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Ghobrial M, Haley H, Gosling R, Taylor DJ, Richardson J, Morgan K, Barmby D, Iqbal J, Krishnamurthy A, Singh R, Conway D, Hall I, Adam Z, Wheeldon N, Grech ED, Storey RF, Rothman A, Payne G, Tahir MN, Smith S, Cooke J, Hunter S, Cartwright N, Sadeque S, Briffa NP, Al-Mohammad A, O'Toole L, Rogers D, Lawford PV, Hose DR, Gunn J, Morris PD. Modelled impact of virtual fractional flow reserve in patients undergoing coronary angiography (VIRTU-4). Heart 2024:heartjnl-2024-324039. [PMID: 38754969 DOI: 10.1136/heartjnl-2024-324039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/28/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The practical application of 'virtual' (computed) fractional flow reserve (vFFR) based on invasive coronary angiogram (ICA) images is unknown. The objective of this cohort study was to investigate the potential of vFFR to guide the management of unselected patients undergoing ICA. The hypothesis was that it changes management in >10% of cases. METHODS vFFR was computed using the Sheffield VIRTUheart system, at five hospitals in the North of England, on 'all-comers' undergoing ICA for non-ST-elevation myocardial infarction acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The cardiologists' management plan (optimal medical therapy, percutaneous coronary intervention (PCI), coronary artery bypass surgery or 'more information required') and confidence level were recorded after ICA, and again after vFFR disclosure. RESULTS 517 patients were screened; 320 were recruited: 208 with ACS and 112 with CCS. The median vFFR was 0.82 (0.70-0.91). vFFR disclosure did not change the mean number of significantly stenosed vessels per patient (1.16 (±0.96) visually and 1.18 (±0.92) with vFFR (p=0.79)). A change in intended management following vFFR disclosure occurred in 22% of all patients; in the ACS cohort, there was a 62% increase in the number planned for medical management, and in the CCS cohort, there was a 31% increase in the number planned for PCI. In all patients, vFFR disclosure increased physician confidence from 8 of 10 (7.33-9) to 9 of 10 (8-10) (p<0.001). CONCLUSION The addition of vFFR to ICA changed intended management strategy in 22% of patients, provided a detailed and specific 'all-in-one' anatomical and physiological assessment of coronary artery disease, and was accompanied by augmentation of the operator's confidence in the treatment strategy.
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Affiliation(s)
- Mina Ghobrial
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hazel Haley
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rebecca Gosling
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute of In Silico medicine, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Daniel James Taylor
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Insigneo Institute of In Silico medicine, University of Sheffield, Sheffield, UK
| | - James Richardson
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kenneth Morgan
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David Barmby
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Javaid Iqbal
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Arvindra Krishnamurthy
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rajender Singh
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dwayne Conway
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ian Hall
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Zulfiquar Adam
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nigel Wheeldon
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ever D Grech
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert F Storey
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute of In Silico medicine, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alexander Rothman
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute of In Silico medicine, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gillian Payne
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Simon Smith
- The Rotherham NHS Foundation Trust, Rotherham, UK
| | - Justin Cooke
- Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Steven Hunter
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Neil Cartwright
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Syed Sadeque
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Norman Paul Briffa
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Abdallah Al-Mohammad
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Laurence O'Toole
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dominic Rogers
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Patricia V Lawford
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Insigneo Institute of In Silico medicine, University of Sheffield, Sheffield, UK
| | - David R Hose
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Insigneo Institute of In Silico medicine, University of Sheffield, Sheffield, UK
| | - Julian Gunn
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute of In Silico medicine, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul D Morris
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute of In Silico medicine, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Chatters R, Dimairo M, Cooper C, Ditta S, Woodward J, Biggs K, Ogunleye D, Thistlethwaite F, Yap C, Rothman A. Exploring the barriers to, and importance of, participant diversity in early-phase clinical trials: an interview-based qualitative study of professionals and patient and public representatives. BMJ Open 2024; 14:e075547. [PMID: 38508621 PMCID: PMC10952868 DOI: 10.1136/bmjopen-2023-075547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES To explore the importance of, and barriers to achieving, diversity in early-phase clinical trials. DESIGN Qualitative interviews analysed using thematic analysis. SETTING AND PARTICIPANTS Five professionals (clinical researchers and methodologists) and three patient and public representatives (those with experience of early-phase clinical trials and/or those from ethnic minority backgrounds) were interviewed between June and August 2022. Participants were identified via their institutional web page, existing contacts or social media (eg, X, formerly known as Twitter). RESULTS Professionals viewed that diversity is not currently considered in all early-phase clinical trials but felt that it should always be taken into account. Such trials are primarily undertaken at a small number of centres, thus limiting the populations they can access. Referrals from clinicians based in the community may increase diversity; however, those referred are often not from underserved groups. Referrals may be hindered by the extra resources required to approach and recruit underserved groups and participants often having to undertake 'self-driven' referrals. Patient and public representatives stated that diversity is important in research staff and that potential participants should be informed of the need for diversity. Those from underserved groups may require clarification regarding the potential harms of a treatment, even if these are unknown. Education may improve awareness and perception of early-phase clinical trials. We provide 14 recommendations to improve diversity in early-phase clinical trials. CONCLUSIONS Diversity should be considered in all early-phase trials. Consideration is required regarding the extent of diversity and how it is addressed. The increased resources needed to recruit those from underserved groups may warrant funders to increase the funds to support the recruitment of such participants. The potential harms and societal benefits of the research should be presented to potential participants in a balanced but accurate way to increase transparency.
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Affiliation(s)
- Robin Chatters
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Munyaradzi Dimairo
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Shamila Ditta
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Jonathan Woodward
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Katie Biggs
- Sheffield Clinical Trials Research Unit (CTRU), Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Fiona Thistlethwaite
- The Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, UK
| | - Alexander Rothman
- Department of Infection, Immunity, and Cardiovascular Disease, The University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Dwivedi K, Sharkey M, Delaney L, Alabed S, Rajaram S, Hill C, Johns C, Rothman A, Mamalakis M, Thompson AAR, Wild J, Condliffe R, Kiely DG, Swift AJ. Improving Prognostication in Pulmonary Hypertension Using AI-quantified Fibrosis and Radiologic Severity Scoring at Baseline CT. Radiology 2024; 310:e231718. [PMID: 38319169 PMCID: PMC10902594 DOI: 10.1148/radiol.231718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 02/07/2024]
Abstract
Background There is clinical need to better quantify lung disease severity in pulmonary hypertension (PH), particularly in idiopathic pulmonary arterial hypertension (IPAH) and PH associated with lung disease (PH-LD). Purpose To quantify fibrosis on CT pulmonary angiograms using an artificial intelligence (AI) model and to assess whether this approach can be used in combination with radiologic scoring to predict survival. Materials and Methods This retrospective multicenter study included adult patients with IPAH or PH-LD who underwent incidental CT imaging between February 2007 and January 2019. Patients were divided into training and test cohorts based on the institution of imaging. The test cohort included imaging examinations performed in 37 external hospitals. Fibrosis was quantified using an established AI model and radiologically scored by radiologists. Multivariable Cox regression adjusted for age, sex, World Health Organization functional class, pulmonary vascular resistance, and diffusing capacity of the lungs for carbon monoxide was performed. The performance of predictive models with or without AI-quantified fibrosis was assessed using the concordance index (C index). Results The training and test cohorts included 275 (median age, 68 years [IQR, 60-75 years]; 128 women) and 246 (median age, 65 years [IQR, 51-72 years]; 142 women) patients, respectively. Multivariable analysis showed that AI-quantified percentage of fibrosis was associated with an increased risk of patient mortality in the training cohort (hazard ratio, 1.01 [95% CI: 1.00, 1.02]; P = .04). This finding was validated in the external test cohort (C index, 0.76). The model combining AI-quantified fibrosis and radiologic scoring showed improved performance for predicting patient mortality compared with a model including radiologic scoring alone (C index, 0.67 vs 0.61; P < .001). Conclusion Percentage of lung fibrosis quantified on CT pulmonary angiograms by an AI model was associated with increased risk of mortality and showed improved performance for predicting patient survival when used in combination with radiologic severity scoring compared with radiologic scoring alone. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Krit Dwivedi
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Michael Sharkey
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Liam Delaney
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Samer Alabed
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Smitha Rajaram
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Catherine Hill
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Christopher Johns
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Alexander Rothman
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Michail Mamalakis
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - A. A. Roger Thompson
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Jim Wild
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Robin Condliffe
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - David G. Kiely
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
| | - Andrew J. Swift
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Glossop Rd, Sheffield S10 2JF, England (K.D., L.D., A.R., M.M., A.A.R.T., J.W., R.C., D.G.K., A.J.S.); Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (M.S., S.A., S.R., C.H., C.J.); and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England (R.C., D.G.K.)
