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Kramer CM, Rodriguez Lozano PF. Advancing Precision Cardiovascular Medicine: Transforming CMR Interpretation With Comprehensive Reference Ranges. JACC Cardiovasc Imaging 2024:S1936-878X(24)00076-7. [PMID: 38613556 DOI: 10.1016/j.jcmg.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Christopher M Kramer
- Cardiovascular Division, Department of Medicine, and Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia, USA.
| | - Patricia F Rodriguez Lozano
- Cardiovascular Division, Department of Medicine, and Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia, USA. https://twitter.com/PRodriguezMD
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Masri A, Sherrid MV, Abraham TP, Choudhury L, Garcia-Pavia P, Kramer CM, Barriales-Villa R, Owens AT, Rader F, Nagueh SF, Olivotto I, Saberi S, Tower-Rader A, Wong TC, Coats CJ, Watkins H, Fifer MA, Solomon SD, Heitner SB, Jacoby DL, Kupfer S, Malik FI, Meng L, Sohn RL, Wohltman A, Maron MS. Efficacy and Safety of Aficamten in Symptomatic Nonobstructive Hypertrophic Cardiomyopathy: Results From the REDWOOD-HCM Trial, Cohort 4. J Card Fail 2024:S1071-9164(24)00082-4. [PMID: 38493832 DOI: 10.1016/j.cardfail.2024.02.020] [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] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND This open-label phase 2 trial evaluated the safety and efficacy of aficamten in patients with nonobstructive hypertrophic cardiomyopathy (nHCM). METHODS Patients with symptomatic nHCM (left ventricular outflow tract obstruction gradient ≤ 30 mmHg, left ventricular ejection fraction [LVEF] ≥ 60%, N-terminal pro-B-type natriuretic peptide [NT-proBNP] > 300 pg/mL) received aficamten 5-15 mg once daily (doses adjusted according to echocardiographic LVEF) for 10 weeks. RESULTS We enrolled 41 patients (mean ± SD age 56 ± 16 years; 59% female). At Week 10, 22 (55%) patients experienced an improvement of ≥ 1 New York Heart Association class; 11 (29%) became asymptomatic. Clinically relevant improvements in Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores occurred in 22 (55%) patients. Symptom relief was paralleled by reductions in NT-proBNP levels (56%; P < 0.001) and high-sensitivity cardiac troponin I (22%; P < 0.005). Modest reductions in LVEF (mean ± SD) of -5.4% ± 10 to 64.6% ± 9.1 were observed. Three (8%) patients had asymptomatic reduction in LVEF < 50% (range: 41%-48%), all returning to normal after 2 weeks of washout. One patient with prior history of aborted sudden cardiac death experienced a fatal arrhythmia during the study. CONCLUSIONS Aficamten administration for symptomatic nHCM was generally safe and was associated with improvements in heart failure symptoms and cardiac biomarkers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04219826.
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Affiliation(s)
- Ahmad Masri
- Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA.
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | | | - Lubna Choudhury
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro de Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | | | | | | | - Sherif F Nagueh
- Section of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Timothy C Wong
- University of Pittsburgh School of Medicine, Division of Cardiology, Pittsburgh, PA, USA
| | - Caroline J Coats
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | - Stuart Kupfer
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Fady I Malik
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Lisa Meng
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Regina L Sohn
- Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Amy Wohltman
- Cytokinetics, Incorporated, South San Francisco, CA, USA
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Siggins C, Pan JA, Löffler AI, Yang Y, Shaw PW, Balfour PC, Epstein FH, Gan LM, Kramer CM, Keeley EC, Salerno M. Cardiometabolic biomarker patterns associated with cardiac MRI defined fibrosis and microvascular dysfunction in patients with heart failure with preserved ejection fraction. Front Cardiovasc Med 2024; 11:1334226. [PMID: 38500750 PMCID: PMC10945015 DOI: 10.3389/fcvm.2024.1334226] [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] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Heart failure with preserved ejection fraction (HFpEF) is a complex disease process influenced by metabolic disorders, systemic inflammation, myocardial fibrosis, and microvascular dysfunction. The goal of our study is to identify potential relationships between plasma biomarkers and cardiac magnetic resonance (CMR) imaging markers in patients with HFpEF. Methods Nineteen subjects with HFpEF and 15 age-matched healthy controls were enrolled and underwent multiparametric CMR and plasma biomarker analysis using the Olink® Cardiometabolic Panel (Olink Proteomics, Uppsala, Sweden). Partial least squares discriminant analysis (PLS-DA) was used to characterize CMR and biomarker variables that differentiate the subject groups into two principal components. Orthogonal projection to latent structures by partial least squares (OPLS) analysis was used to identify biomarker patterns that correlate with myocardial perfusion reserve (MPR) and extracellular volume (ECV) mapping. Results A PLS-DA could differentiate between HFpEF and normal controls with two significant components explaining 79% (Q2 = 0.47) of the differences. For OPLS, there were 7 biomarkers that significantly correlated with ECV (R2 = 0.85, Q = 0.53) and 6 biomarkers that significantly correlated with MPR (R2 = 0.92, Q2 = 0.32). Only 1 biomarker significantly correlated with both ECV and MPR. Discussion Patients with HFpEF have unique imaging and biomarker patterns that suggest mechanisms associated with metabolic disease, inflammation, fibrosis and microvascular dysfunction.
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Affiliation(s)
- Connor Siggins
- Department of Chemistry, University of Virginia, Charlottesville, VA, United States
| | - Jonathan A. Pan
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Adrián I. Löffler
- UCHealth Heart and Vascular Clinic, Greeley Medical Center, Greeley, CO, United States
| | - Yang Yang
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peter W. Shaw
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, NH, United States
| | - Pelbreton C. Balfour
- Baptist Heart & Vascular Institute, Baptist Health Care, Pensacola, FL, United States
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Li-Ming Gan
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christopher M. Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, United States
| | - Ellen C. Keeley
- Department of Medicine, University of Florida, Gainesville, FL, United States
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| | - Michael Salerno
- Department of Radiology, Stanford University, Stanford, CA, United States
- Department of Medicine, Cardiovascular Medicine, Stanford University, Stanford, CA, United States
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Dhingra LS, Sangha V, Aminorroaya A, Bryde R, Gaballa A, Ali AH, Mehra N, Krumholz HM, Sen S, Kramer CM, Martinez MW, Desai MY, Oikonomou EK, Khera R. A Multicenter Evaluation of the Impact of Therapies on Deep Learning-based Electrocardiographic Hypertrophic Cardiomyopathy Markers. medRxiv 2024:2024.01.15.24301011. [PMID: 38293023 PMCID: PMC10827251 DOI: 10.1101/2024.01.15.24301011] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Artificial intelligence-enhanced electrocardiography (AI-ECG) can identify hypertrophic cardiomyopathy (HCM) on 12-lead ECGs and offers a novel way to monitor treatment response. While the surgical or percutaneous reduction of the interventricular septum (SRT) represented initial HCM therapies, mavacamten offers an oral alternative. Objective To evaluate biological response to SRT and mavacamten. Methods We applied an AI-ECG model for HCM detection to ECG images from patients who underwent SRT across three sites: Yale New Haven Health System (YNHHS), Cleveland Clinic Foundation (CCF), and Atlantic Health System (AHS); and to ECG images from patients receiving mavacamten at YNHHS. Results A total of 70 patients underwent SRT at YNHHS, 100 at CCF, and 145 at AHS. At YNHHS, there was no significant change in the AI-ECG HCM score before versus after SRT (pre-SRT: median 0.55 [IQR 0.24-0.77] vs post-SRT: 0.59 [0.40-0.75]). The AI-ECG HCM scores also did not improve post SRT at CCF (0.61 [0.32-0.79] vs 0.69 [0.52-0.79]) and AHS (0.52 [0.35-0.69] vs 0.61 [0.49-0.70]). Among 36 YNHHS patients on mavacamten therapy, the median AI-ECG score before starting mavacamten was 0.41 (0.22-0.77), which decreased significantly to 0.28 (0.11-0.50, p <0.001 by Wilcoxon signed-rank test) at the end of a median follow-up period of 237 days. Conclusions The lack of improvement in AI-based HCM score with SRT, in contrast to a significant decrease with mavacamten, suggests the potential role of AI-ECG for serial monitoring of pathophysiological improvement in HCM at the point-of-care using ECG images.
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Affiliation(s)
- Lovedeep S Dhingra
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Veer Sangha
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Engineering Science, Oxford University, Oxford, UK
| | - Arya Aminorroaya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robyn Bryde
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ, USA
- Sports Cardiology and Hypertrophic Cardiomyopathy, Morristown Medical Center, Morristown, NJ, USA
| | - Andrew Gaballa
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Adel H Ali
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nandini Mehra
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health, Charlottesville, VA, USA
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ, USA
- Sports Cardiology and Hypertrophic Cardiomyopathy, Morristown Medical Center, Morristown, NJ, USA
| | - Milind Y Desai
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Evangelos K Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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Schumann CL, Nealy ZB, Mathew RC, Yang Y, Balfour PC, Shaw PW, Salerno M, Kramer CM, Bourque JM. Pilot Study of Supervised Exercise and Intensive Medical Therapy in Patients With Ischemia With No Evidence of Obstructive Coronary Artery Disease and Coronary Microvascular Dysfunction. Am J Cardiol 2024; 214:142-143. [PMID: 38181860 DOI: 10.1016/j.amjcard.2023.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Christopher L Schumann
- Division of Cardiovascular Medicine; The Cardiac Imaging Center; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Zachariah B Nealy
- Division of Cardiovascular Medicine; The Cardiac Imaging Center; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
| | - Roshin C Mathew
- Division of Cardiovascular Medicine; The Cardiac Imaging Center
| | - Yang Yang
- Biomedical Engineering and Imaging Institute; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pelbreton C Balfour
- Baptist Heart & Vascular Institute and Cardiology Consultants, Pensacola, Florida
| | - Peter W Shaw
- Berkshire Medical Center, Pittsfield, Massachusetts
| | - Michael Salerno
- Department of Medicine, Stanford University, Palo Alto, California
| | - Christopher M Kramer
- Division of Cardiovascular Medicine; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Jamieson M Bourque
- Division of Cardiovascular Medicine; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
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Patel AR, Kramer CM. Perfusion Imaging for the Heart. Magn Reson Imaging Clin N Am 2024; 32:125-134. [PMID: 38007275 DOI: 10.1016/j.mric.2023.09.005] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
The use of myocardial perfusion imaging during a stress cardiac magnetic resonance (CMR) examination for the evaluation of coronary artery disease is now recommended by both US and European guidelines. Several studies have demonstrated high diagnostic accuracy for the detection of hemodynamically significant coronary artery disease. Stress perfusion CMR has been shown to be a noninvasive and cost-effective alternative to guide coronary revascularization.
