < 0.0001). When comparing the two methods, significant positive correlations of EDV (all subjects: r = 0.55; Controls: r = 0.71; and AF patients: r = 0.51) and ESV (all subjects: r = 0.62; Controls: r = 0.47; and AF patients: r = 0.66) were found, with a negative bias for values determined using echo. For a subgroup of participants with ventricular volumes smaller than 49.50 mL, this bias was missing, thus in this case echocardiography could be used as an alternative for MRI. Conclusion: Good correlation and reduced bias were observed for LA Vol and EF determined by echo as compared to cardiac MRI in a mixed cohort of patients with AF and healthy volunteers. For the determination of volume values below 49.50 mL, an excellent correlation was observed between values obtained using echo and MRI, with comparatively reduced bias for the volumes determined by echo. Therefore, in certain cases, echocardiography could be used as a less expensive, less time-consuming, and contraindication free alternative to MRI for cardiac volume determination.
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Affiliation(s)
- Simona Manole
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Claudia Budurea
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - Sorin Pop
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - Alin M. Iliescu
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - Cristiana A. Ciortea
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Stefania D. Iancu
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
| | - Loredana Popa
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Mihaela Coman
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
| | - László Szabó
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
| | - Vasile Coman
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Zoltán Bálint
- IMOGEN Research Institute, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania; (S.M.); (C.B.); (S.P.); (A.M.I.); (C.A.C.); (S.D.I.); (L.P.); (M.C.); (L.S.); (V.C.)
- Faculty of Physics, Babeș-Bolyai University, 400084 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-264-405-300; Fax: +40-264-591-906
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Bryde R, Applewhite AI, Abu Dabrh AM, Taylor BJ, Heckman MG, Filmalter SE, Pujalte G, Rojas C, Heckman AJ, Brigham TJ, Prokop LJ, Shapiro BP. Cardiac structure and function in elite female athletes: A systematic review and meta-analysis. Physiol Rep 2021; 9:e15141. [PMID: 34894105 PMCID: PMC8665377 DOI: 10.14814/phy2.15141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 02/01/2023] Open
Abstract
We conducted a meta-analysis to synthesize the best available evidence comparing cardiac biventricular structure and function using cardiac magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) in elite female athletes and healthy controls (HC). Chronic exposure to exercise may induce cardiac chamber enlargement as a means to augment stroke volume, a condition known as the "athlete's heart." These changes have not been clearly characterized in female athletes. Multiple databases were searched from inception to June 18, 2019. Outcomes of interest included left ventricular (LV) and right ventricular (RV) dimensional, volumetric, mass, and functional assessments in female athletes. Most values were indexed to body surface area. The final search yielded 22 studies, including 1000 female athletes from endurance, strength, and mixed athletic disciplines. CMR-derived LV end-diastolic volume (LVEDV) and RV end-diastolic volume (RVEDV) were greater in endurance athletes (EA) versus HC (17.0% and 18.5%, respectively; both p < 0.001). Similarly, TTE-derived LVEDV and RVEDV were greater in EA versus HC (16.8% and 28.0%, respectively; both p < 0.001). Both LVEF and RVEF were lower in EA versus HC, with the most pronounced difference observed in RVEF via TTE (9%) (p < 0.001). LV stroke volume was greater in EA versus HC via both CMR (18.5%) and TTE (13.2%) (both p < 0.05). Few studies reported data for the mixed athlete (MA) population and even fewer studies reported data for strength athletes (SA), therefore a limited analysis was performed on MA and no analysis was performed on SA. This evidence-synthesis review demonstrates the RV may be more susceptible to ventricular enlargement. General changes in LV and RV structure and function in female EA mirrored changes observed in male counterparts. Further studies are needed to determine if potential adverse outcomes occur secondary to these changes.