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Varian F, Dick J, Battersby C, Roman S, Ablott J, Watson L, Binmahfooz S, Zafar H, Colgan G, Cannon J, Suntharalingam J, Lordan J, Howard L, McCabe C, Wort J, Price L, Church C, Hamilton N, Armstrong I, Hameed A, Hurdman J, Elliot C, Condliffe R, Wilkins M, Webb A, Adlam D, Benza RL, Rahimi K, Shojaei‐Shahrokhabadi M, Lin NX, Wason JMS, McIntosh A, McConnachie A, Middleton JT, Thompson R, Kiely DG, Toshner M, Rothman A. Pulmonary Hypertension: Intensification and Personalization of Combination Rx (PHoenix): A phase IV randomized trial for the evaluation of dose-response and clinical efficacy of riociguat and selexipag using implanted technologies. Pulm Circ 2024; 14:e12337. [PMID: 38500737 PMCID: PMC10945040 DOI: 10.1002/pul2.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 03/20/2024] Open
Abstract
Approved therapies for the treatment of patients with pulmonary arterial hypertension (PAH) mediate pulmonary vascular vasodilatation by targeting distinct biological pathways. International guidelines recommend that patients with an inadequate response to dual therapy with a phosphodiesterase type-5 inhibitor (PDE5i) and endothelin receptor antagonist (ERA), are recommended to either intensify oral therapy by adding a selective prostacyclin receptor (IP) agonist (selexipag), or switching from PDE5i to a soluble guanylate-cyclase stimulator (sGCS; riociguat). The clinical equipoise between these therapeutic choices provides the opportunity for evaluation of individualized therapeutic effects. Traditionally, invasive/hospital-based investigations are required to comprehensively assess disease severity and demonstrate treatment benefits. Regulatory-approved, minimally invasive monitors enable equivalent measurements to be obtained while patients are at home. In this 2 × 2 randomized crossover trial, patients with PAH established on guideline-recommended dual therapy and implanted with CardioMEMS™ (a wireless pulmonary artery sensor) and ConfirmRx™ (an insertable cardiac rhythm monitor), will receive ERA + sGCS, or PDEi + ERA + IP agonist. The study will evaluate clinical efficacy via established clinical investigations and remote monitoring technologies, with remote data relayed through regulatory-approved online clinical portals. The primary aim will be the change in right ventricular systolic volume measured by magnetic resonance imaging (MRI) from baseline to maximal tolerated dose with each therapy. Using data from MRI and other outcomes, including hemodynamics, physical activity, physiological measurements, quality of life, and side effect reporting, we will determine whether remote technology facilitates early evaluation of clinical efficacy, and investigate intra-patient efficacy of the two treatment approaches.
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Affiliation(s)
- Frances Varian
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Jennifer Dick
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
| | | | - Stefan Roman
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Jenna Ablott
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Lisa Watson
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | | | - Hamza Zafar
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | | | - John Cannon
- Royal Papworth Hospital NHS Foundation TrustCambridgeUK
| | | | - Jim Lordan
- Newcastle Hospitals NHS Foundation TrustNewcastleUK
| | - Luke Howard
- Imperial College Healthcare NHS TrustLondonUK
| | - Colm McCabe
- Royal Brompton and HarefieldGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - John Wort
- NHS Greater Glasgow and ClydeGlasgowUK
| | | | - Colin Church
- National Heart and Lung Institute, Faculty of Medicine, Imperial College LondonLondonUK
| | - Neil Hamilton
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Abdul Hameed
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Judith Hurdman
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Charlie Elliot
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Martin Wilkins
- National Heart and Lung Institute, Faculty of Medicine, Imperial College LondonLondonUK
| | - Alastair Webb
- Wolfson Centre for Prevention of Stroke and DementiaUniversity of OxfordOxfordUK
| | - David Adlam
- Cardiovascular Research Unit of LeicesterLeicesterUK
| | - Ray L. Benza
- Mount Sinai HeartIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kazem Rahimi
- Deep Medicine, Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
| | | | - Nan X. Lin
- Biostatistics Research Group, Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - James M. S. Wason
- Biostatistics Research Group, Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Jennifer T. Middleton
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Roger Thompson
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - David G. Kiely
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Mark Toshner
- Department of Medicine, Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
| | - Alexander Rothman
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
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Grafton-Clarke C, Matthews G, Gosling R, Swoboda P, Rothman A, Wild JM, Kiely DG, Condliffe R, Alabed S, Swift AJ, Garg P. The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography. Medicina (Kaunas) 2023; 59:1952. [PMID: 38004001 PMCID: PMC10672763 DOI: 10.3390/medicina59111952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
Background and objectives: Evaluating left ventricular filling pressure (LVFP) plays a crucial role in diagnosing and managing heart failure (HF). While traditional assessment methods involve multi-parametric transthoracic echocardiography (TTE) or right heart catheterisation (RHC), cardiovascular magnetic resonance (CMR) has emerged as a valuable diagnostic tool in HF. This study aimed to assess a simple CMR-derived model to estimate pulmonary capillary wedge pressure (PCWP) in a cohort of patients with suspected or proven heart failure and to investigate its performance in risk-stratifying patients. Materials and methods: A total of 835 patients with breathlessness were evaluated using RHC and CMR and split into derivation (85%) and validation cohorts (15%). Uni-variate and multi-variate linear regression analyses were used to derive a model for PCWP estimation using CMR. The model's performance was evaluated by comparing CMR-derived PCWP with PCWP obtained from RHC. Results: A CMR-derived PCWP incorporating left ventricular mass and the left atrial area (LAA) demonstrated good diagnostic accuracy. The model correctly reclassified 66% of participants whose TTE was 'indeterminate' or 'incorrect' in identifying raised filling pressures. On survival analysis, the CMR-derived PCWP model was predictive for mortality (HR 1.15, 95% CI 1.04-1.28, p = 0.005), which was not the case for PCWP obtained using RHC or TTE. Conclusions: The simplified CMR-derived PCWP model provides an accurate and practical tool for estimating PCWP in patients with suspected or proven heart failure. Its predictive value for mortality suggests the ability to play a valuable adjunctive role in echocardiography, especially in cases with unclear echocardiographic assessment.
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Affiliation(s)
- Ciaran Grafton-Clarke
- Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK; (C.G.-C.)
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
| | - Gareth Matthews
- Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK; (C.G.-C.)
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
| | - Peter Swoboda
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Jim M. Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - David G. Kiely
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Robin Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Pankaj Garg
- Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK; (C.G.-C.)
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
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6
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Williams GJ, Al-Baraikan A, Rademakers FE, Ciravegna F, van de Vosse FN, Lawrie A, Rothman A, Ashley EA, Wilkins MR, Lawford PV, Omholt SW, Wisløff U, Hose DR, Chico TJA, Gunn JP, Morris PD. Wearable technology and the cardiovascular system: the future of patient assessment. Lancet Digit Health 2023; 5:e467-e476. [PMID: 37391266 DOI: 10.1016/s2589-7500(23)00087-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 02/26/2023] [Accepted: 04/19/2023] [Indexed: 07/02/2023]
Abstract
The past decade has seen a dramatic rise in consumer technologies able to monitor a variety of cardiovascular parameters. Such devices initially recorded markers of exercise, but now include physiological and health-care focused measurements. The public are keen to adopt these devices in the belief that they are useful to identify and monitor cardiovascular disease. Clinicians are therefore often presented with health app data accompanied by a diverse range of concerns and queries. Herein, we assess whether these devices are accurate, their outputs validated, and whether they are suitable for professionals to make management decisions. We review underpinning methods and technologies and explore the evidence supporting the use of these devices as diagnostic and monitoring tools in hypertension, arrhythmia, heart failure, coronary artery disease, pulmonary hypertension, and valvular heart disease. Used correctly, they might improve health care and support research.
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Affiliation(s)
- Gareth J Williams
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdulaziz Al-Baraikan
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Frank E Rademakers
- Faculty of Medicine, Department of Cardiology, KU Leuven, Leuven, Belgium
| | - Fabio Ciravegna
- Dipartimento di Informatica, Universitàdi Torino, Turin, Italy
| | - Frans N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Allan Lawrie
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Academic Directorate of Cardiothoracic Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Euan A Ashley
- Department of Medicine, Stanford University, Stanford, CA, US
| | - Martin R Wilkins
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Patricia V Lawford
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Stig W Omholt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; School of Human Movement & Nutrition Sciences, University of Queensland, QLD, Australia
| | - D Rodney Hose
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Timothy J A Chico
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK; Academic Directorate of Cardiothoracic Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; BHF Data Centre, Health Data Research UK, London, UK
| | - Julian P Gunn
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK; Academic Directorate of Cardiothoracic Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul D Morris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK; Academic Directorate of Cardiothoracic Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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7
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Elamin N, Ow KW, Parker WAE, Nelson TA, Middle J, Hanson J, Moyle B, Krishnamurthy A, Barmby D, Morgan K, Adam Z, Rothman A, Morris P, Iqbal J, Hall I, Conway D, Richardson J, Gunn JP, Storey RF. Oral Presentation No. 84 Initial clinical experience with 6-hour enoxaparin regimen in opiate-treated patients undergoing primary percutaneous coronary intervention. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Opioid treatment delays the onset of oral P2Y12 inhibitors in patients with acute ST-segment elevation myocardial infarction (STEMI), leading to suboptimal antithrombotic therapy during primary percutaneous coronary intervention (PPCI).
Material and methods
We retrospectively compared using a prolonged enoxaparin regimen (0.75 mg/kg bolus followed by 6-hour intravenous infusion) to using unfractionated heparin (UFH) with or without tirofiban in opioid-treated patients with STEMI who underwent PPCI. We compared the proportions of acute stent thrombosis (AST) and bleeding events according to the bleeding academic research consortium (BARC) within 24 hours post-PPCI.