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Affiliation(s)
- Amit R Patel
- Department of Medicine, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA.
| | - Christopher M Kramer
- Department of Medicine, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA
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Wang J, Awad M, Zhou R, Wang Z, Wang X, Feng X, Yang Y, Meyer C, Kramer CM, Salerno M. High-resolution spiral real-time cardiac cine imaging with deep learning-based rapid image reconstruction and quantification. NMR Biomed 2024; 37:e5051. [PMID: 37926525 DOI: 10.1002/nbm.5051] [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: 02/15/2023] [Revised: 08/20/2023] [Accepted: 09/08/2023] [Indexed: 11/07/2023]
Abstract
The objective of the current study was to develop and evaluate a DEep learning-based rapid Spiral Image REconstruction (DESIRE) and deep learning (DL)-based segmentation approach to quantify the left ventricular ejection fraction (LVEF) for high-resolution spiral real-time cine imaging, including 2D balanced steady-state free precession imaging at 1.5 T and gradient echo (GRE) imaging at 1.5 and 3 T. A 3D U-Net-based image reconstruction network and 2D U-Net-based image segmentation network were proposed and evaluated. Low-rank plus sparse (L+S) served as the reference for the image reconstruction network and manual contouring of the left ventricle was the reference of the segmentation network. To assess the image reconstruction quality, structural similarity index, peak signal-to-noise ratio, normalized root-mean-square error, and blind grading by two experienced cardiologists (5: excellent; 1: poor) were performed. To assess the segmentation performance, quantification of the LVEF on GRE imaging at 3 T was compared with the quantification from manual contouring. Excellent performance was demonstrated by the proposed technique. In terms of image quality, there was no difference between L+S and the proposed DESIRE technique. For quantification analysis, the proposed DL method was not different to the manual segmentation method (p > 0.05) in terms of quantification of LVEF. The reconstruction time for DESIRE was ~32 s (including nonuniform fast Fourier transform [NUFFT]) per dynamic series (40 frames), while the reconstruction time of L+S with GPU acceleration was approximately 3 min. The DL segmentation takes less than 5 s. In conclusion, the proposed DL-based image reconstruction and quantification techniques enabled 1-min image reconstruction for the whole heart and quantification with automatic reconstruction and quantification of the left ventricle function for high-resolution spiral real-time cine imaging with excellent performance.
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Affiliation(s)
- Junyu Wang
- Department of Medicine, Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Marina Awad
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Ruixi Zhou
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Zhixing Wang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | - Xitong Wang
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Xue Feng
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Yang Yang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Craig Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Department of Medicine, Division of Cardiovascular, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Medicine, Cardiovascular Medicine, Stanford University, Stanford, California, USA
- Department of Radiology, Cardiovascular Imaging, Stanford University, Stanford, California, USA
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Farrar E, Bilchick KC, Gadi SR, Hosadurg N, Kramer CM, Patel AR, Mcclean K, Thomas M, Ayers MP. Impact of a Center of Excellence in Confirming or Excluding a Diagnosis of Hypertrophic Cardiomyopathy. Am J Cardiol 2023; 208:83-91. [PMID: 37820551 PMCID: PMC10792590 DOI: 10.1016/j.amjcard.2023.09.040] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 10/13/2023]
Abstract
Tertiary hospitals with expertise in hypertrophic cardiomyopathy (HCM) are assuming a greater role in confirming and correcting HCM diagnoses at referring centers. The objectives were to establish the frequency of alternate diagnoses from referring centers and identify predictors of accuracy of an HCM diagnosis from the referring centers. Imaging findings from echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging (CMR) in 210 patients referred to an HCM Center of Excellence between September 2020 and October 2022 were reviewed. Clinical and imaging characteristics from pre-referral studies were used to construct a model for predictors of ruling out HCM or confirming the diagnosis using machine learning methods (least absolute shrinkage and selection operator logistic regression). Alternative diagnoses were found in 38 of the 210 patients (18.1%) (median age 60 years, 50% female). A total of 17 of the 38 patients (44.7%) underwent a new CMR after their initial visit, and 14 of 38 patients (36.8%) underwent review of a previous CMR. Increased left ventricular end-diastolic volume, indexed, greater septal thickness measurements, greater left atrial size, asymmetric hypertrophy on echocardiography, and the presence of an implantable cardioverter-defibrillator were associated with higher odds ratios for confirming a diagnosis of HCM, whereas increasing age and the presence of diabetes were more predictive of rejecting a diagnosis of HCM (area under the curve 0.902, p <0.0001). In conclusion, >1 in 6 patients with presumed HCM were found to have an alternate diagnosis after review at an HCM Center of Excellence, and both clinical findings and imaging parameters predicted an alternate diagnosis.
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Affiliation(s)
- Elizabeth Farrar
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
| | - Kenneth C Bilchick
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Sneha R Gadi
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Nisha Hosadurg
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Amit R Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Karen Mcclean
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Matthew Thomas
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Michael P Ayers
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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Wang Z, Feng X, Salerno M, Kramer CM, Meyer CH. Dynamic cardiac MRI with high spatiotemporal resolution using accelerated spiral-out and spiral-in/out bSSFP pulse sequences at 1.5 T. MAGMA 2023; 36:857-867. [PMID: 37665502 PMCID: PMC10667461 DOI: 10.1007/s10334-023-01116-9] [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: 04/28/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To develop two spiral-based bSSFP pulse sequences combined with L + S reconstruction for accelerated ungated, free-breathing dynamic cardiac imaging at 1.5 T. MATERIALS AND METHODS Tiny golden angle rotated spiral-out and spiral-in/out bSSFP sequences combined with view-sharing (VS), compressed sensing (CS), and low-rank plus sparse (L + S) reconstruction were evaluated and compared via simulation and in vivo dynamic cardiac imaging studies. The proposed methods were then validated against the standard cine, in terms of quantitative image assessment and qualitative quality rating. RESULTS The L + S method yielded the least residual artifacts and the best image sharpness among the three methods. Both spiral cine techniques showed clinically diagnostic images (score > 3). Compared to standard cine, there were significant differences in global image quality and edge sharpness for spiral cine techniques, while there was significant difference in image contrast for the spiral-out cine but no significant difference for the spiral-in/out cine. There was good agreement in left ventricular ejection fraction for both the spiral-out cine (- 1.6 [Formula: see text] 3.1%) and spiral-in/out cine (- 1.5 [Formula: see text] 2.8%) against standard cine. DISCUSSION Compared to the time-consuming standard cine (~ 5 min) which requires ECG-gating and breath-holds, the proposed spiral bSSFP sequences achieved ungated, free-breathing cardiac movies at a similar spatial (1.5 × 1.5 × 8 mm3) and temporal resolution (36 ms) per slice for whole heart coverage (10-15 slices) within 45 s, suggesting the clinical potential for improved patient comfort or for imaging patients with arrhythmias or who cannot hold their breath.
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Affiliation(s)
- Zhixing Wang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Xue Feng
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Michael Salerno
- School of Medicine, University Medical Line, Stanford University, Stanford, CA, USA
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
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Arai AE, Schulz-Menger J, Shah DJ, Han Y, Bandettini WP, Abraham A, Woodard PK, Selvanayagam JB, Hamilton-Craig C, Tan RS, Carr J, Teo L, Kramer CM, Wintersperger BJ, Harisinghani MG, Flamm SD, Friedrich MG, Klem I, Raman SV, Haverstock D, Liu Z, Brueggenwerth G, Santiuste M, Berman DS, Pennell DJ. Stress Perfusion Cardiac Magnetic Resonance vs SPECT Imaging for Detection of Coronary Artery Disease. J Am Coll Cardiol 2023; 82:1828-1838. [PMID: 37914512 DOI: 10.1016/j.jacc.2023.08.046] [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] [Received: 07/17/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND GadaCAD2 was 1 of 2 international, multicenter, prospective, Phase 3 clinical trials that led to U.S. Food and Drug Administration approval of gadobutrol to assess myocardial perfusion and late gadolinium enhancement (LGE) in adults with known or suspected coronary artery disease (CAD). OBJECTIVES A prespecified secondary objective was to determine if stress perfusion cardiovascular magnetic resonance (CMR) was noninferior to single-photon emission computed tomography (SPECT) for detecting significant CAD and for excluding significant CAD. METHODS Participants with known or suspected CAD underwent a research rest and stress perfusion CMR that was compared with a gated SPECT performed using standard clinical protocols. For CMR, adenosine or regadenoson served as vasodilators. The total dose of gadobutrol was 0.1 mmol/kg body weight. The standard of reference was a 70% stenosis defined by quantitative coronary angiography (QCA). A negative coronary computed tomography angiography could exclude CAD. Analysis was per patient. CMR, SPECT, and QCA were evaluated by independent central core lab readers blinded to clinical information. RESULTS Participants were predominantly male (61.4% male; mean age 58.9 ± 10.2 years) and were recruited from the United States (75.0%), Australia (14.7%), Singapore (5.7%), and Canada (4.6%). The prevalence of significant CAD was 24.5% (n = 72 of 294). Stress perfusion CMR was statistically superior to gated SPECT for specificity (P = 0.002), area under the receiver operating characteristic curve (P < 0.001), accuracy (P = 0.003), positive predictive value (P < 0.001), and negative predictive value (P = 0.041). The sensitivity of CMR for a 70% QCA stenosis was noninferior and nonsuperior to gated SPECT. CONCLUSIONS Vasodilator stress perfusion CMR, as performed with gadobutrol 0.1 mmol/kg body weight, had superior diagnostic accuracy for diagnosis and exclusion of significant CAD vs gated SPECT.