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Affiliation(s)
- Robyn Bryde
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
| | | | - Abd Moain Abu Dabrh
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of General Internal MedicineIntegrative Medicine and HealthMayo ClinicJacksonvilleFloridaUSA
| | - Bryan J. Taylor
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
| | | | - Sara E. Filmalter
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of Sports MedicineDepartment of OrthopedicsMayo ClinicJacksonvilleFloridaUSA
| | - George Pujalte
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of Sports MedicineDepartment of OrthopedicsMayo ClinicJacksonvilleFloridaUSA
| | - Carlos Rojas
- Department of RadiologyMayo ClinicJacksonvilleFloridaUSA
| | | | | | | | - Brian P. Shapiro
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
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Mateus T, Costa A, Viegas D, Marques A, Herdeiro MT, Rebelo S. Outcome measures frequently used to assess muscle strength in patients with myotonic dystrophy type 1: a systematic review. Neuromuscul Disord 2021; 32:99-115. [PMID: 35031191 DOI: 10.1016/j.nmd.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
Measurement of muscle strength is fundamental for the management of patients with myotonic dystrophy type 1 (DM1). Nevertheless, guidance on this topic is somewhat limited due to heterogeneous outcome measures used. This systematic literature review aimed to summarize the most frequent outcome measures to assess muscle strength in patients with DM1. We searched on Pubmed, Web of Science and Embase databases. Observational studies using measures of muscle strength assessment in adult patients with DM1 were included. From a total of 80 included studies, 24 measured cardiac, 45 skeletal and 23 respiratory muscle strength. The most common method and outcome measures used to assess cardiac muscle strength were echocardiography and ejection fraction, for skeletal muscle strength were quantitative muscle test, manual muscle test and maximum isometric torque and medical research council and for respiratory muscle strength were manometry and maximal inspiratory and expiratory pressure. We successfully gathered the more consensual methods and measures to evaluate muscle strength in future clinical studies, particularly to test muscle strength response to treatments in patients with DM1. Future consensus on a set of measures to evaluate muscle strength (core outcome set), is important for these patients.
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Affiliation(s)
- Tiago Mateus
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Adriana Costa
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Diana Viegas
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory - Lab3R, Institute of Biomedicine (iBiMED), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Sandra Rebelo
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal.
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11
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Bensimon-Brito A, Boezio GLM, Cardeira-da-Silva J, Wietelmann A, Ramkumar S, Lundegaard PR, Helker CSM, Ramadass R, Piesker J, Nauerth A, Mueller C, Stainier DYR. Integration of multiple imaging platforms to uncover cardiovascular defects in adult zebrafish. Cardiovasc Res 2021; 118:2665-2687. [PMID: 34609500 PMCID: PMC9491864 DOI: 10.1093/cvr/cvab310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/29/2021] [Indexed: 11/29/2022] Open
Abstract
Aims Mammalian models have been instrumental in investigating adult heart function and human disease. However, electrophysiological differences with human hearts and high costs motivate the need for non-mammalian models. The zebrafish is a well-established genetic model to study cardiovascular development and function; however, analysis of cardiovascular phenotypes in adult specimens is particularly challenging as they are opaque. Methods and results Here, we optimized and combined multiple imaging techniques including echocardiography, magnetic resonance imaging, and micro-computed tomography to identify and analyse cardiovascular phenotypes in adult zebrafish. Using alk5a/tgfbr1a mutants as a case study, we observed morphological and functional cardiovascular defects that were undetected with conventional approaches. Correlation analysis of multiple parameters revealed an association between haemodynamic defects and structural alterations of the heart, as observed clinically. Conclusion We report a new, comprehensive, and sensitive platform to identify otherwise indiscernible cardiovascular phenotypes in adult zebrafish.
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Affiliation(s)
- Anabela Bensimon-Brito
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany.,DZHK German Centre for Cardiovascular Research, Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Giulia L M Boezio
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany.,DZHK German Centre for Cardiovascular Research, Partner Site Rhine-Main, Bad Nauheim, Germany
| | - João Cardeira-da-Silva
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany.,DZHK German Centre for Cardiovascular Research, Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Astrid Wietelmann
- Scientific Service Group MRI and µ-CT, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Srinath Ramkumar
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany.,DZHK German Centre for Cardiovascular Research, Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Pia R Lundegaard
- Laboratory for Molecular Cardiology, Department of Cardiology, Vascular, Pulmonary and Infectious Diseases, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian S M Helker
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Radhan Ramadass
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Janett Piesker
- Scientific Service Group Microscopy, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | | | | | - Didier Y R Stainier
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany.,DZHK German Centre for Cardiovascular Research, Partner Site Rhine-Main, Bad Nauheim, Germany
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12
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Theodoropoulos KC, Avci Demir F, Masoero G, Lukban BF, Fonseca T, Monaghan MJ, Papachristidis A. Incidental finding of accessory mitral valve tissue on routine adult echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:805-807. [PMID: 33644857 DOI: 10.1002/jcu.23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Accessory mitral valve tissue is a rare congenital cardiac abnormality that sometimes can cause left ventricular outflow tract obstruction. We herein present the case of a 55-year-old male with an incidental finding of accessory mitral valve tissue on transthoracic echocardiography. The patient was managed conservatively as accessory tissue was not causing left ventricular outflow obstruction and there were no hemodynamic consequences.