Results
270 opioid-treated patients with a mean age of 63 [SD ± 12] years were enrolled, of which 49 (18%) were with diabetes mellitus (DM). 90 (34%) patients (mean age 61 [SD ± 11] years) received enoxaparin, 110 (41%) (mean age 65 [SD ± 14] years) UFH with tirofiban, and 69 (25%) (mean age 63 [SD ± 12] years) UFH only. Compared to the other strategies, a higher proportion of DM was observed in the enoxaparin-treated group (21%). No AST was associated with enoxaparin compared to 2 (1.8%) events in UFH with tirofiban and 1 (1.4%) in UFH only. The rate of severe bleeding events (BARC 2 and 3) was significantly lower in the enoxaparin-treated patients than in UFH with tirofiban (0 (0%) vs. 8 (7%), P = 0.01). 3 enoxaparin-treated patients needed switching to tirofiban as a bailout strategy due to distal vessel embolisation.
Conclusions
The novel 6-hour enoxaparin regimen is safe during PPCI and was associated with fewer bleeding events than UFH with tirofiban.
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Affiliation(s)
- Nadir Elamin
- Sheffield Teaching Hospitals; University of Sheffield
| | - Kok Weng Ow
- Sheffield Teaching Hospitals; University of Sheffield
| | | | | | | | | | | | | | | | | | | | | | - Paul Morris
- Sheffield Teaching Hospitals; University of Sheffield
| | | | | | | | | | - Julian P Gunn
- Sheffield Teaching Hospitals; University of Sheffield
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8
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Garg P, Gosling R, Swoboda P, Jones R, Rothman A, Wild JM, Kiely DG, Condliffe R, Alabed S, Swift AJ. Cardiac magnetic resonance identifies raised left ventricular filling pressure: prognostic implications. Eur Heart J 2022; 43:2511-2522. [PMID: 35512290 PMCID: PMC9259376 DOI: 10.1093/eurheartj/ehac207] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 03/13/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS Non-invasive imaging is routinely used to estimate left ventricular (LV) filling pressure (LVFP) in heart failure (HF). Cardiovascular magnetic resonance (CMR) is emerging as an important imaging tool for sub-phenotyping HF. However, currently, LVFP cannot be estimated from CMR. This study sought to investigate (i) if CMR can estimate LVFP in patients with suspected HF and (ii) if CMR-modelled LVFP has prognostic power. METHODS AND RESULTS Suspected HF patients underwent right heart catheterization (RHC), CMR and transthoracic echocardiography (TTE) (validation cohort only) within 24 h of each other. Right heart catheterization measured pulmonary capillary wedge pressure (PCWP) was used as a reference for LVFP. At follow-up, death was considered as the primary endpoint. We enrolled 835 patients (mean age: 65 ± 13 years, 40% male). In the derivation cohort (n = 708, 85%), two CMR metrics were associated with RHC PCWP:LV mass and left atrial volume. When applied to the validation cohort (n = 127, 15%), the correlation coefficient between RHC PCWP and CMR-modelled PCWP was 0.55 (95% confidence interval: 0.41-0.66, P < 0.0001). Cardiovascular magnetic resonance-modelled PCWP was superior to TTE in classifying patients as normal or raised filling pressures (76 vs. 25%). Cardiovascular magnetic resonance-modelled PCWP was associated with an increased risk of death (hazard ratio: 1.77, P < 0.001). At Kaplan-Meier analysis, CMR-modelled PCWP was comparable to RHC PCWP (≥15 mmHg) to predict survival at 7-year follow-up (35 vs. 37%, χ2 = 0.41, P = 0.52). CONCLUSION A physiological CMR model can estimate LVFP in patients with suspected HF. In addition, CMR-modelled LVFP has a prognostic role.
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Affiliation(s)
- Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Peter Swoboda
- The Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Rachel Jones
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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9
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Alandejani F, Alabed S, Garg P, Goh ZM, Karunasaagarar K, Sharkey M, Salehi M, Aldabbagh Z, Dwivedi K, Mamalakis M, Metherall P, Uthoff J, Johns C, Rothman A, Condliffe R, Hameed A, Charalampoplous A, Lu H, Plein S, Greenwood JP, Lawrie A, Wild JM, de Koning PJH, Kiely DG, Van Der Geest R, Swift AJ. Training and clinical testing of artificial intelligence derived right atrial cardiovascular magnetic resonance measurements. J Cardiovasc Magn Reson 2022; 24:25. [PMID: 35387651 PMCID: PMC8988415 DOI: 10.1186/s12968-022-00855-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Right atrial (RA) area predicts mortality in patients with pulmonary hypertension, and is recommended by the European Society of Cardiology/European Respiratory Society pulmonary hypertension guidelines. The advent of deep learning may allow more reliable measurement of RA areas to improve clinical assessments. The aim of this study was to automate cardiovascular magnetic resonance (CMR) RA area measurements and evaluate the clinical utility by assessing repeatability, correlation with invasive haemodynamics and prognostic value. METHODS A deep learning RA area CMR contouring model was trained in a multicentre cohort of 365 patients with pulmonary hypertension, left ventricular pathology and healthy subjects. Inter-study repeatability (intraclass correlation coefficient (ICC)) and agreement of contours (DICE similarity coefficient (DSC)) were assessed in a prospective cohort (n = 36). Clinical testing and mortality prediction was performed in n = 400 patients that were not used in the training nor prospective cohort, and the correlation of automatic and manual RA measurements with invasive haemodynamics assessed in n = 212/400. Radiologist quality control (QC) was performed in the ASPIRE registry, n = 3795 patients. The primary QC observer evaluated all the segmentations and recorded them as satisfactory, suboptimal or failure. A second QC observer analysed a random subcohort to assess QC agreement (n = 1018). RESULTS All deep learning RA measurements showed higher interstudy repeatability (ICC 0.91 to 0.95) compared to manual RA measurements (1st observer ICC 0.82 to 0.88, 2nd observer ICC 0.88 to 0.91). DSC showed high agreement comparing automatic artificial intelligence and manual CMR readers. Maximal RA area mean and standard deviation (SD) DSC metric for observer 1 vs observer 2, automatic measurements vs observer 1 and automatic measurements vs observer 2 is 92.4 ± 3.5 cm2, 91.2 ± 4.5 cm2 and 93.2 ± 3.2 cm2, respectively. Minimal RA area mean and SD DSC metric for observer 1 vs observer 2, automatic measurements vs observer 1 and automatic measurements vs observer 2 was 89.8 ± 3.9 cm2, 87.0 ± 5.8 cm2 and 91.8 ± 4.8 cm2. Automatic RA area measurements all showed moderate correlation with invasive parameters (r = 0.45 to 0.66), manual (r = 0.36 to 0.57). Maximal RA area could accurately predict elevated mean RA pressure low and high-risk thresholds (area under the receiver operating characteristic curve artificial intelligence = 0.82/0.87 vs manual = 0.78/0.83), and predicted mortality similar to manual measurements, both p < 0.01. In the QC evaluation, artificial intelligence segmentations were suboptimal at 108/3795 and a low failure rate of 16/3795. In a subcohort (n = 1018), agreement by two QC observers was excellent, kappa 0.84. CONCLUSION Automatic artificial intelligence CMR derived RA size and function are accurate, have excellent repeatability, moderate associations with invasive haemodynamics and predict mortality.
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Affiliation(s)
- Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ze Ming Goh
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Kavita Karunasaagarar
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Michael Sharkey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mahan Salehi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ziad Aldabbagh
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Michail Mamalakis
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Pete Metherall
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Johanna Uthoff
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Chris Johns
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Abdul Hameed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Athanasios Charalampoplous
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Haiping Lu
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) &, Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) &, Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, UK
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Patrick J H de Koning
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rob Van Der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK.
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10
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Wang S, Intille S, Ponnada A, Do B, Rothman A, Dunton G. Investigating Microtemporal Processes Underlying Health Behavior Adoption and Maintenance: Protocol for an Intensive Longitudinal Observational Study (Preprint). JMIR Res Protoc 2022; 11:e36666. [PMID: 35834296 PMCID: PMC9335174 DOI: 10.2196/36666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Shirlene Wang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Stephen Intille
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Aditya Ponnada
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Bridgette Do
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Alexander Rothman
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Genevieve Dunton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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11
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Wilkins MR, Mckie MA, Law M, Roussakis AA, Harbaum L, Church C, Coghlan JG, Condliffe R, Howard LS, Kiely DG, Lordan J, Rothman A, Suntharalingam J, Toshner M, Wort SJ, Villar SS. Positioning imatinib for pulmonary arterial hypertension: A phase I/II design comprising dose finding and single-arm efficacy. Pulm Circ 2021; 11:20458940211052823. [PMID: 34868551 PMCID: PMC8642118 DOI: 10.1177/20458940211052823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/19/2021] [Indexed: 12/21/2022] Open
Abstract
Pulmonary arterial hypertension is an unmet clinical need. Imatinib, a tyrosine kinase inhibitor, 200 to 400 mg daily reduces pulmonary artery pressure and increases functional capacity in this patient group, but is generally poorly tolerated at the higher dose. We have designed an open-label, single-arm clinical study to investigate whether there is a tolerated dose of imatinib that can be better targeted to patients who will benefit. The study consists of two parts. Part 1 seeks to identify the best tolerated dose of Imatinib in the range from 100 and up to 400 mg using a Bayesian Continuous Reassessment Method. Part 2 will measure efficacy after 24 weeks treatment with the best tolerated dose using a Simon's two-stage design. The primary efficacy endpoint is a binary variable. For patients with a baseline pulmonary vascular resistance (PVR) >1000 dynes · s · cm-5, success is defined by an absolute reduction in PVR of ≥300 dynes · s · cm-5 at 24 weeks. For patients with a baseline PVR ≤1000 dynes · s · cm-5, success is a 30% reduction in PVR at 24 weeks. PVR will also be evaluated as a continuous variable by genotype as an exploratory analysis. Evaluating the response to that dose by genotype may inform a prospective biomarker-driven study.