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Affiliation(s)
| | - Jeanette Schulz-Menger
- Helios Klinikum Berlin Buch Klinik für Kardiologie und Nephrologie Abteilung Kardio-MRT, Berlin, Germany
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Yuchi Han
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Arun Abraham
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Pamela K Woodard
- Washington University School of Medicine, St Louis, Missouri, USA
| | | | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore
| | - James Carr
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynette Teo
- National University Hospital, Singapore, Singapore
| | | | - Bernd J Wintersperger
- University of Toronto, Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | | | - Igor Klem
- Duke University, Durham, North Carolina, USA
| | - Subha V Raman
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Zheyu Liu
- Bayer Pharmaceuticals LLC, Whippany, New Jersey, USA
| | | | | | | | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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11
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Browne WF, Sung J, Majdalany BS, Khaja MS, Calligaro K, Contrella BN, Ferencik M, Gunn AJ, Kapoor BS, Keefe NA, Kokabi N, Kramer CM, Kwun R, Shamoun F, Sharma AM, Steenburg SD, Trout AT, Vijay K, Wang DS, Steigner ML. ACR Appropriateness Criteria® Sudden Onset of Cold, Painful Leg: 2023 Update. J Am Coll Radiol 2023; 20:S565-S573. [PMID: 38040470 DOI: 10.1016/j.jacr.2023.08.012] [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] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Acute onset of a cold, painful leg, also known as acute limb ischemia, describes the sudden loss of perfusion to the lower extremity and carries significant risk of morbidity and mortality. Acute limb ischemia requires rapid identification and the management of suspected vascular compromise and is inherently driven by clinical considerations. The objectives of initial imaging include confirmation of diagnosis, identifying the location and extent of vascular occlusion, and preprocedural/presurgical planning. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Jeffrey Sung
- Research Author, Weill Cornell Medical College, New York, New York
| | - Bill S Majdalany
- Panel Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Minhaj S Khaja
- Panel Vice-Chair, University of Michigan, Ann Arbor, Michigan
| | - Keith Calligaro
- Pennsylvania Hospital, Philadelphia, Pennsylvania; Society for Vascular Surgery
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Nicole A Keefe
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Christopher M Kramer
- University of Virginia Health, Charlottesville, Virginia; Society for Cardiovascular Magnetic Resonance
| | - Richard Kwun
- Swedish Medical Center, Issaquah, Washington; American College of Emergency Physicians
| | - Fadi Shamoun
- Mayo Clinic Arizona, Phoenix, Arizona; American Society of Echocardiography
| | - Aditya M Sharma
- University of Virginia Health System, Charlottesville, Virginia, Primary care physician
| | - Scott D Steenburg
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Commission on Nuclear Medicine and Molecular Imaging
| | - Kanupriya Vijay
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - David S Wang
- Stanford University Medical Center, Stanford, California
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12
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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13
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Hosadurg N, Kramer CM. Magnetic Resonance Imaging Techniques in Peripheral Arterial Disease. Adv Wound Care (New Rochelle) 2023; 12:611-625. [PMID: 37058352 PMCID: PMC10468560 DOI: 10.1089/wound.2022.0161] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/12/2023] [Indexed: 04/15/2023] Open
Abstract
Significance: Peripheral arterial disease (PAD) leads to a significant burden of morbidity and impaired quality of life globally. Diabetes is a significant risk factor accelerating the development of PAD with an associated increase in the risk of chronic wounds, tissue, and limb loss. Various magnetic resonance imaging (MRI) techniques are being increasingly acknowledged as useful methods of accurately assessing PAD. Recent Advances: Conventionally utilized MRI techniques for assessing macrovascular disease have included contrast enhanced magnetic resonance angiography (MRA), noncontrast time of flight MRA, and phase contrast MRI, but have significant limitations. In recent years, novel noncontrast MRI methods assessing skeletal muscle perfusion and metabolism such as arterial spin labeling (ASL), blood-oxygen-level dependent (BOLD) imaging, and chemical exchange saturation transfer (CEST) have emerged. Critical Issues: Conventional non-MRI (such as ankle-brachial index, arterial duplex ultrasonography, and computed tomographic angiography) and MRI based modalities image the macrovasculature. The underlying mechanisms of PAD that result in clinical manifestations are, however, complex, and imaging modalities that can assess the interaction between impaired blood flow, microvascular tissue perfusion, and muscular metabolism are necessary. Future Directions: Further development and clinical validation of noncontrast MRI methods assessing skeletal muscle perfusion and metabolism, such as ASL, BOLD, CEST, intravoxel incoherent motion microperfusion, and techniques that assess plaque composition, are advancing this field. These modalities can provide useful prognostic data and help in reliable surveillance of outcomes after interventions.
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Affiliation(s)
- Nisha Hosadurg
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher M. Kramer
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
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14
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Udelson JE, Kelsey MD, Nanna MG, Fordyce CB, Yow E, Clare RM, Mark DB, Patel MR, Rogers C, Curzen N, Pontone G, Maurovich-Horvat P, De Bruyne B, Greenwood JP, Marinescu V, Leipsic J, Stone GW, Ben-Yehuda O, Berry C, Hogan SE, Redfors B, Ali ZA, Byrne RA, Kramer CM, Yeh RW, Martinez B, Mullen S, Huey W, Anstrom KJ, Al-Khalidi HR, Chiswell K, Vemulapalli S, Douglas PS. Deferred Testing in Stable Outpatients With Suspected Coronary Artery Disease: A Prespecified Secondary Analysis of the PRECISE Randomized Clinical Trial. JAMA Cardiol 2023; 8:915-924. [PMID: 37610768 PMCID: PMC10448368 DOI: 10.1001/jamacardio.2023.2614] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/26/2023] [Indexed: 08/24/2023]
Abstract
Importance Guidelines recommend deferral of testing for symptomatic people with suspected coronary artery disease (CAD) and low pretest probability. To our knowledge, no randomized trial has prospectively evaluated such a strategy. Objective To assess process of care and health outcomes in people identified as minimal risk for CAD when testing is deferred. Design, Setting, and Participants This randomized, pragmatic effectiveness trial included prespecified subgroup analysis of the PRECISE trial at 65 North American and European sites. Participants identified as minimal risk by the validated PROMISE minimal risk score (PMRS) were included. Intervention Randomization to a precision strategy using the PMRS to assign those with minimal risk to deferred testing and others to coronary computed tomography angiography with selective computed tomography-derived fractional flow reserve, or to usual testing (stress testing or catheterization with PMRS masked). Randomization was stratified by PMRS risk. Main Outcome Composite of all-cause death, nonfatal myocardial infarction (MI), or catheterization without obstructive CAD through 12 months. Results Among 2103 participants, 422 were identified as minimal risk (20%) and randomized to deferred testing (n = 214) or usual testing (n = 208). Mean age (SD) was 46 (8.6) years; 304 were women (72%). During follow-up, 138 of those randomized to deferred testing never had testing (64%), whereas 76 had a downstream test (36%) (at median [IQR] 48 [15-78] days) for worsening (30%), uncontrolled (10%), or new symptoms (6%), or changing clinician preference (19%) or participant preference (10%). Results were normal for 96% of these tests. The primary end point occurred in 2 deferred testing (0.9%) and 13 usual testing participants (6.3%) (hazard ratio, 0.15; 95% CI, 0.03-0.66; P = .01). No death or MI was observed in the deferred testing participants, while 1 noncardiovascular death and 1 MI occurred in the usual testing group. Two participants (0.9%) had catheterizations without obstructive CAD in the deferred testing group and 12 (5.8%) with usual testing (P = .02). At baseline, 70% of participants had frequent angina and there was similar reduction of frequent angina to less than 20% at 12 months in both groups. Conclusion and Relevance In symptomatic participants with suspected CAD, identification of minimal risk by the PMRS guided a strategy of initially deferred testing. The strategy was safe with no observed adverse outcome events, fewer catheterizations without obstructive CAD, and similar symptom relief compared with usual testing. Trial Registration ClinicalTrials.gov Identifier: NCT03702244.
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Affiliation(s)
- James E. Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Michelle D. Kelsey
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher B. Fordyce
- Division of Cardiology, Department of Medicine, and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Yow
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Robert M. Clare
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | | | - Nick Curzen
- Faculty of Medicine, University of Southampton and Cardiothoracic Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, and Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Onze Lieve Vrouwziekenhuis-Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Victor Marinescu
- Midwest Cardiovascular Institute, Chicago Medical School, Edward-Elmhurst Health, Naperville, Illinois
- Edward-Elmhurst Health, Naperville, Illinois
| | - Jonathon Leipsic
- Departments of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | - Shea E. Hogan
- CPC Clinical Research, and University of Colorado School of Medicine, Aurora
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ziad A. Ali
- St Francis Hospital & Heart Center, Roslyn, New York
| | - Robert A. Byrne
- Department of Cardiology and Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Beth Martinez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Hussein R. Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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15
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Douglas PS, Nanna MG, Kelsey MD, Yow E, Mark DB, Patel MR, Rogers C, Udelson JE, Fordyce CB, Curzen N, Pontone G, Maurovich-Horvat P, De Bruyne B, Greenwood JP, Marinescu V, Leipsic J, Stone GW, Ben-Yehuda O, Berry C, Hogan SE, Redfors B, Ali ZA, Byrne RA, Kramer CM, Yeh RW, Martinez B, Mullen S, Huey W, Anstrom KJ, Al-Khalidi HR, Vemulapalli S. Comparison of an Initial Risk-Based Testing Strategy vs Usual Testing in Stable Symptomatic Patients With Suspected Coronary Artery Disease: The PRECISE Randomized Clinical Trial. JAMA Cardiol 2023; 8:904-914. [PMID: 37610731 PMCID: PMC10448364 DOI: 10.1001/jamacardio.2023.2595] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/26/2023] [Indexed: 08/24/2023]
Abstract
Importance Trials showing equivalent or better outcomes with initial evaluation using coronary computed tomography angiography (cCTA) compared with stress testing in patients with stable chest pain have informed guidelines but raise questions about overtesting and excess catheterization. Objective To test a modified initial cCTA strategy designed to improve clinical efficiency vs usual testing (UT). Design, Setting, and Participants This was a pragmatic randomized clinical trial enrolling participants from December 3, 2018, to May 18, 2021, with a median of 11.8 months of follow-up. Patients from 65 North American and European sites with stable symptoms of suspected coronary artery disease (CAD) and no prior testing were randomly assigned 1:1 to precision strategy (PS) or UT. Interventions PS incorporated the Prospective Multicenter Imaging Study for the Evaluation of Chest Pain (PROMISE) minimal risk score to quantitatively select minimal-risk participants for deferred testing, assigning all others to cCTA with selective CT-derived fractional flow reserve (FFR-CT). UT included site-selected stress testing or catheterization. Site clinicians determined subsequent care. Main Outcomes and Measures Outcomes were clinical efficiency (invasive catheterization without obstructive CAD) and safety (death or nonfatal myocardial infarction [MI]) combined into a composite primary end point. Secondary end points included safety components of the primary outcome and medication use. Results A total of 2103 participants (mean [SD] age, 58.4 [11.5] years; 1056 male [50.2%]) were included in the study, and 422 [20.1%] were classified as minimal risk. The primary end point occurred in 44 of 1057 participants (4.2%) in the PS group and in 118 of 1046 participants (11.3%) in the UT group (hazard ratio [HR], 0.35; 95% CI, 0.25-0.50). Clinical efficiency was higher with PS, with lower rates of catheterization without obstructive disease (27 [2.6%]) vs UT participants (107 [10.2%]; HR, 0.24; 95% CI, 0.16-0.36). The safety composite of death/MI was similar (HR, 1.52; 95% CI, 0.73-3.15). Death occurred in 5 individuals (0.5%) in the PS group vs 7 (0.7%) in the UT group (HR, 0.71; 95% CI, 0.23-2.23), and nonfatal MI occurred in 13 individuals (1.2%) in the PS group vs 5 (0.5%) in the UT group (HR, 2.65; 95% CI, 0.96-7.36). Use of lipid-lowering (450 of 900 [50.0%] vs 365 of 873 [41.8%]) and antiplatelet (321 of 900 [35.7%] vs 237 of 873 [27.1%]) medications at 1 year was higher in the PS group compared with the UT group (both P < .001). Conclusions and Relevance An initial diagnostic approach to stable chest pain starting with quantitative risk stratification and deferred testing for minimal-risk patients and cCTA with selective FFR-CT in all others increased clinical efficiency relative to UT at 1 year. Additional randomized clinical trials are needed to verify these findings, including safety. Trial Registration ClinicalTrials.gov Identifier: NCT03702244.