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Affiliation(s)
| | - Fulya Avci Demir
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Giovani Masoero
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Benito Francisco Lukban
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Tiago Fonseca
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Mark J Monaghan
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Alexandros Papachristidis
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
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13
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Quick S, Heidrich FM, Winkler MV, Winkler AH, Ibrahim K, Linke A, Speiser U, Grabmaier U, Buhmann C, Marxreiter F, Saft C, Danek A, Hermann A, Peikert K. Cardiac manifestation is evident in chorea-acanthocytosis but different from McLeod syndrome. Parkinsonism Relat Disord 2021; 88:90-95. [PMID: 34153885 DOI: 10.1016/j.parkreldis.2021.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/30/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We aimed to study the various cardiac manifestations of the two core neuroacanthocytosis (NA) syndromes, namely chorea-acanthocytosis (ChAc) and McLeod syndrome (MLS). So far, cardiac involvement has been described as specific feature only for MLS. METHODS We studied six patients with ChAc (mean age 44.5 years, five men, one woman) and six patients with MLS (mean age 57.1 years, all men). Cardiac evaluation included echocardiography and/or cardiac magnetic resonance imaging (cardiac MRI), 24-h ECG-recording and examination of cardiac biomarkers. RESULTS Cardiac involvement of ChAc was found in four of six patients. Two patients showed mildly reduced left ventricular ejection fraction (LVEF), two other patients mild to moderate left ventricular (LV) dilatation. Neither an increase in ventricular ectopic beats nor ventricular tachycardia were evident in ChAc. Four of five MLS patients showed left ventricle dilatation and reduced left ventricular ejection fraction (LVEF). Two of these, in addition, had critical ventricular tachycardia. High sensitive troponin T was elevated in all patients, for whom data were available (n = 10). In contrast, elevation of high sensitive troponin I was found in one of six ChAc and one of two MLS patients. CONCLUSION For the first time, we reveal cardiac involvement in a cohort of six ChAc patients, while the risk to develop heart failure seems lower than in MLS. Our study confirms the malignant nature of MLS in terms of ventricular arrhythmias and progression to advanced heart failure. Herein, we define disease-specific recommendations for cardiac assessment in both conditions.
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Affiliation(s)
- Silvio Quick
- Department of Cardiology, Angiology and Intensive Care, Klinikum Chemnitz gGmbH, Medizincampus Chemnitz der Technischen Universität Dresden, Dresden, Germany.
| | - Felix Matthias Heidrich
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Max-Valentin Winkler
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Anna Helene Winkler
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Karim Ibrahim
- Department of Cardiology, Angiology and Intensive Care, Klinikum Chemnitz gGmbH, Medizincampus Chemnitz der Technischen Universität Dresden, Dresden, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Uwe Speiser
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Ulrich Grabmaier
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, LMU Munich, 81377, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, 80802, Munich, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Franz Marxreiter
- Movement Disorders Outpatient Clinic, Department of Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany; Center for Rare Movement Disorders, Department of Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Carsten Saft
- Department of Neurology, St. Josef Hospital, Ruhr-University, Gudrunstraße 56, 44791, Bochum, Germany
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Germany
| | - Andreas Hermann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center, University of Rostock, Rostock, Germany; DZNE, German Center for Neurodegenerative Diseases, Research Site Rostock/Greifswald, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, Rostock, Germany
| | - Kevin Peikert
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center, University of Rostock, Rostock, Germany.