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Affiliation(s)
- Martin R. Wilkins
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Mikel A. Mckie
- MRC Biostatistics Unit, School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, UK
| | - Martin Law
- MRC Biostatistics Unit, School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, UK
| | | | - Lars Harbaum
- Golden Jubilee National Hospital, University of Glasgow, Scotland, UK
| | - Colin Church
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - J Gerry Coghlan
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Luke S Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - David G Kiely
- Newcastle Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne, UK
| | - Jim Lordan
- Royal United Hospital, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Alexander Rothman
- Heart Lung Research Institute, University of Cambridge, Cambridge, UK
| | | | - Mark Toshner
- Royal Brompton Hospital, Guy’s and St Thomas’s Trust, London, UK
| | - Stephen J Wort
- Royal Brompton Hospital, Guy’s and St Thomas’s Trust, London, UK
| | - Sofía S. Villar
- MRC Biostatistics Unit, School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, UK
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12
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Elhawaz A, Archer GT, Zafar H, Fidock B, Barker N, Jones R, Rothman A, Hose R, Al-Mohammad A, Briffa N, Hunter S, Braidley P, Hall IR, Grech E, van der Geest RJ, Gunn JP, Swift AJ, Wild JM, Garg P. Left ventricular blood flow kinetic energy is associated with the six-minute walk test and left ventricular remodelling post valvular intervention in aortic stenosis. Quant Imaging Med Surg 2021; 11:1470-1482. [PMID: 33816183 DOI: 10.21037/qims-20-586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Left ventricular (LV) kinetic energy (KE) assessment by four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) may offer incremental value over routine assessment in aortic stenosis (AS). The main objective of this study is to investigate the LV KE in patients with AS before and after the valve intervention. In addition, this study aimed to investigate if LV KE offers incremental value for its association to the six-minute walk test (6MWT) or LV remodelling post-intervention. Methods We recruited 18 patients with severe AS. All patients underwent transthoracic echocardiography for mean pressure gradient (mPG), CMR including 4D flow and 6MWT. Patients were invited for post-valve intervention follow-up CMR at 3 months and twelve patients returned for follow-up CMR. KE assessment of LV blood flow and the components (direct, delayed, retained and residual) were carried out for all cases. LV KE parameters were normalised to LV end-diastolic volume (LVEDV). Results For LV blood flow KE assessment, the metrics including time delay (TD) for peak E-wave from base to mid-ventricle (14±48 vs. 2.5±9.75 ms, P=0.04), direct (4.91±5.07 vs. 1.86±1.72 µJ, P=0.01) and delayed (2.46±3.13 vs. 1.38±1.15 µJ, P=0.03) components of LV blood flow demonstrated a significant change between pre- and post-valve intervention. Only LV KEiEDV (r=-0.53, P<0.01), diastolic KEiEDV (r=-0.53, P<0.01) and Ewave KEiEDV (r=-0.38, P=0.04) demonstrated association to the 6MWT. However, Pre-operative LV KEiEDV (r=0.67, P=0.02) demonstrated association to LV remodelling post valve intervention. Conclusions LV blood flow KE is associated with 6MWT and LV remodelling in patients with AS. LV KE assessment provides incremental value over routine LV function and pressure gradient (PG) assessment in AS.
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Affiliation(s)
- Alaa Elhawaz
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Gareth T Archer
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Hamza Zafar
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Benjamin Fidock
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Natasha Barker
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rachel Jones
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rod Hose
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdallah Al-Mohammad
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Norman Briffa
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steven Hunter
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Peter Braidley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ian R Hall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ever Grech
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rob J van der Geest
- Division of Image Processing, Leiden University Medical Centre, Leiden, The Netherlands
| | - Julian P Gunn
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James M Wild
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
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13
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Fidock B, Archer G, Barker N, Elhawaz A, Al-Mohammad A, Rothman A, Hose R, Hall IR, Grech E, Briffa N, Lewis N, van der Geest RJ, Zhang JM, Zhong L, Swift AJ, Wild JM, De Gárate E, Bucciarelli-Ducci C, Bax JJ, Plein S, Myerson S, Garg P. Standard and emerging CMR methods for mitral regurgitation quantification. Int J Cardiol 2021; 331:316-321. [PMID: 33548381 PMCID: PMC8040969 DOI: 10.1016/j.ijcard.2021.01.066] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There are several methods to quantify mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR). The interoperability of these methods and their reproducibility remains undetermined. OBJECTIVE To determine the agreement and reproducibility of different MR quantification methods by CMR across all aetiologies. METHODS Thirty-five patients with MR were recruited (primary MR = 12, secondary MR = 10 and MVR = 13). Patients underwent CMR, including cines and four-dimensional flow (4D flow). Four methods were evaluated: MRStandard (left ventricular stroke volume - aortic forward flow by phase contrast), MRLVRV (left ventricular stroke volume - right ventricular stroke volume), MRJet (direct jet quantification by 4D flow) and MRMVAV (mitral forward flow by 4D flow - aortic forward flow by 4D flow). For all cases and MR types, 520 MR volumes were recorded by these 4 methods for intra-/inter-observer tests. RESULTS In primary MR, MRMVAV and MRLVRV were comparable to MRStandard (P > 0.05). MRJet resulted in significantly higher MR volumes when compared to MRStandard (P < 0.05) In secondary MR and MVR cases, all methods were comparable. In intra-observer tests, MRMVAV demonstrated least bias with best limits of agreement (bias = -0.1 ml, -8 ml to 7.8 ml, P = 0.9) and best concordance correlation coefficient (CCC = 0.96, P < 0.01). In inter-observer tests, for primary MR and MVR, least bias and highest CCC were observed for MRMVAV. For secondary MR, bias was lowest for MRJet (-0.1 ml, PNS). CONCLUSION CMR methods of MR quantification demonstrate agreement in secondary MR and MVR. In primary MR, this was not observed. Across all types of MR, MRMVAV quantification demonstrated the highest reproducibility and consistency.
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Affiliation(s)
| | | | | | | | - Abdallah Al-Mohammad
- University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Rod Hose
- University of Sheffield, Sheffield, UK
| | - Ian R Hall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ever Grech
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Norman Briffa
- University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nigel Lewis
- University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | | | | | | | | | | | - Jeroen J Bax
- Leiden University Medical Centre, Leiden, the Netherlands
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14
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Gollust SE, Vogel RI, Rothman A, Yzer M, Fowler EF, Nagler RH. Americans' perceptions of disparities in COVID-19 mortality: Results from a nationally-representative survey. Prev Med 2020; 141:106278. [PMID: 33027615 PMCID: PMC7533111 DOI: 10.1016/j.ypmed.2020.106278] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 01/08/2023]
Abstract
As with many other infectious and chronic conditions, the COVID-19 crisis in the United States (U.S.) reveals severe inequities in health. The objective of this study was to describe public perceptions of disparities in mortality from COVID-19 and examine correlates of those perceptions. We fielded a nationally-representative survey in late April 2020, asking participants how much they agreed with four statements describing group-level COVID-19 disparities: older people compared to younger, people with chronic health conditions compared to those without, poorer people compared to wealthier, and Black people compared to white people. We also measured personal characteristics, experience with COVID-19, and information sources. Overall agreement with age- and health condition-related disparities was high (>80%) while agreement with socioeconomic (SES) and racial disparities was lower (52%). Higher education and income were generally associated with greater agreement with disparities. Partisanship and information sources used were associated with perceptions of SES- and racial-disparities, with Democrats and those attune to national news-but not Fox cable news-more likely to perceive these disparities. As of April 2020, information about age- and health condition-related disparities in COVID-19 was well known by the U.S. public, while information about social disparities was less recognized and varied along socioeconomic and partisan lines.