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Affiliation(s)
- Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michelle D. Kelsey
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Eric Yow
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | | | - James E. Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Christopher B. Fordyce
- Division of Cardiology, Department of Medicine, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, Cardiothoracic Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Onze Lieve Vrouwziekenhuis Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, United Kingdom
| | - Victor Marinescu
- Midwest Cardiovascular Institute, Chicago Medical School, Edward-Elmhurst Health, Naperville, Illinois
| | - Jonathon Leipsic
- Departments of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | - Shea E. Hogan
- CPC Clinical Research, University of Colorado School of Medicine, Aurora
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ziad A. Ali
- St Francis Hospital & Heart Center, Roslyn, New York
| | - Robert A. Byrne
- Department of Cardiology, Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Beth Martinez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Hussein R. Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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16
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Gonzales RA, Ibáñez DH, Hann E, Popescu IA, Burrage MK, Lee YP, Altun İ, Weintraub WS, Kwong RY, Kramer CM, Neubauer S, Ferreira VM, Zhang Q, Piechnik SK. Quality control-driven deep ensemble for accountable automated segmentation of cardiac magnetic resonance LGE and VNE images. Front Cardiovasc Med 2023; 10:1213290. [PMID: 37753166 PMCID: PMC10518404 DOI: 10.3389/fcvm.2023.1213290] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/16/2023] [Indexed: 09/28/2023] Open
Abstract
Background Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is the gold standard for non-invasive myocardial tissue characterisation. However, accurate segmentation of the left ventricular (LV) myocardium remains a challenge due to limited training data and lack of quality control. This study addresses these issues by leveraging generative adversarial networks (GAN)-generated virtual native enhancement (VNE) images to expand the training set and incorporating an automated quality control-driven (QCD) framework to improve segmentation reliability. Methods A dataset comprising 4,716 LGE images (from 1,363 patients with hypertrophic cardiomyopathy and myocardial infarction) was used for development. To generate additional clinically validated data, LGE data were augmented with a GAN-based generator to produce VNE images. LV was contoured on these images manually by clinical observers. To create diverse candidate segmentations, the QCD framework involved multiple U-Nets, which were combined using statistical rank filters. The framework predicted the Dice Similarity Coefficient (DSC) for each candidate segmentation, with the highest predicted DSC indicating the most accurate and reliable result. The performance of the QCD ensemble framework was evaluated on both LGE and VNE test datasets (309 LGE/VNE images from 103 patients), assessing segmentation accuracy (DSC) and quality prediction (mean absolute error (MAE) and binary classification accuracy). Results The QCD framework effectively and rapidly segmented the LV myocardium (<1 s per image) on both LGE and VNE images, demonstrating robust performance on both test datasets with similar mean DSC (LGE: 0.845 ± 0.075 ; VNE: 0.845 ± 0.071 ; p = n s ). Incorporating GAN-generated VNE data into the training process consistently led to enhanced performance for both individual models and the overall framework. The quality control mechanism yielded a high performance (MAE = 0.043 , accuracy = 0.951 ) emphasising the accuracy of the quality control-driven strategy in predicting segmentation quality in clinical settings. Overall, no statistical difference (p = n s ) was found when comparing the LGE and VNE test sets across all experiments. Conclusions The QCD ensemble framework, leveraging GAN-generated VNE data and an automated quality control mechanism, significantly improved the accuracy and reliability of LGE segmentation, paving the way for enhanced and accountable diagnostic imaging in routine clinical use.
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Affiliation(s)
- Ricardo A. Gonzales
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Daniel H. Ibáñez
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Artificio, Cambridge, MA, United States
| | - Evan Hann
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Iulia A. Popescu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Matthew K. Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Yung P. Lee
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - İbrahim Altun
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - William S. Weintraub
- MedStar Health Research Institute, Georgetown University, Washington, DC, United States
| | - Raymond Y. Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | | | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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17
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Ayers MP, Kramer CM. Imaging Myofibrillar Disarray and Microvascular Dysfunction in Hypertrophic Cardiomyopathy: Novel Imaging Biomarkers for a New Era in Therapeutics. Circulation 2023; 148:819-821. [PMID: 37669360 PMCID: PMC10491427 DOI: 10.1161/circulationaha.123.065789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Affiliation(s)
| | - Christopher M. Kramer
- Cardiovascular Division, Department of Medicine
- Department of Radiology and Medical Imaging
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18
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Abstract
The diagnosis and management of hypertrophic cardiomyopathy (HCM) requires multimodality imaging. Transthoracic echocardiogram (TTE) remains the first-line imaging modality to diagnose HCM identifying morphology and obstruction, which includes left ventricular outflow obstruction, midcavitary obstruction and systolic anterior motion. Cardiac magnetic resonance imaging (CMR) can adjudicate equivocal cases, rule out alternative diagnoses and evaluate for risk factors of sudden cardiac death. Imaging with TTE or transesophageal echocardiogram can also guide alcohol septal ablation or surgical myectomy respectively. Furthermore, TTE can guide medical management of these patients by following peak gradients. Thus, multimodality imaging in HCM is crucial throughout the course of these patients' care.
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Affiliation(s)
- Tiffany Dong
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yvonne Gilliland
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health, Charlottesville, VA, USA
| | - Abraham Theodore
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Milind Desai
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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19
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Rrapo-Kaso E, Loffler AI, Petroni GR, Meyer CH, Walker M, Kay JR, DiMaria JM, Domanchuk K, Carr JC, McDermott MM, Kramer CM. Alirocumab and plaque volume, calf muscle blood flow, and walking performance in peripheral artery disease: A randomized clinical trial. Vasc Med 2023; 28:282-289. [PMID: 37093712 PMCID: PMC10552651 DOI: 10.1177/1358863x231169324] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND The distal superficial femoral artery (SFA) is most commonly affected in peripheral artery disease (PAD). The effects of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor alirocumab added to statin therapy on SFA atherosclerosis, downstream flow, and walking performance are unknown. METHODS Thirty-five patients with PAD on maximally tolerated statin therapy were recruited. Patients were randomized to alirocumab 150 mg subcutaneously (n = 18) or matching placebo (n = 17) therapy every 2 weeks for 1 year. The primary outcome was change in SFA plaque volume by black blood magnetic resonance imaging (MRI). Secondary outcomes were changes in calf muscle perfusion by cuff/occlusion hyperemia arterial spin labeling MRI, 6-minute walk distance (6MWD), low-density lipoprotein (LDL) cholesterol, and other biomarkers. RESULTS Age (mean ± SD) was 64 ± 8 years, 20 (57%) patients were women, 17 (49%) were Black individuals, LDL was 107 ± 36 mg/dL, and the ankle-brachial index 0.71 ± 0.20. The LDL fell more with alirocumab than placebo (mean [95% CI]) (-49.8 [-66.1 to -33.6] vs -7.7 [-19.7 to 4.3] mg/dL; p < 0.0001). Changes in SFA plaque volume and calf perfusion showed no difference between groups when adjusted for baseline (+0.25 [-0.29 to 0.79] vs -0.04 [-0.47 to 0.38] cm3; p = 0.37 and 0.22 [-8.67 to 9.11] vs 3.81 [-1.45 to 9.08] mL/min/100 g; p = 0.46, respectively), nor did 6MWD. CONCLUSION In this exploratory study, the addition of alirocumab therapy to statins did not alter SFA plaque volume, calf perfusion or 6MWD despite significant LDL lowering. Larger studies with longer follow up that include plaque characterization may improve understanding of the effects of intensive LDL-lowering therapy in PAD (ClinicalTrials.gov Identifier: NCT02959047).