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14
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Jahmunah V, Ng EYK, San TR, Acharya UR. Automated detection of coronary artery disease, myocardial infarction and congestive heart failure using GaborCNN model with ECG signals. Comput Biol Med 2021; 134:104457. [PMID: 33991857 DOI: 10.1016/j.compbiomed.2021.104457] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 01/02/2023]
Abstract
Cardiovascular diseases (CVDs) are main causes of death globally with coronary artery disease (CAD) being the most important. Timely diagnosis and treatment of CAD is crucial to reduce the incidence of CAD complications like myocardial infarction (MI) and ischemia-induced congestive heart failure (CHF). Electrocardiogram (ECG) signals are most commonly employed as the diagnostic screening tool to detect CAD. In this study, an automated system (AS) was developed for the automated categorization of electrocardiogram signals into normal, CAD, myocardial infarction (MI) and congestive heart failure (CHF) classes using convolutional neural network (CNN) and unique GaborCNN models. Weight balancing was used to balance the imbalanced dataset. High classification accuracies of more than 98.5% were obtained by the CNN and GaborCNN models respectively, for the 4-class classification of normal, coronary artery disease, myocardial infarction and congestive heart failure classes. GaborCNN is a more preferred model due to its good performance and reduced computational complexity as compared to the CNN model. To the best of our knowledge, this is the first study to propose GaborCNN model for automated categorizing of normal, coronary artery disease, myocardial infarction and congestive heart failure classes using ECG signals. Our proposed system is equipped to be validated with bigger database and has the potential to aid the clinicians to screen for CVDs using ECG signals.
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Affiliation(s)
- V Jahmunah
- Department of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - E Y K Ng
- Department of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
| | | | - U Rajendra Acharya
- School of Engineering, Ngee Ann Polytechnic, Singapore; Biomedical Engineering, School of Social Science and Technology, Singapore University of Social Sciences, Singapore; International Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto, Japan; Department Bioinformatics and Medical Engineering, Asia University, Taiwan; School of Management and Enterprise, University of Southern Queensland, Australia.
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15
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Lim AZ, Jones DM, Bates MGD, Schaefer AM, O'Sullivan J, Feeney C, Farrugia ME, Bourke JP, Turnbull DM, Gorman GS, McFarland R, Ng YS. Risk of cardiac manifestations in adult mitochondrial disease caused by nuclear genetic defects. Open Heart 2021. [PMCID: PMC8021886 DOI: 10.1136/openhrt-2020-001510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective Regular cardiac surveillance is advocated for patients with primary mitochondrial DNA disease. However, there is limited information to guide clinical practice in mitochondrial conditions caused by nuclear DNA defects. We sought to determine the frequency and spectrum of cardiac abnormalities identified in adult mitochondrial disease originated from the nuclear genome. Methods Adult patients with a genetically confirmed mitochondrial disease were identified and followed up at the national clinical service for mitochondrial disease in Newcastle upon Tyne, UK (January 2009 to December 2018). Case notes, molecular genetics reports, laboratory data and cardiac investigations, including serial electrocardiograms and echocardiograms, were reviewed. Results In this cohort-based observational study, we included 146 adult patients (92 women) (mean age 53.6±18.7 years, 95% CI 50.6 to 56.7) with a mean follow-up duration of 7.9±5.1 years (95% CI 7.0 to 8.8). Eleven different nuclear genotypes were identified: TWNK, POLG, RRM2B, OPA1, GFER, YARS2, TYMP, ETFDH, SDHA, TRIT1 and AGK. Cardiac abnormalities were detected in 14 patients (9.6%). Seven of these patients (4.8%) had early-onset cardiac manifestations: hypertrophic cardiomyopathy required cardiac transplantation (AGK; n=2/2), left ventricular (LV) hypertrophy and bifascicular heart block (GFER; n=2/3) and mild LV dysfunction (GFER; n=1/3, YARS2; n=1/2, TWNK; n=1/41). The remaining seven patients had acquired heart disease most likely related to conventional cardiovascular risk factors and presented later in life (14.6±12.8 vs 55.1±8.9 years, p<0.0001). Conclusions Our findings demonstrate that the risk of cardiac involvement is genotype specific, suggesting that routine cardiac screening is not indicated for most adult patients with nuclear gene-related mitochondrial disease.