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Affiliation(s)
- Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States of America.
| | - Rachel I Vogel
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Alexander Rothman
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States of America
| | - Marco Yzer
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, United States of America
| | - Erika Franklin Fowler
- Department of Government, Wesleyan University, Middletown, CT, United States of America
| | - Rebekah H Nagler
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, United States of America
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15
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Jones R, Varian F, Alabed S, Morris P, Rothman A, Swift AJ, Lewis N, Kyriacou A, Wild JM, Al-Mohammad A, Zhong L, Dastidar A, Storey RF, Swoboda PP, Bax JJ, Garg P. Meta-analysis of echocardiographic quantification of left ventricular filling pressure. ESC Heart Fail 2020; 8:566-576. [PMID: 33230957 PMCID: PMC7835555 DOI: 10.1002/ehf2.13119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/04/2020] [Accepted: 11/03/2020] [Indexed: 12/31/2022] Open
Abstract
Aims The clinical reliability of echocardiographic surrogate markers of left ventricular filling pressures (LVFPs) across different cardiovascular pathologies remains unanswered. The main objective was to evaluate the evidence of how effectively different echocardiographic indices estimate true LVFP. Methods and results Design: this is a systematic review and meta‐analysis. Data source: Scopus, PubMed and Embase. Eligibility criteria for selecting studies were those that used echocardiography to predict or estimate pulmonary capillary wedge pressure or left ventricular end‐diastolic pressures. Twenty‐seven studies met criteria. Only eight studies (30%) reported both correlation coefficient and bias between non‐invasive and invasively measured LVFPs. The majority of studies (74%) recorded invasive pulmonary capillary wedge pressure as a surrogate for left ventricular end‐diastolic pressures. The pooled correlation coefficient overall was r = 0.69 [95% confidence interval (CI) 0.63–0.75, P < 0.01]. Evaluation by cohort demonstrated varying association: heart failure with preserved ejection fraction (11 studies, n = 575, r = 0.59, 95% CI 0.53–0.64) and heart failure with reduced ejection fraction (8 studies, n = 381, r = 0.67, 95% CI 0.61–0.72). Conclusions Echocardiographic indices show moderate pooled association to invasively measured LVFP; however, this varies widely with disease state. In heart failure with preserved ejection fraction, no single echocardiography‐based metric offers a reliable estimate. In heart failure with reduced ejection fraction, mitral inflow‐derived indices (E/e′, E/A, E/Vp, and EDcT) have reasonable clinical applicability. While an integrated approach of several echocardiographic metrics provides the most promise for estimating LVFP reliably, such strategies need further validation in larger, patient‐specific studies.
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Affiliation(s)
- Rachel Jones
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK
| | - Frances Varian
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK.,Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK
| | - Paul Morris
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK.,Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Nigel Lewis
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andreas Kyriacou
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James M Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Abdallah Al-Mohammad
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK.,Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | | | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jeroen J Bax
- Cardiology Directorate, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK.,Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
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16
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Garg P, Wood S, Swift AJ, Fent G, Lewis N, Rogers D, Rothman A, Charalampopoulos A, Al‐Mohammad A. Clinical predictors of all-cause mortality in patients presenting to specialist heart failure clinic with raised NT-proBNP and no heart failure. ESC Heart Fail 2020; 7:1791-1800. [PMID: 32496010 PMCID: PMC7373941 DOI: 10.1002/ehf2.12742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/02/2020] [Accepted: 04/21/2020] [Indexed: 01/15/2023] Open
Abstract
AIMS Clinical outcomes for patients suspected of having heart failure (HF) who do not meet the diagnostic criteria of any type of HF by echocardiography remain unknown. The aim of this study was to investigate the clinical predictors of all-cause mortality in patients with suspected HF, a raised N-terminal pro-b-type natriuretic peptide (NTproBNP) and who do not meet the diagnostic criteria of any type of HF by echocardiography. METHODS AND RESULTS Relevant data were taken from the Sheffield HEArt Failure (SHEAF) registry (222349P4). The inclusion criteria were presence of symptoms raising suspicion of HF, NTproBNP > 400 pg/mL, and preserved left ventricular function. Exclusion criteria were any type of HF by echocardiography. The outcome was defined as all-cause mortality. Cox proportional-hazards regression model was used to investigate the association between the survival time of patients and clinical variables; 1031 patients were identified with NTproBNP > 400 pg/mL but who did not have echocardiographic evidence of HF. All-cause mortality was 21.5% (222 deaths) over the mean follow-up (FU) period of 6 ± 2 years. NTproBNP was similar in patients who were alive or dead (P = 0.96). However, age (HR 1, P < 0.01), chronic kidney disease (CKD, HR 1.2, P < 0.01), chronic pulmonary obstructive disease (COPD, HR 1.6, P < 0.01), dementia (HR 5.9, P < 0.01), male gender (HR 1.4, P < 0.01), first-degree atrioventricular block (HR 2.1, P < 0.01), left axis deviation (HR 1.6, P = 0.04), and diabetes (HR 1.4, P = 0.03) were associated with all-cause mortality. In multivariate regression, age, gender, CKD stage, COPD, and dementia were independently associated with mortality. In patients with NTproBNP > 627 pg/mL, NYHA class predicted death (II, 19.6%; III, 27.4%; IV, 66.7%; P < 0.01). CONCLUSIONS Patients with no HF on echocardiography but raised NTproBNP suffer excess mortality particularly in the presence of certain clinical variables. Age, male gender, worsening CKD stage, presence of COPD, and dementia are independently associated with all-cause mortality in these patients. An NTproBNP > 627 pg/mL coupled with NYHA class could identify patients at greatest risk of death.
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Affiliation(s)
- Pankaj Garg
- Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Steven Wood
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Andrew J. Swift
- Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Graham Fent
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Nigel Lewis
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Dominic Rogers
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Alexander Rothman
- Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | | | - Abdallah Al‐Mohammad
- Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
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17
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Rothman A, Jaiswal V, Evans WN, Restrepo H, Galindo A. Percutaneous retrieval of fractured intravascular catheters in premature infants. J Neonatal Perinatal Med 2019; 13:413-417. [PMID: 31771073 DOI: 10.3233/npm-180159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Premature infants often require long-term indwelling intravascular catheters. Occasionally, catheters fracture and migrate into cardiovascular structures, risking perforation, infection, thrombosis, and interference with cardiac and valve function. This case series describes our experience with percutaneous retrieval of broken intravascular catheters. METHODS A gooseneck micro-snare was used to retrieve fractured catheters in four premature infants, weighing between 840 and 1930 grams. RESULTS All procedures were successful without complications. CONCLUSIONS Gooseneck-snare retrieval of broken indwelling intravascular catheters can be performed safely and successfully in premature infants even those that weigh less than 1000 grams.
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Affiliation(s)
- A Rothman
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, University of Nevada Las Vegas, School of Medicine, Las Vegas, NV, USA
| | - V Jaiswal
- Department of Pediatrics, University of Nevada Las Vegas, School of Medicine, Las Vegas, NV, USA
| | - W N Evans
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, University of Nevada Las Vegas, School of Medicine, Las Vegas, NV, USA
| | - H Restrepo
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, University of Nevada Las Vegas, School of Medicine, Las Vegas, NV, USA
| | - A Galindo
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Pediatrics, University of Nevada Las Vegas, School of Medicine, Las Vegas, NV, USA
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18
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Olazagasti C, Rothman A, Sampat D, Chow D, Seetharamu N, Steiger D. P2.11-03 Implementing Physician Education to Increase Lung Cancer Screening Compliance. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Dolan EB, Varela CE, Mendez K, Whyte W, Levey RE, Robinson ST, Maye E, O'Dwyer J, Beatty R, Rothman A, Fan Y, Hochstein J, Rothenbucher SE, Wylie R, Starr JR, Monaghan M, Dockery P, Duffy GP, Roche ET. An actuatable soft reservoir modulates host foreign body response. Sci Robot 2019; 4:4/33/eaax7043. [PMID: 33137787 DOI: 10.1126/scirobotics.aax7043] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/01/2019] [Indexed: 12/18/2022]
Abstract
The performance of indwelling medical devices that depend on an interface with soft tissue is plagued by complex, unpredictable foreign body responses. Such devices-including breast implants, biosensors, and drug delivery devices-are often subject to a collection of biological host responses, including fibrosis, which can impair device functionality. This work describes a milliscale dynamic soft reservoir (DSR) that actively modulates the biomechanics of the biotic-abiotic interface by altering strain, fluid flow, and cellular activity in the peri-implant tissue. We performed cyclical actuation of the DSR in a preclinical rodent model. Evaluation of the resulting host response showed a significant reduction in fibrous capsule thickness (P = 0.0005) in the actuated DSR compared with non-actuated controls, whereas the collagen density and orientation were not changed. We also show a significant reduction in myofibroblasts (P = 0.0036) in the actuated group and propose that actuation-mediated strain reduces differentiation and proliferation of myofibroblasts and therefore extracellular matrix production. Computational models quantified the effect of actuation on the reservoir and surrounding fluid. By adding a porous membrane and a therapy reservoir to the DSR, we demonstrate that, with actuation, we could (i) increase transport of a therapy analog and (ii) enhance pharmacokinetics and time to functional effect of an inotropic agent. The dynamic reservoirs presented here may act as a versatile tool to further understand, and ultimately to ameliorate, the host response to implantable biomaterials.