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Affiliation(s)
- Elona Rrapo-Kaso
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Adrian I Loffler
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Gina R Petroni
- Departments of Public Health Sciences, University of Virginia Health, Charlottesville, VA, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia Health, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | - McCall Walker
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Jennifer R. Kay
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | - Joseph M DiMaria
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | | | - James C Carr
- Department of Medicine, Northwestern University, Chicago, IL, USA
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Mary M McDermott
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
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20
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Berry C, Kramer CM, Kunadian V, Patel TR, Villines T, Kwong RY, Raharjo DE. Great Debate: Computed tomography coronary angiography should be the initial diagnostic test in suspected angina. Eur Heart J 2023; 44:2366-2375. [PMID: 36917627 PMCID: PMC10327881 DOI: 10.1093/eurheartj/ehac597] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Affiliation(s)
- Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, University of Glasgow, Glasgow, G128TA, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee St., Box 800158, Charlottesville, VA 22908, USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Box 800170, Charlottesville, VA 22908, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Toral R Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee St., Box 800158, Charlottesville, VA 22908, USA
| | - Todd Villines
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee St., Box 800158, Charlottesville, VA 22908, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniell Edward Raharjo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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21
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Hermida U, Stojanovski D, Raman B, Ariga R, Young AA, Carapella V, Carr-White G, Lukaschuk E, Piechnik SK, Kramer CM, Desai MY, Weintraub WS, Neubauer S, Watkins H, Lamata P. Left ventricular anatomy in obstructive hypertrophic cardiomyopathy: beyond basal septal hypertrophy. Eur Heart J Cardiovasc Imaging 2023; 24:807-818. [PMID: 36441173 PMCID: PMC10229266 DOI: 10.1093/ehjci/jeac233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS Obstructive hypertrophic cardiomyopathy (oHCM) is characterized by dynamic obstruction of the left ventricular (LV) outflow tract (LVOT). Although this may be mediated by interplay between the hypertrophied septal wall, systolic anterior motion of the mitral valve, and papillary muscle abnormalities, the mechanistic role of LV shape is still not fully understood. This study sought to identify the LV end-diastolic morphology underpinning oHCM. METHODS AND RESULTS Cardiovascular magnetic resonance images from 2398 HCM individuals were obtained as part of the NHLBI HCM Registry. Three-dimensional LV models were constructed and used, together with a principal component analysis, to build a statistical shape model capturing shape variations. A set of linear discriminant axes were built to define and quantify (Z-scores) the characteristic LV morphology associated with LVOT obstruction (LVOTO) under different physiological conditions and the relationship between LV phenotype and genotype. The LV remodelling pattern in oHCM consisted not only of basal septal hypertrophy but a combination with LV lengthening, apical dilatation, and LVOT inward remodelling. Salient differences were observed between obstructive cases at rest and stress. Genotype negative cases showed a tendency towards more obstructive phenotypes both at rest and stress. CONCLUSIONS LV anatomy underpinning oHCM consists of basal septal hypertrophy, apical dilatation, LV lengthening, and LVOT inward remodelling. Differences between oHCM cases at rest and stress, as well as the relationship between LV phenotype and genotype, suggest different mechanisms for LVOTO. Proposed Z-scores render an opportunity of redefining management strategies based on the relationship between LV anatomy and LVOTO.
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Affiliation(s)
- Uxio Hermida
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
| | - David Stojanovski
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
| | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rina Ariga
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alistair A Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
| | - Valentina Carapella
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
| | - Gerry Carr-White
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Elena Lukaschuk
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stefan K Piechnik
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher M Kramer
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, OH, USA
| | - William S Weintraub
- MedStar Health Research Institute, Georgetown University, Washington, DC, USA
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hugh Watkins
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
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22
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Li J, Minczuk K, Huang Q, Kemp BA, Howell NL, Chordia MD, Roy RJ, Patrie JT, Qureshi Z, Kramer CM, Epstein FH, Carey RM, Kundu BK, Keller SR. Progressive Cardiac Metabolic Defects Accompany Diastolic and Severe Systolic Dysfunction in Spontaneously Hypertensive Rat Hearts. J Am Heart Assoc 2023; 12:e026950. [PMID: 37183873 PMCID: PMC10227297 DOI: 10.1161/jaha.122.026950] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 04/14/2023] [Indexed: 05/16/2023]
Abstract
Background Cardiac metabolic abnormalities are present in heart failure. Few studies have followed metabolic changes accompanying diastolic and systolic heart failure in the same model. We examined metabolic changes during the development of diastolic and severe systolic dysfunction in spontaneously hypertensive rats (SHR). Methods and Results We serially measured myocardial glucose uptake rates with dynamic 2-[18F] fluoro-2-deoxy-d-glucose positron emission tomography in vivo in 9-, 12-, and 18-month-old SHR and Wistar Kyoto rats. Cardiac magnetic resonance imaging determined systolic function (ejection fraction) and diastolic function (isovolumetric relaxation time) and left ventricular mass in the same rats. Cardiac metabolomics was performed at 12 and 18 months in separate rats. At 12 months, SHR hearts, compared with Wistar Kyoto hearts, demonstrated increased isovolumetric relaxation time and slightly reduced ejection fraction indicating diastolic and mild systolic dysfunction, respectively, and higher (versus 9-month-old SHR decreasing) 2-[18F] fluoro-2-deoxy-d-glucose uptake rates (Ki). At 18 months, only few SHR hearts maintained similar abnormalities as 12-month-old SHR, while most exhibited severe systolic dysfunction, worsening diastolic function, and markedly reduced 2-[18F] fluoro-2-deoxy-d-glucose uptake rates. Left ventricular mass normalized to body weight was elevated in SHR, more pronounced with severe systolic dysfunction. Cardiac metabolite changes differed between SHR hearts at 12 and 18 months, indicating progressive defects in fatty acid, glucose, branched chain amino acid, and ketone body metabolism. Conclusions Diastolic and severe systolic dysfunction in SHR are associated with decreasing cardiac glucose uptake, and progressive abnormalities in metabolite profiles. Whether and which metabolic changes trigger progressive heart failure needs to be established.
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Affiliation(s)
- Jie Li
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVA
| | - Krzysztof Minczuk
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVA
- Department of Experimental Physiology and PathophysiologyMedical University of BiałystokBialystokPoland
| | - Qiao Huang
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVA
| | - Brandon A. Kemp
- Department of Medicine, Division of Endocrinology and MetabolismUniversity of VirginiaCharlottesvilleVA
| | - Nancy L. Howell
- Department of Medicine, Division of Endocrinology and MetabolismUniversity of VirginiaCharlottesvilleVA
| | - Mahendra D. Chordia
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVA
| | - R. Jack Roy
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVA
| | - James T. Patrie
- Department of Public Health SciencesUniversity of VirginiaCharlottesvilleVA
| | - Zoraiz Qureshi
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVA
- Department of Computer ScienceUniversity of VirginiaCharlottesvilleVA
| | - Christopher M. Kramer
- Department of Medicine, Cardiovascular DivisionUniversity of VirginiaCharlottesvilleVA
| | | | - Robert M. Carey
- Department of Medicine, Division of Endocrinology and MetabolismUniversity of VirginiaCharlottesvilleVA
| | - Bijoy K. Kundu
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVA
- Department of Biomedical EngineeringUniversity of VirginiaCharlottesvilleVA
- Cardiovascular Research CenterUniversity of VirginiaCharlottesvilleVA
| | - Susanna R. Keller
- Department of Medicine, Division of Endocrinology and MetabolismUniversity of VirginiaCharlottesvilleVA
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23
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Heydari B, Satriano A, Jerosch-Herold M, Kolm P, Kim DY, Cheng K, Choi YL, Antiochos P, White JA, Mahmod M, Chan K, Raman B, Desai MY, Ho CY, Dolman SF, Desvigne-Nickens P, Maron MS, Friedrich MG, Schulz-Menger J, Piechnik SK, Appelbaum E, Weintraub WS, Neubauer S, Kramer CM, Kwong RY. 3-Dimensional Strain Analysis of Hypertrophic Cardiomyopathy: Insights From the NHLBI International HCM Registry. JACC Cardiovasc Imaging 2023; 16:478-491. [PMID: 36648040 PMCID: PMC10802851 DOI: 10.1016/j.jcmg.2022.10.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Abnormal global longitudinal strain (GLS) has been independently associated with adverse cardiac outcomes in both obstructive and nonobstructive hypertrophic cardiomyopathy. OBJECTIVES The goal of this study was to understand predictors of abnormal GLS from baseline data from the National Heart, Lung, and Blood Institute (NHLBI) Hypertrophic Cardiomyopathy Registry (HCMR). METHODS The study evaluated comprehensive 3-dimensional left ventricular myocardial strain from cine cardiac magnetic resonance in 2,311 patients from HCMR using in-house validated feature-tracking software. These data were correlated with other imaging markers, serum biomarkers, and demographic variables. RESULTS Abnormal median GLS (> -11.0%) was associated with higher left ventricular (LV) mass index (93.8 ± 29.2 g/m2 vs 75.1 ± 19.7 g/m2; P < 0.0001) and maximal wall thickness (21.7 ± 5.2 mm vs 19.3 ± 4.1 mm; P < 0.0001), lower left (62% ± 9% vs 66% ± 7%; P < 0.0001) and right (68% ± 11% vs 69% ± 10%; P < 0.01) ventricular ejection fractions, lower left atrial emptying functions (P < 0.0001 for all), and higher presence and myocardial extent of late gadolinium enhancement (6 SD and visual quantification; P < 0.0001 for both). Elastic net regression showed that adjusted predictors of GLS included female sex, Black race, history of syncope, presence of systolic anterior motion of the mitral valve, reverse curvature and apical morphologies, LV ejection fraction, LV mass index, and both presence/extent of late gadolinium enhancement and baseline N-terminal pro-B-type natriuretic peptide and troponin levels. CONCLUSIONS Abnormal strain in hypertrophic cardiomyopathy is associated with other imaging and serum biomarkers of increased risk. Further follow-up of the HCMR cohort is needed to understand the independent relationship between LV strain and adverse cardiac outcomes in hypertrophic cardiomyopathy.