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Affiliation(s)
- Albert Zishen Lim
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Daniel M Jones
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew G D Bates
- Department of Cardiology, James Cook University Hospital, Middlesbrough, UK
| | - Andrew M Schaefer
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - John O'Sullivan
- Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Catherine Feeney
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Maria E Farrugia
- Queen Elizabeth University Hospital, Institute of Neurological Sciences, Glasgow, UK
| | - John P Bourke
- Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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16
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Miller RJH, Slomka PJ. Is SPECT LVEF assessment more accurate than CT at higher heart rates? More evidence for complementary information in multimodality imaging. J Nucl Cardiol 2021; 28:317-319. [PMID: 32383082 DOI: 10.1007/s12350-020-02130-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Robert J H Miller
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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17
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Bergom C, Rubenstein J, Wilson JF, Welsh A, Ibrahim ESH, Prior P, Schottstaedt AM, Eastwood D, Zhang MJ, Currey A, Puckett L, Strande JL, Bradley JA, White J. A Pilot Study of Cardiac MRI in Breast Cancer Survivors After Cardiotoxic Chemotherapy and Three-Dimensional Conformal Radiotherapy. Front Oncol 2020; 10:506739. [PMID: 33178571 PMCID: PMC7596658 DOI: 10.3389/fonc.2020.506739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE/OBJECTIVES Node-positive breast cancer patients often receive chemotherapy and regional nodal irradiation. The cardiotoxic effects of these treatments, however, may offset some of the survival benefit. Cardiac magnetic resonance (CMR) is an emerging modality to assess cardiac injury. This is a pilot trial assessing cardiac damage using CMR in patients who received anthracycline-based chemotherapy and three-dimensional conformal radiotherapy (3DCRT) regional nodal irradiation using heart constraints. MATERIALS AND METHODS Node-positive breast cancer patients (2000-2008) treated with anthracycline-based chemotherapy and 3DCRT regional nodal irradiation (including the internal mammary chain nodes) with heart ventricular constraints (V25 < 10%) were invited to participate. Cardiac tissues were contoured and analyzed separately for whole heart (pericardium) and for combined ventricles and left atrium (myocardium). CMR obtained ventricular function/dimensions, late gadolinium enhancement (LGE), global longitudinal strain (GLS), and extracellular volume fraction (ECV) as measures of cardiac injury and/or early fibrosis. CMR parameters were correlated with dose-volume constraints using Spearman correlations. RESULTS Fifteen left-sided and five right-sided patients underwent CMR. Median diagnosis age was 50 (32-77). No patients had baseline cardiac disease before regional nodal irradiation. Median time after 3DCRT was 8.3 years (5.2-14.4). Median left-sided mean heart dose (MHD) was 4.8 Gy (1.1-11.2) and V25 was 5.7% (0-12%). Median left ventricular ejection fraction (LVEF) was 63%. No abnormal LGE was observed. No correlations were seen between whole heart doses and LVEF, LV mass, GLS, or LV dimensions. Increasing ECV did not correlate with increased heart or ventricular doses. However, correlations between higher LV mass and ventricular mean dose, V10, and V25 were seen. CONCLUSION At a median follow-up of 8.3 years, this cohort of node-positive breast cancer patients who received anthracycline-based chemotherapy and regional nodal irradiation had no clinically abnormal CMR findings. However, correlations between ventricular mean dose, V10, and V25 and LV mass were seen. Larger corroborating studies that include advanced techniques for measuring regional heart mechanics are warranted.
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Affiliation(s)
- Carmen Bergom
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jason Rubenstein
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - J. Frank Wilson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Aimee Welsh
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - El-Sayed H. Ibrahim
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Phillip Prior
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Daniel Eastwood
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mei-Jie Zhang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Adam Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Lindsay Puckett
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jennifer L. Strande
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Julie A. Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Julia White
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
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18
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Ibrahim ESH, Baruah D, Budde M, Rubenstein J, Frei A, Schlaak R, Gore E, Bergom C. Optimized cardiac functional MRI of small-animal models of cancer radiation therapy. Magn Reson Imaging 2020; 73:130-137. [PMID: 32866598 DOI: 10.1016/j.mri.2020.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/23/2020] [Accepted: 08/20/2020] [Indexed: 01/27/2023]
Abstract
Cardiac MRI of small animal models of cancer radiation therapy (RT) is a valuable tool for studying the effect of RT on the heart. However, standard cardiac MRI exams require long scanning times, which is challenging for sick animals that may not survive extended periods of imaging under anesthesia. The purpose of this study is to develop an optimized, fast MRI exam for comprehensive cardiac functional imaging of small-animal models of cancer RT. Ten adult female rats (2 non-irradiated and 8 irradiated) were scanned using the developed exam. Optimal imaging parameters were determined, which minimized scanning time while ensuring measurement accuracy and avoiding imaging artifacts. This optimized, fast MRI exam lasted for 30 min, which was tolerated by all animals. EF was normal in all imaged rats, although it was significantly increased in the irradiated rats, which also showed ventricular hypertrophy. However, myocardial strain was significantly reduced in the irradiated rats. In conclusion, a fast MRI exam has been developed for comprehensive cardiac functional imaging of rats in 30 min, with optimized imaging parameters to ensure accurate measurements and tolerance by irradiated rats. The generated strain measurements provide an early marker of regional cardiac dysfunction before global function is affected.