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Affiliation(s)
- E B Dolan
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland.,Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C E Varela
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - K Mendez
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - W Whyte
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - R E Levey
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - S T Robinson
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Maye
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J O'Dwyer
- Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland.,Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - R Beatty
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - A Rothman
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Y Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - J Hochstein
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - S E Rothenbucher
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - R Wylie
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J R Starr
- Epidemiology and Biostatistics Core, The Forsyth Institute, 245 First Street, Cambridge, MA, USA
| | - M Monaghan
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - P Dockery
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - G P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland. .,Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - E T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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20
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Fidock B, Barker N, Balasubramanian N, Archer G, Fent G, Al-Mohammad A, Richardson J, O'Toole L, Briffa N, Rothman A, van der Geest R, Hose R, Wild JM, Swift AJ, Garg P. A Systematic Review of 4D-Flow MRI Derived Mitral Regurgitation Quantification Methods. Front Cardiovasc Med 2019; 6:103. [PMID: 31428619 PMCID: PMC6688118 DOI: 10.3389/fcvm.2019.00103] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/15/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Four-dimensional flow cardiac magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology that can be used to quantify mitral regurgitation (MR) volume. Current methods of quantification have demonstrated limitations in accurate analysis, particularly in difficult cases such as complex congenital heart disease. 4D flow CMR methods aim to circumvent these limitations and allow accurate quantification of MR volume even in complex cases. This systematic review aims to summarize the available literature on 4D flow CMR MR quantification methods and examine their ability to accurately classify MR severity. Methods: Structured searches were carried out on Medline and EMBASE in December 2018 to identify suitable research outcome studies. The titles and abstracts were screened for relevance, with a third adjudicator utilized when study suitability was uncertain. Results: Seven studies met the eligibility criteria and were included in the systematic review. The most widely used 4D flow MRI method was retrospective valve tracking (RVT) which was examined in five papers. The key finding of these papers was that RVT is a reliable and accurate method of regurgitant volume quantification. Conclusions: MR quantification through 4D flow MRI is both feasible and accurate. The evidence gathered suggests that for MR assessment, 4D flow MRI is potentially as accurate and reliable to echocardiography and may be complementary to this technique. Further work on MR quantification 4D flow image analysis is needed to determine the most accurate analysis technique and to demonstrate 4D flow MRI as a predictor of clinical outcome. PROSPERO Registration Number: CRD42019122837, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019122837
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Affiliation(s)
- Benjamin Fidock
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Natasha Barker
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Nithin Balasubramanian
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Gareth Archer
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Graham Fent
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - James Richardson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Laurence O'Toole
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Norman Briffa
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alexander Rothman
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | | | - Rod Hose
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - James M Wild
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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21
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Middleton JT, Maulik A, Lewis R, Kiely DG, Toshner M, Charalampopoulos A, Kyriacou A, Rothman A. Arrhythmic Burden and Outcomes in Pulmonary Arterial Hypertension. Front Med (Lausanne) 2019; 6:169. [PMID: 31396515 PMCID: PMC6664000 DOI: 10.3389/fmed.2019.00169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/08/2019] [Indexed: 12/17/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a devastating, life-limiting disease driven by small vessel vascular remodeling leading to a rise in pulmonary vascular resistance (PVR). Patients present with a range of symptoms including shortness of breath, exercise intolerance, palpitations or syncope. Symptoms may be related to vascular disease progression or arrhythmia secondary to the adaptation of the right heart to pressure overload. Arrhythmic burden is high in patients with left heart disease and guideline-based treatment of arrhythmias improves quality of life and prognosis. In PAH the incidence and prevalence of arrhythmias is less well-defined and there are no PAH-specific guidelines for arrhythmia management. We undertook a literature search identifying 13 relevant papers; detection of arrhythmias was acquired from 12-lead electrocardiogram (ECG) or Holter monitors. In all forms of pulmonary hypertension (PH) the prevalence of supraventricular arrhythmias (SVA) was 26–31%, ventricular arrhythmias (VA) 24% and a 5-year incidence of SVA ~13.2–25.1%. Prevalence and incidence of arrhythmias in PAH is less clear due to limited study numbers and the heterogenous nature of the patient population studied. For arrhythmia treatment, only single-arm studies of therapeutic strategies were reported using antiarrhythmic drugs (AAD), direct current cardioversion (DCCV) and ablation. Periods between ECG or Holter have not been investigated, highlighting the possibility that significant arrhythmias may be undetected. Advances in monitoring allow long-term surveillance via implanted/non-invasive monitors. Use of such technologies may provide an accurate estimate of incidence and prevalence of arrhythmias in patients with PAH, further defining relationships to adverse outcomes, and therapeutic options.
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Affiliation(s)
- Jennifer T Middleton
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom.,Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Angshuman Maulik
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom.,Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Robert Lewis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Mark Toshner
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,Royal Papworth Hospital NHS Foundation Trust, Cambridgeshire, United Kingdom
| | - Athanasios Charalampopoulos
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Andreas Kyriacou
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alexander Rothman
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom.,Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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22
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Barker N, Fidock B, Balasubramanian N, Macdonald AW, Capener D, Johns CS, Karunasaagarar K, Fent G, Al-Mohammad A, Rothman A, Kiely DG, Wild JM, Swift A, Garg P. P165A novel cardiac magnetic resonance imaging model to predict level of mixed venous oxygen levels in pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Barker
- University of Sheffield, Infection Immunity and Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - B Fidock
- University of Sheffield, Infection Immunity and Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - N Balasubramanian
- University of Sheffield, Infection Immunity and Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - A W Macdonald
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - D Capener
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - C S Johns
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - K Karunasaagarar
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - G Fent
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - A Al-Mohammad
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - A Rothman
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - D G Kiely
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - J M Wild
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - A Swift
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - P Garg
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
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23
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Fidock B, Balasubramanian N, Barker N, Macdonald A, Capener D, Johns C, Karunasaagarar K, Fent G, Al-Mohammad A, Rothman A, Kiely D, Swift A, Wild J, Garg P. 284An accurate, multi-parametric cardiovascular magnetic resonance model to predict mean pulmonary artery pressure in pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez114.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Fidock
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - N Balasubramanian
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - N Barker
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - A Macdonald
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - D Capener
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - C Johns
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - K Karunasaagarar
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - G Fent
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - A Al-Mohammad
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - A Rothman
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - D Kiely
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - A Swift
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - J Wild
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - P Garg
- University of Sheffield, Sheffield, United Kingdom of Great Britain & Northern Ireland
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24
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Alfaidi MA, Chamberlain J, Rothman A, Crossman D, Villa-Uriol MC, Hadoke P, Wu J, Schenkel T, Evans PC, Francis SE. Dietary Docosahexaenoic Acid Reduces Oscillatory Wall Shear Stress, Atherosclerosis, and Hypertension, Most Likely Mediated via an IL-1-Mediated Mechanism. J Am Heart Assoc 2018; 7:e008757. [PMID: 29960988 PMCID: PMC6064924 DOI: 10.1161/jaha.118.008757] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypertension is a complex condition and a common cardiovascular risk factor. Dietary docosahexaenoic acid (DHA) modulates atherosclerosis and hypertension, possibly via an inflammatory mechanism. IL-1 (interleukin 1) has an established role in atherosclerosis and inflammation, although whether IL-1 inhibition modulates blood pressure is unclear. METHODS AND RESULTS Male apoE-/- (apolipoprotein E-null) mice were fed either a high fat diet or a high fat diet plus DHA (300 mg/kg per day) for 12 weeks. Blood pressure and cardiac function were assessed, and effects of DHA on wall shear stress and atherosclerosis were determined. DHA supplementation improved left ventricular function, reduced wall shear stress and oscillatory shear at ostia in the descending aorta, and significantly lowered blood pressure compared with controls (119.5±7 versus 159.7±3 mm Hg, P<0.001, n=4 per group). Analysis of atheroma following DHA feeding in mice demonstrated a 4-fold reduction in lesion burden in distal aortas and in brachiocephalic arteries (P<0.001, n=12 per group). In addition, DHA treatment selectively decreased plaque endothelial IL-1β (P<0.01). CONCLUSIONS Our findings revealed that raised blood pressure can be reduced by inhibiting IL-1 indirectly by administration of DHA in the diet through a mechanism that involves a reduction in wall shear stress and local expression of the proinflammatory cytokine IL-1β.