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Affiliation(s)
- Bobak Heydari
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | | | - Paul Kolm
- MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Kathleen Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yuna L Choi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - James A White
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Kenneth Chan
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Carolyn Y Ho
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Martin S Maron
- Lahey Hospital & Medical Center, Boston, Massachusetts, USA
| | | | - Jeanette Schulz-Menger
- Charité Experimental Clinical Research Center and Helios Clinics Berlin-Buch, Berlin, Germany
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Stefan Neubauer
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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24
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Patel AR, Kramer CM. Quantitative myocardial blood flow assessment using stress cardiac magnetic resonance: one step closer to widespread clinical adoption. Eur Heart J Cardiovasc Imaging 2023; 24:435-436. [PMID: 36595286 DOI: 10.1093/ehjci/jeac263] [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: 01/04/2023] Open
Affiliation(s)
- Amit R Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health, 1215 Lee Street, Charlottesville, VA 22908, USA
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25
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Gadi S, Farrar E, Ayers M, Kramer CM. EARLY REFERRAL TO A HYPERTROPHIC CARDIOMYOPATHY CENTER OF EXCELLENCE MAY IMPROVE DIAGNOSTIC ACCURACY AND ENHANCE HEALTHCARE DELIVERY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01150-6] [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: 03/06/2023]
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26
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Kaso ER, Loffler AI, Petroni GR, Meyer C, Walker MR, Carr JC, McDermott MM, Kramer CM. LDL CHOLESTEROL LOWERING WITH PCSK9 INHIBITION AND PLAQUE VOLUME, CALF MUSCLE PERFUSION, AND WALKING PERFORMANCE IN PERIPHERAL ARTERIAL DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02455-5] [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: 03/06/2023]
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McParland J, Logan J, Hosadurg N, Kramer CM. EOSINOPHILIC MYOCARDITIS PRESENTING AS MULTIFOCAL STROKES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03059-0] [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: 03/06/2023]
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Hosadurg N, May S, Patel AR, Kramer CM, Lozano PR. UNRAVELING A RIGHT ATRIAL MASS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03283-7] [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: 03/06/2023]
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Hanchate S, Perry A, McClean K, Kramer CM, Ayers M. MAVACAMTEN IN HYPERTROPHIC CARDIOMYOPATHY: EFFECTIVE, BUT AFFORDABLE? J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01157-9] [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: 03/06/2023]
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Tadros R, Zheng SL, Grace C, Jordà P, Francis C, Jurgens SJ, Thomson KL, Harper AR, Ormondroyd E, West DM, Xu X, Theotokis PI, Buchan RJ, McGurk KA, Mazzarotto F, Boschi B, Pelo E, Lee M, Noseda M, Varnava A, Vermeer AM, Walsh R, Amin AS, van Slegtenhorst MA, Roslin N, Strug LJ, Salvi E, Lanzani C, de Marvao A, Roberts JD, Tremblay-Gravel M, Giraldeau G, Cadrin-Tourigny J, L'Allier PL, Garceau P, Talajic M, Pinto YM, Rakowski H, Pantazis A, Baksi J, Halliday BP, Prasad SK, Barton PJ, O'Regan DP, Cook SA, de Boer RA, Christiaans I, Michels M, Kramer CM, Ho CY, Neubauer S, Matthews PM, Wilde AA, Tardif JC, Olivotto I, Adler A, Goel A, Ware JS, Bezzina CR, Watkins H. Large scale genome-wide association analyses identify novel genetic loci and mechanisms in hypertrophic cardiomyopathy. medRxiv 2023:2023.01.28.23285147. [PMID: 36778260 PMCID: PMC9915807 DOI: 10.1101/2023.01.28.23285147] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is an important cause of morbidity and mortality with both monogenic and polygenic components. We here report results from the largest HCM genome-wide association study (GWAS) and multi-trait analysis (MTAG) including 5,900 HCM cases, 68,359 controls, and 36,083 UK Biobank (UKB) participants with cardiac magnetic resonance (CMR) imaging. We identified a total of 70 loci (50 novel) associated with HCM, and 62 loci (32 novel) associated with relevant left ventricular (LV) structural or functional traits. Amongst the common variant HCM loci, we identify a novel HCM disease gene, SVIL, which encodes the actin-binding protein supervillin, showing that rare truncating SVIL variants cause HCM. Mendelian randomization analyses support a causal role of increased LV contractility in both obstructive and non-obstructive forms of HCM, suggesting common disease mechanisms and anticipating shared response to therapy. Taken together, the findings significantly increase our understanding of the genetic basis and molecular mechanisms of HCM, with potential implications for disease management.
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Affiliation(s)
- Rafik Tadros
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sean L Zheng
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Christopher Grace
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Paloma Jordà
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Catherine Francis
- National Heart & Lung Institute, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sean J Jurgens
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kate L Thomson
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Oxford Genetics Laboratories, Churchill Hospital, Oxford, UK
| | - Andrew R Harper
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Elizabeth Ormondroyd
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Dominique M West
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Xiao Xu
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Pantazis I Theotokis
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Rachel J Buchan
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Kathryn A McGurk
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Francesco Mazzarotto
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | | | - Michael Lee
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Michela Noseda
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Amanda Varnava
- National Heart & Lung Institute, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, Imperial College London, London, UK
| | - Alexa Mc Vermeer
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Clinical Genetics, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
| | - Roddy Walsh
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ahmad S Amin
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marjon A van Slegtenhorst
- Department of Clinical Genetics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicole Roslin
- The Centre for Applied Genomics, Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lisa J Strug
- Departments of Statistical Sciences and Computer Science, Data Sciences Institute, University of Toronto, Toronto, ON, Canada
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada
- Ontario Regional Centre, Canadian Statistical Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Erika Salvi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Lanzani
- Genomics of Renal Diseases and Hypertension Unit, Nephrology Operative Unit, IRCCS San Raffaele Hospital, Milan, Italy
- Chair of Nephrology, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio de Marvao
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Maxime Tremblay-Gravel
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Genevieve Giraldeau
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Philippe L L'Allier
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Patrick Garceau
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mario Talajic
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Yigal M Pinto
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Antonis Pantazis
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - John Baksi
- National Heart & Lung Institute, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Brian P Halliday
- National Heart & Lung Institute, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sanjay K Prasad
- National Heart & Lung Institute, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Paul Jr Barton
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Stuart A Cook
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Imke Christiaans
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michelle Michels
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Paul M Matthews
- Department of Brain Sciences and UK Dementia Research Institute, Imperial College London, London, UK
| | - Arthur A Wilde
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- ECGen, Cardiogenetics Focus Group of EHRA, France
| | - Jean-Claude Tardif
- Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, Meyer Children Hospital, University of Florence, Florence, Italy
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anuj Goel
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - James S Ware
- National Heart & Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Program in Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Connie R Bezzina
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, (ERN GUARD-HEART; https://guardheart.ern-net.eu)
| | - Hugh Watkins
- Radcliffe Department of Medicine, University of Oxford, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
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Aung N, Lopes LR, van Duijvenboden S, Harper AR, Goel A, Grace C, Ho CY, Weintraub WS, Kramer CM, Neubauer S, Watkins HC, Petersen SE, Munroe PB. Genome-Wide Analysis of Left Ventricular Maximum Wall Thickness in the UK Biobank Cohort Reveals a Shared Genetic Background With Hypertrophic Cardiomyopathy. Circ Genom Precis Med 2023; 16:e003716. [PMID: 36598836 PMCID: PMC9946169 DOI: 10.1161/circgen.122.003716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 10/13/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Left ventricular maximum wall thickness (LVMWT) is an important biomarker of left ventricular hypertrophy and provides diagnostic and prognostic information in hypertrophic cardiomyopathy (HCM). Limited information is available on the genetic determinants of LVMWT. METHODS We performed a genome-wide association study of LVMWT measured from the cardiovascular magnetic resonance examinations of 42 176 European individuals. We evaluated the genetic relationship between LVMWT and HCM by performing pairwise analysis using the data from the Hypertrophic Cardiomyopathy Registry in which the controls were randomly selected from UK Biobank individuals not included in the cardiovascular magnetic resonance sub-study. RESULTS Twenty-one genetic loci were discovered at P<5×10-8. Several novel candidate genes were identified including PROX1, PXN, and PTK2, with known functional roles in myocardial growth and sarcomere organization. The LVMWT genetic risk score is predictive of HCM in the Hypertrophic Cardiomyopathy Registry (odds ratio per SD: 1.18 [95% CI, 1.13-1.23]) with pairwise analyses demonstrating a moderate genetic correlation (rg=0.53) and substantial loci overlap (19/21). CONCLUSIONS Our findings provide novel insights into the genetic underpinning of LVMWT and highlight its shared genetic background with HCM, supporting future endeavours to elucidate the genetic etiology of HCM.
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Affiliation(s)
- Nay Aung
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry (N.A., S.v.D., S.E.P., P.B.M.)
- National Institute for Health and Care Research, Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London (N.A., S.v.D., S.E.P., P.B.M.)
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield (N.A., L.R.L., S.E.P.)
| | - Luis R Lopes
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield (N.A., L.R.L., S.E.P.)
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London (L.R.L.)
| | - Stefan van Duijvenboden
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry (N.A., S.v.D., S.E.P., P.B.M.)
- National Institute for Health and Care Research, Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London (N.A., S.v.D., S.E.P., P.B.M.)
| | - Andrew R Harper
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H., A.G., C.G., H.C.W.)
| | - Anuj Goel
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H., A.G., C.G., H.C.W.)
| | - Christopher Grace
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H., A.G., C.G., H.C.W.)
| | - Carolyn Y Ho
- Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | | | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health System, Charlottesville (C.M.K.)
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, United Kingdom (S.N., H.C.W.)
| | - Hugh C Watkins
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine (A.R.H., A.G., C.G., S.N., H.C.W.)
- Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H., A.G., C.G., H.C.W.)
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, United Kingdom (S.N., H.C.W.)
| | - Steffen E Petersen
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry (N.A., S.v.D., S.E.P., P.B.M.)
- National Institute for Health and Care Research, Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London (N.A., S.v.D., S.E.P., P.B.M.)
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield (N.A., L.R.L., S.E.P.)
| | - Patricia B Munroe
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry (N.A., S.v.D., S.E.P., P.B.M.)
- National Institute for Health and Care Research, Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London (N.A., S.v.D., S.E.P., P.B.M.)