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Affiliation(s)
- El-Sayed H Ibrahim
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Dhiraj Baruah
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Matthew Budde
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Jason Rubenstein
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Anne Frei
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Rachel Schlaak
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Elizabeth Gore
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Carmen Bergom
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA; Washington University School of Medicine, 4511 Forest Park Ave, St. Louis, MI 63108, USA..
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19
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Bohnen S, Avanesov M, Jagodzinski A, Schnabel RB, Zeller T, Karakas M, Schneider J, Tahir E, Cavus E, Spink C, Radunski UK, Ojeda F, Adam G, Blankenberg S, Lund GK, Muellerleile K. Cardiovascular magnetic resonance imaging in the prospective, population-based, Hamburg City Health cohort study: objectives and design. J Cardiovasc Magn Reson 2018; 20:68. [PMID: 30244673 PMCID: PMC6151919 DOI: 10.1186/s12968-018-0490-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this work is to describe the objectives and design of cardiovascular magnetic resonance (CMR) imaging in the single center, prospective, population-based Hamburg City Health study (HCHS). The HCHS aims at improving risk stratification for coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF). METHODS The HCHS will finally include 45,000 inhabitants of the city of Hamburg (Germany) between 45 and 74 years who undergo an extensive cardiovascular evaluation and collection of biomaterials. Risk-scores for CAD, AF and HF are used to create enriched subpopulations who are invited for CMR. A total number of approximately 12,362 subjects will undergo CMR and incident CAD, AF and HF will be assessed after 6 years follow-up. The standard CMR protocol includes cine-CMR, T1 and T2 mapping, aortic/mitral valve flow measurements, Late gadolinium enhancement, angiographies and measurements of aortic distensibility. A stress-perfusion scan is added in individuals at risk for CAD. The workflow of CMR data acquisition and analyses was evaluated in a pilot cohort of 200 unselected subjects. RESULTS The obtained CMR findings in the pilot cohort agree with current reference values and demonstrate the ability of the established workflow to accomplish the objectives of HCHS. CONCLUSIONS CMR in HCHS promises novel insights into major cardiovascular diseases, their subclinical precursors and the prognostic value of novel imaging biomarkers. The HCHS database will facilitate combined analyses of imaging, clinical and molecular data ("Radiomics").
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Affiliation(s)
- Sebastian Bohnen
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Annika Jagodzinski
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Renate B. Schnabel
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Tanja Zeller
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Mahir Karakas
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Jan Schneider
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ersin Cavus
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Clemens Spink
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulf K. Radunski
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Francisco Ojeda
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stefan Blankenberg
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Gunnar K. Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Kai Muellerleile
- University Heart Center Hamburg, Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
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20
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Greene SJ, Mentz RJ, Fiuzat M, Butler J, Solomon SD, Ambrosy AP, Mehta C, Teerlink JR, Zannad F, O'Connor CM. Reassessing the Role of Surrogate End Points in Drug Development for Heart Failure. Circulation 2018; 138:1039-1053. [PMID: 30354535 PMCID: PMC6205720 DOI: 10.1161/circulationaha.118.034668] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With few notable exceptions, drug development for heart failure (HF) has become progressively more challenging, and there remain no definitively proven therapies for patients with acute HF or HF with preserved ejection fraction. Inspection of temporal trends suggests an increasing rate of disagreement between early-phase and phase III trial end points. Preliminary results from phase II HF trials are frequently promising, but increasingly followed by disappointing phase III results. Given this potential disconnect, it is reasonable to carefully re-evaluate the purpose, design, and execution of phase II HF trials, with particular attention directed toward the surrogate end points commonly used by these studies. In this review, we offer a critical reappraisal of the role of phase II HF trials and surrogate end points, highlighting challenges in their use and interpretation, lessons learned from past experiences, and specific strengths and weaknesses of various surrogate outcomes. We conclude by proposing a series of approaches that should be considered for the goal of optimizing the efficiency of HF drug development. This review is based on discussions between scientists, clinical trialists, industry and government sponsors, and regulators that took place at the Cardiovascular Clinical Trialists Forum in Washington, DC, on December 2, 2016.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, NC (S.J.G., R.J.M., M.F., C.M.O.)