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Affiliation(s)
- Mabruka A Alfaidi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom
| | - Janet Chamberlain
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom
| | | | - Maria-Cruz Villa-Uriol
- INSIGNEO Institute for in silico Medicine & Department of Computer Science, University of Sheffield, United Kingdom
| | - Patrick Hadoke
- BHF Centre of Excellence, University of Edinburgh, United Kingdom
| | - Junxi Wu
- BHF Centre of Excellence, University of Edinburgh, United Kingdom
| | - Torsten Schenkel
- Department of Engineering and Mathematics, Hallam University, Sheffield, United Kingdom
| | - Paul C Evans
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom
| | - Sheila E Francis
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom
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25
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Zhang HD, Lv ZC, Wang LT, Rothman A, Lian TY, He YY, Wu Y, Lawrie A, Beghetti M, Jing ZC. Prognostic Significance of Reduced Blood Pressure Response to Exercise in Pediatric Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2017; 196:1478-1481. [PMID: 28375639 DOI: 10.1164/rccm.201701-0131le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hong-Da Zhang
- 1 Tongji University Shanghai, China.,2 State Key Laboratory of Cardiovascular Disease, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China.,3 The Medical School, University of Sheffield Sheffield, United Kingdom and
| | - Zi-Chao Lv
- 2 State Key Laboratory of Cardiovascular Disease, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Li-Ting Wang
- 2 State Key Laboratory of Cardiovascular Disease, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Alexander Rothman
- 3 The Medical School, University of Sheffield Sheffield, United Kingdom and
| | - Tian-Yu Lian
- 2 State Key Laboratory of Cardiovascular Disease, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Yang-Yang He
- 2 State Key Laboratory of Cardiovascular Disease, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Yan Wu
- 2 State Key Laboratory of Cardiovascular Disease, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Allan Lawrie
- 3 The Medical School, University of Sheffield Sheffield, United Kingdom and
| | | | - Zhi-Cheng Jing
- 1 Tongji University Shanghai, China.,2 State Key Laboratory of Cardiovascular Disease, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
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26
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Crossman D, Rothman A. The Canakinumab Antiinflammatory Thrombosis Outcome Study trial-the starting gun has fired. J Thorac Dis 2017; 9:4922-4925. [PMID: 29312693 PMCID: PMC5756992 DOI: 10.21037/jtd.2017.11.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/18/2017] [Indexed: 12/16/2022]
Affiliation(s)
- David Crossman
- School of Medicine, University of St Andrews, North Haugh, St Andrews, Scotland
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27
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Pickworth J, Rothman A, Iremonger J, Casbolt H, Hopkinson K, Hickey PM, Gladson S, Shay S, Morrell NW, Francis SE, West JD, Lawrie A. Differential IL-1 signaling induced by BMPR2 deficiency drives pulmonary vascular remodeling. Pulm Circ 2017; 7:768-776. [PMID: 28828907 PMCID: PMC5703124 DOI: 10.1177/2045893217729096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bone morphogenetic protein receptor type 2 (BMPR2) mutations are present in patients with heritable and idiopathic pulmonary arterial hypertension (PAH). Circulating levels of interleukin-1 (IL-1) are raised in patients and animal models. Whether interplay between BMP and IL-1 signaling can explain the local manifestation of PAH in the lung remains unclear. Cell culture, siRNA, and mRNA microarray analysis of RNA isolated from human pulmonary artery (PASMC) and aortic (AoSMC) smooth muscle cells were used. R899X+/– BMPR2 transgenic mice fed a Western diet for six weeks were given daily injections of IL-1ß prior to assessment for PAH and tissue collection. PASMC have reduced inflammatory activation in response to IL-1ß compared with AoSMCs; however, PASMC with reduced BMPR2 demonstrated an exaggerated response. Mice treated with IL-1ß had higher white blood cell counts and significantly raised serum protein levels of IL-6 and osteoprotegerin (OPG) plasma levels recapitulating in vitro data. Phenotypically, IL-1ß treated mice demonstrated increased pulmonary vascular remodeling. IL-1ß induces an exaggerated pulmonary artery specific transcriptomic inflammatory response when BMPR2 signaling is reduced.
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Affiliation(s)
- Josephine Pickworth
- 1 Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- 1 Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James Iremonger
- 1 Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Helen Casbolt
- 1 Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Kay Hopkinson
- 1 Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Peter M Hickey
- 1 Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | | | | | - Sheila E Francis
- 1 Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Allan Lawrie
- 1 Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Rothman A, Arnold N, Abou Hanna J, Rowland H, Poff B, Macdonald K, Nagy M, Panian T, Sundaram B, Pham P, Forouzan O, Gunn J, Lawrie A, Chronos N. P612Feasibility and safety of a wireless pulmonary artery pressure monitoring system in chronic porcine models of pulmonary hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lin J, Iremonger J, Pickworth J, Rothman A, Casbolt H, Arnold N, Elliot C, Condliffe R, Kiely D, Lawrie A. P245 Whole blood levels of microrna-34a predict survival and regulate genes associated with pulmonary arterial hypertension. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Johnson LB, Boyd LD, Rainchuso L, Rothman A, Mayer B. Eating disorder professionals' perceptions of oral health knowledge. Int J Dent Hyg 2015; 15:164-171. [PMID: 26449876 DOI: 10.1111/idh.12183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess the oral health knowledge among professionals who specialize in treating eating disorders, and identify to what extent their education, and training addresses oral health care delivery, and recommendations for individuals with eating disorders. METHOD Participants for this study were licensed behavioural and medical providers specializing in eating disorder treatment (n = 107), and recruited through professional eating disorder organizations. Participants completed an anonymous, online questionnaire (33 items) assessing level of oral health-related education, knowledge and treatment recommendations within the participant's respective eating disorder discipline. RESULTS The majority of respondents (85%) were formally trained in eating disorders, and of those trained, 64.4% were not satisfied with the level of oral health education during formal education, and 19.5% report no oral health education. Respondents consider their knowledge of risk of oral disease for their clients/patients as average or above (84%), and ranked tooth erosion as the greatest reason for oral care (63%) while dry mouth led in the rankings for least significant reason for oral care (33%). Referral for oral care was found to be more common after reports of complication (55%). DISCUSSION According to these findings, eating disorder professionals regard oral health care for their clients as significant, and may be unaware of associated oral risk factors, current oral care standards and long-term oral effects of disordered eating apart from enamel erosion.
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Affiliation(s)
- L B Johnson
- Forsyth School of Dental Hygiene, MCPHS University, Boston, MA, USA
| | - L D Boyd
- Forsyth School of Dental Hygiene, MCPHS University, Boston, MA, USA
| | - L Rainchuso
- Forsyth School of Dental Hygiene, MCPHS University, Boston, MA, USA
| | - A Rothman
- Forsyth School of Dental Hygiene, MCPHS University, Boston, MA, USA
| | - B Mayer
- Multi-Service Eating Disorder Association, Newton, MA, USA
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Dawson S, Pickworth J, Rothman A, Iremonger J, Arnold N, Francis S, Lawrie A. T5 Opg Regulates Pulmonary Arterial Smooth Muscle Cell Proliferation And The Expression Of Pah-associated Genes Via Fas. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
The repeal of Don't Ask, Don't Tell (DADT) is a success story. As of September 20, 2011, one of the most egregious cases of modern day government-sanctioned discrimination has been overturned. But my (Lawrence Korb) involvement with military policy toward gays and lesbians began early in our country's journey toward open service--18 years before the creation of DADT and 30 years before the Obama Administration successfully opened the armed forces to gay and lesbian service members. In 1981, I joined the Pentagon shortly after the Carter administration announced a new Pentagon policy stating that "homosexuality is incompatible with military service" (U.S. Naval Institute [USNI], 2011). As Assistant Secretary of Defense for Manpower, Reserve Affairs, Installations, and Logistics, the responsibility of writing the directive to implement this ban fell to my office. In this article, I detail my recollections from this period in American military history: the codification of the gay ban in U.S. Department of Defense policy.
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Vlahov D, Agarwal SR, Buckley RM, Caiaffa WT, Corvalan CF, Ezeh AC, Finkelstein R, Friel S, Harpham T, Hossain M, de Faria Leao B, Mboup G, Montgomery MR, Netherland JC, Ompad DC, Prasad A, Quinn AT, Rothman A, Satterthwaite DE, Stansfield S, Watson VJ. Roundtable on Urban Living Environment Research (RULER). J Urban Health 2011; 88:793-857. [PMID: 21910089 PMCID: PMC3191208 DOI: 10.1007/s11524-011-9613-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For 18 months in 2009-2010, the Rockefeller Foundation provided support to establish the Roundtable on Urban Living Environment Research (RULER). Composed of leading experts in population health measurement from a variety of disciplines, sectors, and continents, RULER met for the purpose of reviewing existing methods of measurement for urban health in the context of recent reports from UN agencies on health inequities in urban settings. The audience for this report was identified as international, national, and local governing bodies; civil society; and donor agencies. The goal of the report was to identify gaps in measurement that must be filled in order to assess and evaluate population health in urban settings, especially in informal settlements (or slums) in low- and middle-income countries. Care must be taken to integrate recommendations with existing platforms (e.g., Health Metrics Network, the Institute for Health Metrics and Evaluation) that could incorporate, mature, and sustain efforts to address these gaps and promote effective data for healthy urban management. RULER noted that these existing platforms focus primarily on health outcomes and systems, mainly at the national level. Although substantial reviews of health outcomes and health service measures had been conducted elsewhere, such reviews covered these in an aggregate and perhaps misleading way. For example, some spatial aspects of health inequities, such as those pointed to in the 2008 report from the WHO's Commission on the Social Determinants of Health, received limited attention. If RULER were to focus on health inequities in the urban environment, access to disaggregated data was a priority. RULER observed that some urban health metrics were already available, if not always appreciated and utilized in ongoing efforts (e.g., census data with granular data on households, water, and sanitation but with little attention paid to the spatial dimensions of these data). Other less obvious elements had not exploited the gains realized in spatial measurement technology and techniques (e.g., defining geographic and social urban informal settlement boundaries, classification of population-based amenities and hazards, and innovative spatial measurement of local governance for health). In summary, the RULER team identified three major areas for enhancing measurement to motivate action for urban health-namely, disaggregation of geographic areas for intra-urban risk assessment and action, measures for both social environment and governance, and measures for a better understanding of the implications of the physical (e.g., climate) and built environment for health. The challenge of addressing these elements in resource-poor settings was acknowledged, as was the intensely political nature of urban health metrics. The RULER team went further to identify existing global health metrics structures that could serve as platforms for more granular metrics specific for urban settings.