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Maron MS, Masri A, Choudhury L, Olivotto I, Saberi S, Wang A, Garcia-Pavia P, Lakdawala NK, Nagueh SF, Rader F, Tower-Rader A, Turer AT, Coats C, Fifer MA, Owens A, Solomon SD, Watkins H, Barriales-Villa R, Kramer CM, Wong TC, Paige SL, Heitner SB, Kupfer S, Malik FI, Meng L, Wohltman A, Abraham T. Phase 2 Study of Aficamten in Patients With Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2023; 81:34-45. [PMID: 36599608 DOI: 10.1016/j.jacc.2022.10.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/12/2022] [Accepted: 10/12/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Left ventricular outflow tract (LVOT) obstruction is a major determinant of heart failure symptoms in obstructive hypertrophic cardiomyopathy (oHCM). Aficamten, a next-in-class cardiac myosin inhibitor, may lower gradients and improve symptoms in these patients. OBJECTIVES This study aims to evaluate the safety and efficacy of aficamten in patients with oHCM. METHODS Patients with oHCM and LVOT gradients ≥30 mm Hg at rest or ≥50 mm Hg with Valsalva were randomized 2:1 to receive aficamten (n = 28) or placebo (n = 13) in 2 dose-finding cohorts. Doses were titrated based on gradients and ejection fraction (EF). Safety and changes in gradient, EF, New York Heart Association functional class, and cardiac biomarkers were assessed over a 10-week treatment period and after a 2-week washout. RESULTS From baseline to 10 weeks, aficamten reduced gradients at rest (mean difference: -40 ± 27 mm Hg, and -43 ± 37 mm Hg in Cohorts 1 and 2, P = 0.0003 and P = 0.0004 vs placebo, respectively) and with Valsalva (-36 ± 27 mm Hg and -53 ± 44 mm Hg, P = 0.001 and <0.0001 vs placebo, respectively). There were modest reductions in EF (-6% ± 7.5% and -12% ± 5.9%, P = 0.007 and P < 0.0001 vs placebo, respectively). Symptomatic improvement in ≥1 New York Heart Association functional class was observed in 31% on placebo, and 43% and 64% on aficamten in Cohorts 1 and 2, respectively (nonsignificant). With aficamten, N-terminal pro-B-type natriuretic peptide was reduced (62% relative to placebo, P = 0.0002). There were no treatment interruptions and adverse events were similar between treatment arms. CONCLUSIONS Aficamten resulted in substantial reductions in LVOT gradients with most patients experiencing improvement in biomarkers and symptoms. These results highlight the potential of sarcomere-targeted therapy for treatment of oHCM.
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Affiliation(s)
- Martin S Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
| | - Ahmad Masri
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Sara Saberi
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Andrew Wang
- Duke University Hospital, Durham, North Carolina, USA
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro de Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | | | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Florian Rader
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | | | - Anjali Owens
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Timothy C Wong
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sharon L Paige
- Cytokinetics Incorporated, South San Francisco, California, USA
| | | | - Stuart Kupfer
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Fady I Malik
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Lisa Meng
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Amy Wohltman
- Cytokinetics Incorporated, South San Francisco, California, USA
| | - Theodore Abraham
- University of California, San Francisco, San Francisco, California, USA
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Abstract
Hypertrophic cardiomyopathy is the most common genetic heart disease. Biomarkers, molecules measurable in the blood, could inform the clinician by aiding in diagnosis, directing treatment, and predicting outcomes. We present an updated review of circulating biomarkers in hypertrophic cardiomyopathy representing key pathologic processes including wall stretch, myocardial necrosis, fibrosis, inflammation, hypertrophy, and endothelial dysfunction, in addition to their clinical significance.
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Affiliation(s)
| | | | | | | | - Michael Salerno
- Department of Medicine, Cardiovascular DivisionUniversity of VirginiaCharlottesvilleVA
| | - Christopher M. Kramer
- Department of Medicine, Cardiovascular DivisionUniversity of VirginiaCharlottesvilleVA
| | - Ellen C. Keeley
- Department of MedicineUniversity of FloridaGainesvilleFL,Division of Cardiovascular MedicineUniversity of FloridaGainesvilleFL
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Javaid A, Zghyer F, Kim C, Spaulding EM, Isakadze N, Ding J, Kargillis D, Gao Y, Rahman F, Brown DE, Saria S, Martin SS, Kramer CM, Blumenthal RS, Marvel FA. Medicine 2032: The future of cardiovascular disease prevention with machine learning and digital health technology. Am J Prev Cardiol 2022; 12:100379. [PMID: 36090536 PMCID: PMC9460561 DOI: 10.1016/j.ajpc.2022.100379] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/21/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022] Open
Abstract
Machine learning (ML) refers to computational algorithms that iteratively improve their ability to recognize patterns in data. The digitization of our healthcare infrastructure is generating an abundance of data from electronic health records, imaging, wearables, and sensors that can be analyzed by ML algorithms to generate personalized risk assessments and promote guideline-directed medical management. ML's strength in generating insights from complex medical data to guide clinical decisions must be balanced with the potential to adversely affect patient privacy, safety, health equity, and clinical interpretability. This review provides a primer on key advances in ML for cardiovascular disease prevention and how they may impact clinical practice.
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Sahota M, Saraskani SR, Xu H, Li L, Majeed AW, Hermida U, Neubauer S, Desai M, Weintraub W, Desvigne-Nickens P, Schulz-Menger J, Kwong RY, Kramer CM, Young AA, Lamata P. Machine learning evaluation of LV outflow obstruction in hypertrophic cardiomyopathy using three-chamber cardiovascular magnetic resonance. Int J Cardiovasc Imaging 2022; 38:2695-2705. [PMID: 36201099 PMCID: PMC9708771 DOI: 10.1007/s10554-022-02724-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
Left ventricular outflow tract obstruction (LVOTO) is common in hypertrophic cardiomyopathy (HCM), but relationships between anatomical metrics and obstruction are poorly understood. We aimed to develop machine learning methods to evaluate LVOTO in HCM patients and quantify relationships between anatomical metrics and obstruction. This retrospective analysis of 1905 participants of the HCM Registry quantified 11 anatomical metrics derived from 14 landmarks automatically detected on the three-chamber long axis cine CMR images. Linear and logistic regression was used to quantify strengths of relationships with the presence of LVOTO (defined by resting Doppler pressure drop of > 30 mmHg), using the area under the receiver operating characteristic (AUC). Intraclass correlation coefficients between the network predictions and three independent observers showed similar agreement to that between observers. The distance from anterior mitral valve leaflet tip to basal septum (AML-BS) was most highly correlated with Doppler pressure drop (R2 = 0.19, p < 10-5). Multivariate stepwise regression found the best predictive model included AML-BS, AML length to aortic valve diameter ratio, AML length to LV width ratio, and midventricular septal thickness metrics (AUC 0.84). Excluding AML-BS, metrics grouped according to septal hypertrophy, LV geometry, and AML anatomy each had similar associations with LVOTO (AUC 0.71, 0.71, 0.68 respectively, p = ns), significantly less than their combination (AUC 0.77, p < 0.05 for each). Anatomical metrics derived from a standard three-chamber CMR cine acquisition can be used to highlight risk of LVOTO, and suggest further investigation if necessary. A combination of geometric factors is required to provide the best risk prediction.
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Affiliation(s)
- Manisha Sahota
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Rd, London, SE1 7EU, UK
| | - Sepas Ryan Saraskani
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Rd, London, SE1 7EU, UK
| | - Hao Xu
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Rd, London, SE1 7EU, UK
| | - Liandong Li
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Rd, London, SE1 7EU, UK
| | - Abdul Wahab Majeed
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Rd, London, SE1 7EU, UK
| | - Uxio Hermida
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Rd, London, SE1 7EU, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Milind Desai
- Cardiovascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Jeanette Schulz-Menger
- ECRC and Department of Cardiology, HELIOS Klinik Berlin-Buch, Clinic for Cardiology and Nephrology, DZHK Partnersite Berlin, Charité Medical University Berlin, Berlin, Germany
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Alistair A Young
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Rd, London, SE1 7EU, UK.
| | - Pablo Lamata
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Rd, London, SE1 7EU, UK
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36
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Bivona DJ, Tallavajhala S, Abdi M, Oomen PJA, Gao X, Malhotra R, Darby A, Monfredi OJ, Mangrum JM, Mason P, Mazimba S, Salerno M, Kramer CM, Epstein FH, Holmes JW, Bilchick KC. Cardiac magnetic resonance defines mechanisms of sex-based differences in outcomes following cardiac resynchronization therapy. Front Cardiovasc Med 2022; 9:1007806. [PMID: 36186999 PMCID: PMC9521735 DOI: 10.3389/fcvm.2022.1007806] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Mechanisms of sex-based differences in outcomes following cardiac resynchronization therapy (CRT) are poorly understood. Objective To use cardiac magnetic resonance (CMR) to define mechanisms of sex-based differences in outcomes after CRT and describe distinct CMR-based phenotypes of CRT candidates based on sex and non-ischemic/ischemic cardiomyopathy type. Materials and methods In a prospective study, sex-based differences in three short-term CRT response measures [fractional change in left ventricular end-systolic volume index 6 months after CRT (LVESVI-FC), B-type natriuretic peptide (BNP) 6 months after CRT, change in peak VO2 6 months after CRT], and long-term survival were evaluated with respect to 39 baseline parameters from CMR, exercise testing, laboratory testing, electrocardiograms, comorbid conditions, and other sources. CMR was also used to quantify the degree of left-ventricular mechanical dyssynchrony by deriving the circumferential uniformity ratio estimate (CURE-SVD) parameter from displacement encoding with stimulated echoes (DENSE) strain imaging. Statistical methods included multivariable linear regression with evaluation of interaction effects associated with sex and cardiomyopathy type (ischemic and non-ischemic cardiomyopathy) and survival analysis. Results Among 200 patients, the 54 female patients (27%) pre-CRT had a smaller CMR-based LVEDVI (p = 0.04), more mechanical dyssynchrony based on the validated CMR CURE-SVD parameter (p = 0.04), a lower frequency of both late gadolinium enhancement (LGE) and ischemic cardiomyopathy (p < 0.0001), a greater RVEF (p = 0.02), and a greater frequency of LBBB (p = 0.01). After categorization of patients into four groups based on cardiomyopathy type (ischemic/non-ischemic cardiomyopathy) and sex, female patients with non-ischemic cardiomyopathy had the lowest CURE-SVD (p = 0.003), the lowest pre-CRT BNP levels (p = 0.01), the lowest post-CRT BNP levels (p = 0.05), and the most favorable LVESVI-FC (p = 0.001). Overall, female patients had better 3-year survival before adjustment for cardiomyopathy type (p = 0.007, HR = 0.45) and after adjustment for cardiomyopathy type (p = 0.009, HR = 0.67). Conclusion CMR identifies distinct phenotypes of female CRT patients with non-ischemic and ischemic cardiomyopathy relative to male patients stratified by cardiomyopathy type. The more favorable short-term response and long-term survival outcomes in female heart failure patients with CRT were associated with lower indexed CMR-based LV volumes, decreased presence of scar associated with prior myocardial infarction and ICM, and greater CMR-based dyssynchrony with the CURE-SVD.