- Division of Cardiology, Duke University School of Medicine, Durham, NC (S.J.G., R.J.M.)
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, NC (S.J.G., R.J.M., M.F., C.M.O.)
- Division of Cardiology, Duke University School of Medicine, Durham, NC (S.J.G., R.J.M.)
| | - Mona Fiuzat
- Duke Clinical Research Institute, Durham, NC (S.J.G., R.J.M., M.F., C.M.O.)
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson (J.B.)
| | - Scott D Solomon
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA (S.D.S.)
| | - Andrew P Ambrosy
- Division of Cardiology, The Permanente Medical Group, San Francisco, CA (A.P.A.)
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (A.P.A.)
| | - Cyrus Mehta
- Harvard School of Public Health, Boston, MA (C.M.)
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center, CA (J.R.T.)
- School of Medicine, University of California, San Francisco (J.R.T.)
| | - Faiez Zannad
- Université de Lorraine, Institut National de la Santé et de la Recherche Médicale U1116 and Centre d'Investigation Clinique 1433, FCRIN INI-CRCT, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre les Nancy, France (F.Z.)
| | - Christopher M O'Connor
- Duke Clinical Research Institute, Durham, NC (S.J.G., R.J.M., M.F., C.M.O.)
- Inova Heart and Vascular Institute, Falls Church, VA (C.M.O.)
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21
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Timm KN, Miller JJ, Henry JA, Tyler DJ. Cardiac applications of hyperpolarised magnetic resonance. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2018; 106-107:66-87. [PMID: 31047602 DOI: 10.1016/j.pnmrs.2018.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/14/2018] [Accepted: 05/29/2018] [Indexed: 05/05/2023]
Abstract
Cardiovascular disease is the leading cause of death world-wide. It is increasingly recognised that cardiac pathologies show, or may even be caused by, changes in metabolism, leading to impaired cardiac energetics. The heart turns over 15 times its own weight in ATP every day and thus relies heavily on the availability of substrates and on efficient oxidation to generate this ATP. A number of old and emerging drugs that target different aspects of metabolism are showing promising results with regard to improved cardiac outcomes in patients. A non-invasive imaging technique that could assess the role of different aspects of metabolism in heart disease, as well as measure changes in cardiac energetics due to treatment, would be valuable in the routine clinical care of cardiac patients. Hyperpolarised magnetic resonance spectroscopy and imaging have revolutionised metabolic imaging, allowing real-time metabolic flux assessment in vivo for the first time. In this review we summarise metabolism in the healthy and diseased heart, give an introduction to the hyperpolarisation technique, 'dynamic nuclear polarisation' (DNP), and review the preclinical studies that have thus far explored healthy cardiac metabolism and different models of human heart disease. We furthermore show what advances have been made to translate this technique into the clinic, what technical challenges still remain and what unmet clinical needs and unexplored metabolic substrates still need to be assessed by researchers in this exciting and fast-moving field.
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Affiliation(s)
- Kerstin N Timm
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK.
| | - Jack J Miller
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK; Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK; Clarendon Laboratory, Department of Physics, University of Oxford, UK.
| | - John A Henry
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK.
| | - Damian J Tyler
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK; Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK.