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Affiliation(s)
- David Vlahov
- School of Nursing, University of California-San Francisco San Francisco, CA, USA,
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Morton AC, Foley C, Rothman A, Gunn J, Greenwood JP, Hall A, Fox K, Lees B, Flather M, Crossman D. 15 Investigation of IL-1 inhibition in patients presenting with non-ST elevation myocardial infarction acute coronary syndromes (the MRC ILA Heart Study). Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dijkstra A, Rothman A, Pietersma S. The persuasive effects of framing messages on fruit and vegetable consumption according to regulatory focus theory. Psychol Health 2011; 26:1036-48. [PMID: 21598188 DOI: 10.1080/08870446.2010.526715] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
According to Regulatory Focus theory (RFT), outcomes in persuasive messages can be framed in four different ways, as gains, non-gains, losses or non-losses. In study 1, the persuasiveness of all four frames was compared and the presence/absence effect that was expected on the basis of the feature-positive effect was verified: Statements about present outcomes (gain, loss) were more persuasive than those about absent outcomes (non-gain, non-loss). However, this study failed to support the prediction that a gain-framed message would be more persuasive than a loss-framed message when promoting a prevention behaviour. Study 2 was designed to examine the latter finding. It was hypothesised that the threat posed by the loss-framed message in study 1 was too low to elicit a defensive reaction. Therefore, in study 2, the personal relevance of the gain and the loss framed message was manipulated. Consistent with predictions, the gain-framed message was more persuasive than the loss-framed message, but only when the message was personalised to increase self-relevance. Moreover, the effect was due to a significant drop in persuasion in the loss condition, probably caused by a defensive reaction. These data shed a new light on the findings of past framing studies.
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Affiliation(s)
- Arie Dijkstra
- Department of Social and Organizational Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
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Rothman A, Mayman GA, Evans WN, Berthoty D. Overlapping covered stents to exclude a postcoarctation stenting aortic aneurysm. Pediatr Cardiol 2008; 29:962-5. [PMID: 18049787 DOI: 10.1007/s00246-007-9158-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
Abstract
An 18-year-old boy who underwent coil occlusion of a patent ductus arteriosus and stenting for aortic coarctation at 13 years of age had evidence of re-stenosis. Cardiac catheterization and angiography showed a 25-mmHg gradient across the stent and a large aneurysm originating at midstent level. The aneurysm measured 2 cm in width and 4.3 cm in length. At a subsequent catheterization procedure, two 4.5-cm-long overlapping Cheatham platinum covered stents were implanted, completely excluding the aneurysm. Computed tomographic (CT) angiography 2 years later showed no evidence of endoleak or re-stenosis.
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Affiliation(s)
- A Rothman
- Children's Heart Center and Department of Pediatrics, Las Vegas, University of Nevada, 3006 S. Maryland Parkway, Las Vegas, Nevada 89109, USA.
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van der Pligt J, de Ridder D, Oldenburg B, Rothman A. Editorial. Health Psychol Rev 2008. [DOI: 10.1080/17437190802310025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mayman GA, Evans WN, Acherman RJ, Cass KA, Kip KT, Luna CF, Rothman A, Coviello L, Restrepo H. IMPROVEMENT IN EXERCISE CAPACITY IN OVERWEIGHT CHILDREN TREATED IN A LIFESTYLE MODIFICATION PROGRAM. J Investig Med 2007. [DOI: 10.1097/00042871-200701010-00306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Acherman RJ, Evans WN, Mayman GA, Luna CF, Rothman A, Collazos JC, Restrepo H. PRENATAL DIAGNOSIS OF SIGNIFICANT STRUCTURAL HEART DISEASE BY ECHOCARDIOGRAPHY IN CLARK COUNTY, NEVADA, FROM 2004 TO 2006. J Investig Med 2007. [DOI: 10.1097/00042871-200701010-00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rothman A, Acherman RJ, Luna CF, Restrepo H. Enlarged left vitelline vein remnant as a cause of cyanosis after the Fontan procedure: resolution with an Amplatzer vascular plug. Pediatr Cardiol 2006; 27:381-4. [PMID: 16541221 DOI: 10.1007/s00246-005-1270-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 6-year-old girl with heterotaxy and a functional single ventricle had persistent cyanosis 4 years after a fenestrated Fontan procedure. Cardiac catheterization revealed a large venous fistula from a left-sided hepatic vein to the coronary sinus, resulting in desaturation. The anomalous vein was occluded with an Amplatzer vascular plug.
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Affiliation(s)
- A Rothman
- Children's Heart Center and the Department of Pediatrics, University of Nevada School of Medicine, 3006 S. Maryland Parkway #690, Las Vegas, NV 89109, USA.
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Kip KT, Evans WN, Mayman GA, Acherman RJ, Cass KA, Rothman A, Luna CF, Restrepo H. 157 FAMILIAL HISTORY OF HYPERCHOLESTEROLEMIA AND ALTERED LIPID PANEL IN OVERWEIGHT CHILDREN AND ADOLESCENTS. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Luna C, Evans WN, Mayman GA, Acherman RJ, Kip KT, Cass KA, Rothman A, Gustafson A, Lowe A, Coviello L, Restrepo H. 329 EFFECTS OF A 12-WEEK RISK FACTOR REDUCTION PROGRAM IN OVERWEIGHT CHILDREN AND ADOLESCENTS WITH METABOLIC SYNDROME. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Evans WN, Mayman GA, Acherman RJ, Cass KA, Kip KT, Rothman A, Luna CF, Gustafson A, Lowe A, Coviello L, Restrepo H. 405 PLASMA LEVELS OF C-REACTIVE PROTEIN IN OVERWEIGHT CHILDREN AND ADOLESCENTS WITH CARDIAC-RELATED FAMILIAL RISK FACTORS.:. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rothman A, Evans W, Mayman G, Acherman R, Luna C, Restrepo H. Changes in Brain Natriuretic Peptide Levels in Patients with Congenital Heart Disease Undergoing Cardiac Catheterization. J Investig Med 2006. [DOI: 10.1177/108155890605401s135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- A. Rothman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - W.N. Evans
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - G.A. Mayman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - R.J. Acherman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - C.F. Luna
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - H. Restrepo
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
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Kip K, Evans W, Mayman G, Acherman R, Cass K, Rothman A, Luna C, Restrepo H. Familial History of Hypercholesterolemia and Altered Lipid Panel in Overweight Children and Adolescents. J Investig Med 2006. [DOI: 10.1177/108155890605401s41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- K.T. Kip
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - W.N. Evans
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - G.A. Mayman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - R.J. Acherman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - K.A. Cass
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - A. Rothman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - C.F. Luna
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - H. Restrepo
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
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Luna CF, Evans WN, Mayman GA, Acherman RJ, Kip KT, Cass KA, Rothman A, Gustafson A, Lowe A, Coviello L, Restrepo H. 398 QUANTITATIVE CHANGES IN DIAGNOSTIC CRITERIA OF METABOLIC SYNDROME IN OVERWEIGHT CHILDREN AND ADOLESCENTS ENROLLED IN A 12-WEEK MEDICALLY SUPERVISED RISK FACTOR REDUCTION PROGRAM.:. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rothman A, Evans WN, Mayman GA, Acherman RJ, Luna CF, Restrepo H. 252 CHANGES IN BRAIN NATRIURETIC PEPTIDE LEVELS IN PATIENTS WITH CONGENITAL HEART DISEASE UNDERGOING CARDIAC CATHETERIZATION. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Acherman R, Diaz G, Marquez A, Montealegre A, Ruiz A, Evans W, Mayman G, Cass K, Luna C, Rothman A, Restrepo H. Use of Brain Natriuretic Peptide in the Diagnosis of Patent Ductus Arteriosus in Preterm Infants. J Investig Med 2006. [DOI: 10.1177/108155890605401s53a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- R.J. Acherman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - G. Diaz
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - A. Marquez
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - A. Montealegre
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - A. Ruiz
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - W.N. Evans
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - G.A. Mayman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - K.A. Cass
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - C.F Luna
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - A. Rothman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
| | - H. Restrepo
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
- Instituto Materno Infantil, Universidad Nacional, Bogota, Colombia
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Evans WN, Mayman GA, Acherman RJ, Cass KA, Kip KT, Rothman A, Luna CF, Coviello L, Lowe A, Gustafson A, Restrepo H. 328 CHANGES IN SERUM LIPID VALUES IN OVERWEIGHT CHILDREN AND ADOLESCENTS TREATED FOR 12 WEEKS UNDER MEDICAL SUPERVISION.:. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Luna C, Evans W, Mayman G, Acherman R, Kip K, Cass K, Rothman A, Gustafson A, Lowe A, Coviello L, Restrepo H. Effects of a 12-Week Risk Factor Reduction Program in Overweight Children and Adolescents with Metabolic Syndrome. J Investig Med 2006. [DOI: 10.1177/108155890605401s212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- C.F. Luna
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - W.N. Evans
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - G.A. Mayman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - R.J. Acherman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - K.T. Kip
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - K.A. Cass
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - A. Rothman
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - A. Gustafson
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - A. Lowe
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - L. Coviello
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
| | - H. Restrepo
- Children's Heart Center, University of Nevada, School of Medicine, Las Vegas, NV
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