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22
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Benza RL, Raina A, Gupta H, Murali S, Burden A, Zastrow MS, Park MH, Simon MA. Bosentan-based, treat-to-target therapy in patients with pulmonary arterial hypertension: results from the COMPASS-3 study. Pulm Circ 2017; 8:2045893217741480. [PMID: 29064349 PMCID: PMC5798685 DOI: 10.1177/2045893217741480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The phase 4 COMPASS-3 study evaluated whether a singular endpoint produces clinically meaningful outcomes in patients with pulmonary arterial hypertension (PAH). The relationship between cardiac magnetic resonance imaging (cMRI)-derived parameters and right heart catheterization (RHC) measurements was also examined. In COMPASS-3 (ClinicalTrials.gov NCT00433329), 100 patients with PAH received bosentan monotherapy for 16 weeks. Patients continued monotherapy if their 6-min walk distance (6MWD) was ≥380 m, or otherwise received add-on sildenafil for an additional 12 weeks. 6MWD, RHC, and cMRI were performed at baseline, week 16, and week 28 (6MWD and cMRI). Baseline median 6MWD was 274 m and 82% of patients had WHO Functional Class III/IV. At week 16, 17% (n = 16) of remaining patients achieved the 6MWD threshold and 78 (83%) did not. In the intention-to-treat population, median 6MWD increased significantly relative to baseline (week 16 = 308 m; week 28 = 327 m; P < 0.001). At week 28, 9/16 (monotherapy) and 15/76 (20%; add-on sildenafil) patients met the target threshold. Baseline cMRI-derived and RHC-derived parameters showed moderate-to-strong correlations (e.g. right to left ventricular end-diastolic ratio [RVEDV:LVEDV] correlated strongly with pulmonary vascular resistance [r = +0.729, P < 0.0001]). cMRI-derived parameters predicted clinical worsening/decline (e.g. week 16 RVEDV:LVDEV [P = 0.0172]). Time to clinical worsening/decline did not differ between patients based on 6MWD threshold achievement. No unexpected safety events were reported. A substantial proportion of patients failed to achieve the goal of 380 m, regardless of treatment. Several cMRI parameters predicted clinical worsening/decline and its non-invasive nature further supports its use in future clinical trials.
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Affiliation(s)
| | - Amresh Raina
- 1 6618 Allegheny General Hospital, Pittsburgh, PA, USA
| | - Himanshu Gupta
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Annie Burden
- 3 Statistical Consultancy, Quanticate, Hitchin, Hertfordshire, UK
| | - Michael S Zastrow
- 4 17430 Former employee of Actelion Pharmaceuticals US, South San Francisco, CA, USA
| | - Myung H Park
- 5 23534 Houston Methodist Hospital, Houston, TX, USA
| | - Marc A Simon
- 6 University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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23
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Dias KA, Spence AL, Sarma S, Oxborough D, Timilsina AS, Davies PS, Cain PA, Leong GM, Ingul CB, Coombes JS. Left ventricular morphology and function in adolescents: Relations to fitness and fatness. Int J Cardiol 2017; 240:313-319. [DOI: 10.1016/j.ijcard.2017.03.047] [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: 01/30/2017] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 12/19/2022]
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24
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Spartera M, Damascelli A, Mozes F, De Cobelli F, La Canna G. Three-dimensional speckle tracking longitudinal strain is related to myocardial fibrosis determined by late-gadolinium enhancement. Int J Cardiovasc Imaging 2017; 33:1351-1360. [DOI: 10.1007/s10554-017-1115-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/09/2017] [Indexed: 01/09/2023]
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25
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Wong C, Chen S, Iyngkaran P. Cardiac Imaging in Heart Failure with Comorbidities. Curr Cardiol Rev 2017; 13:63-75. [PMID: 27492227 PMCID: PMC5324322 DOI: 10.2174/1573403x12666160803100928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/19/2023] Open
Abstract
Imaging modalities stand at the frontiers for progress in congestive heart failure (CHF) screening, risk stratification and monitoring. Advancements in echocardiography (ECHO) and Magnetic Resonance Imaging (MRI) have allowed for improved tissue characterizations, cardiac motion analysis, and cardiac performance analysis under stress. Common cardiac comorbidities such as hypertension, metabolic syndromes and chronic renal failure contribute to cardiac remodeling, sharing similar pathophysiological mechanisms starting with interstitial changes, structural changes and finally clinical CHF. These imaging techniques can potentially detect changes earlier. Such information could have clinical benefits for screening, planning preventive therapies and risk stratifying patients. Imaging reports have often focused on traditional measures without factoring these novel parameters. This review is aimed at providing a synopsis on how we can use this information to assess and monitor improvements for CHF with comorbidities.
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Affiliation(s)
- Chiew Wong
- Flinders University, NT Medical School, Darwin Australia
| | - Sylvia Chen
- Flinders University, NT Medical School, Darwin Australia
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