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Affiliation(s)
- Derek J. Bivona
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Srikar Tallavajhala
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Pim J. A. Oomen
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | - Xu Gao
- Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Rohit Malhotra
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Andrew Darby
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Oliver J. Monfredi
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - J. Michael Mangrum
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Pamela Mason
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Sula Mazimba
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Michael Salerno
- Department of Medicine and Radiology, Stanford University, Palo Alto, CA, United States
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, United States
| | - Jeffrey W. Holmes
- Department of Medicine, Surgery, and Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kenneth C. Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
- *Correspondence: Kenneth C. Bilchick,
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Papanastasiou CA, Bazmpani MA, Kokkinidis DG, Zegkos T, Efthimiadis G, Tsapas A, Karvounis H, Ziakas A, Kalogeropoulos AP, Kramer CM, Karamitsos TD. The prognostic value of right ventricular ejection fraction by cardiovascular magnetic resonance in heart failure: A systematic review and meta-analysis. Int J Cardiol 2022; 368:94-103. [PMID: 35961612 DOI: 10.1016/j.ijcard.2022.08.008] [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: 05/16/2022] [Revised: 06/29/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is considered the gold standard for the assessment of right ventricular ejection fraction (RVEF). Previous studies have suggested that RVEF may be a predictor of adverse outcomes in heart failure (HF). In this study, we aimed to systematically review the prognostic value of RVEF, evaluated by CMR, across the spectrum of left ventricular systolic function in patients with HF. METHODS Electronic databases were searched for studies investigating the prognostic value of RVEF in HF, irrespective of left ventricular ejection fraction (LVEF). A random-effects meta-analysis was conducted for mortality and HF hospitalization. Subgroup analyses were also performed based on the presence of reduced (<50%) or preserved LVEF (≥50%). RESULTS In total, 46 studies enrolling 14,344 patients were included. In the pooled analyses, impaired RVEF was a powerful predictor of mortality (HR: 1.26, 95% CI: 1.18-1.33, I2: 13%, per 10% decrease in RVEF) and death or HF hospitalization (HR: 1.31, 95% Cl: 1.2-1.42, I2: 27%, per 10% decrease in RVEF). A decrease in RVEF was strongly associated with increased risk of mortality or hospitalization both in HF with reduced EF (HR: 1.24, 95% CI: 1.13-1.36, I2: 2%, per 10% decrease in RVEF) and in HF with preserved EF (HR: 1.24, 95% CI: 1.09-1.40, I2: 0%, per 10% decrease in RVEF). CONCLUSION Impaired RVEF on CMR strongly predicts adverse outcomes in patients with HF regardless of LVEF. RV systolic function should be carefully evaluated in these patients. Prospero Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256967.
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Affiliation(s)
- Christos A Papanastasiou
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria-Anna Bazmpani
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, New Haven, CT, USA
| | - Thomas Zegkos
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Efthimiadis
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, UK
| | - Haralambos Karvounis
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas P Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Christopher M Kramer
- Department of Medicine (Cardiovascular Division), University of Virginia Health System, Charlottesville, VA, USA
| | - Theodoros D Karamitsos
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Sporkin HL, Patel TR, Betz Y, Mathew R, Schumann CL, Meyer CH, Kramer CM. Chemical Exchange Saturation Transfer Magnetic Resonance Imaging Identifies Abnormal Calf Muscle-Specific Energetics in Peripheral Artery Disease. Circ Cardiovasc Imaging 2022; 15:e013869. [PMID: 35861977 DOI: 10.1161/circimaging.121.013869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) results in exercise-induced ischemia in leg muscles. 31Phosphorus (P) magnetic resonance spectroscopy demonstrates prolonged phosphocreatine recovery time constant after exercise in PAD but has low signal to noise, low spatial resolution, and requires multinuclear hardware. Chemical exchange saturation transfer (CEST) is a quantitative magnetic resonance imaging method for imaging substrate (CEST asymmetry [CESTasym]) concentration by muscle group. We hypothesized that kinetics measured by CEST could distinguish between patients with PAD and controls. METHODS Patients with PAD and age-matched normal subjects were imaged at 3T with a transmit-receive coil around the calf. Four CEST mages were acquired over 24-second intervals. The subjects then performed plantar flexion exercise on a magnetic resonance imaging-compatible ergometer until calf exhaustion. Twenty-five CEST images were obtained at end exercise. Regions of interest were drawn around individual muscle groups, and (CESTasym) decay times were fitted by exponential curve to CEST values. In 10 patients and 11 controls, 31P spectra were obtained 20 minutes later after repeat exercise. Five patients and 5 controls returned at a mean of 1±1 days later for repeat CEST studies. RESULTS Thirty-five patients with PAD (31 male, age 66±8 years) and 29 controls (11 male, age 63±8 years) were imaged with CEST. The CESTasym decay times for the whole calf (341±332 versus 153±72 seconds; P<0.03) as well as for the gastrocnemius and posterior tibialis were longer in patients with PAD. Agreement between CESTasym decay and phosphocreatine recovery time constant was good. CONCLUSIONS CEST is a magnetic resonance imaging method that can distinguish energetics in patients with PAD from age-matched normal subjects on a per muscle group basis. CEST agrees reasonably well with the gold standard 31P magnetic resonance spectroscopy. Moreover, CEST has higher spatial resolution, creates an image, and does not require multinuclear hardware and thus may be more suitable for clinical studies in PAD.
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Affiliation(s)
- Helen L Sporkin
- Departments of Biomedical Engineering (H.L.S., C.H.M.), University of Virginia Health, Charlottesville
| | - Toral R Patel
- Medicine, Cardiovascular Division (T.R.P., Y.B., R.M., C.L.S., C.M.K.), University of Virginia Health, Charlottesville
| | - Yaqub Betz
- Medicine, Cardiovascular Division (T.R.P., Y.B., R.M., C.L.S., C.M.K.), University of Virginia Health, Charlottesville
| | - Roshin Mathew
- Medicine, Cardiovascular Division (T.R.P., Y.B., R.M., C.L.S., C.M.K.), University of Virginia Health, Charlottesville
| | - Christopher L Schumann
- Medicine, Cardiovascular Division (T.R.P., Y.B., R.M., C.L.S., C.M.K.), University of Virginia Health, Charlottesville
| | - Craig H Meyer
- Departments of Biomedical Engineering (H.L.S., C.H.M.), University of Virginia Health, Charlottesville.,Radiology and Medical Imaging (C.H.M., C.M.K.), University of Virginia Health, Charlottesville
| | - Christopher M Kramer
- Medicine, Cardiovascular Division (T.R.P., Y.B., R.M., C.L.S., C.M.K.), University of Virginia Health, Charlottesville.,Radiology and Medical Imaging (C.H.M., C.M.K.), University of Virginia Health, Charlottesville
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Kramer CM, Rodriguez Lozano PF. Chronic Myocardial Iron After Myocardial Infarction: A Sign of Weakness, Not Strength. JACC Cardiovasc Imaging 2022; 15:1043-1045. [PMID: 35680212 DOI: 10.1016/j.jcmg.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA.
| | - Patricia F Rodriguez Lozano
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA. https://twitter.com/PRodriguezMD
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40
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Bivona DJ, Tallavajhala S, Abdi M, Oomen PJ, Gao X, Malhotra R, Darby AE, Monfredi OJ, Mangrum JM, Mason PK, Mazimba S, Salerno M, Kramer CM, Epstein FH, Holmes JW, Bilchick KC. Machine learning for multidimensional response and survival after cardiac resynchronization therapy using features from cardiac magnetic resonance. Heart Rhythm O2 2022; 3:542-552. [PMID: 36340495 PMCID: PMC9626744 DOI: 10.1016/j.hroo.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) response is complex, and better approaches are required to predict survival and need for advanced therapies. Objective The objective was to use machine learning to characterize multidimensional CRT response and its relationship with long-term survival. Methods Associations of 39 baseline features (including cardiac magnetic resonance [CMR] findings and clinical parameters such as glomerular filtration rate [GFR]) with a multidimensional CRT response vector (consisting of post-CRT left ventricular end-systolic volume index [LVESVI] fractional change, post-CRT B-type natriuretic peptide, and change in peak VO2) were evaluated. Machine learning generated response clusters, and cross-validation assessed associations of clusters with 4-year survival. Results Among 200 patients (median age 67.4 years, 27.0% women) with CRT and CMR, associations with more than 1 response parameter were noted for the CMR CURE-SVD dyssynchrony parameter (associated with post-CRT brain natriuretic peptide [BNP] and LVESVI fractional change) and GFR (associated with peak VO2 and post-CRT BNP). Machine learning defined 3 response clusters: cluster 1 (n = 123, 90.2% survival [best]), cluster 2 (n = 45, 60.0% survival [intermediate]), and cluster 3 (n = 32, 34.4% survival [worst]). Adding the 6-month response cluster to baseline features improved the area under the receiver operating characteristic curve for 4-year survival from 0.78 to 0.86 (P = .02). A web-based application was developed for cluster determination in future patients. Conclusion Machine learning characterizes distinct CRT response clusters influenced by CMR features, kidney function, and other factors. These clusters have a strong and additive influence on long-term survival relative to baseline features.
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41
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Sun C, Robinson A, Wang Y, Bilchick KC, Kramer CM, Weller D, Salerno M, Epstein FH. A Slice-Low-Rank Plus Sparse (slice-L + S) Reconstruction Method for k-t Undersampled Multiband First-Pass Myocardial Perfusion MRI. Magn Reson Med 2022; 88:1140-1155. [PMID: 35608225 PMCID: PMC9325064 DOI: 10.1002/mrm.29281] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
Purpose The synergistic use of k‐t undersampling and multiband (MB) imaging has the potential to provide extended slice coverage and high spatial resolution for first‐pass perfusion MRI. The low‐rank plus sparse (L + S) model has shown excellent performance for accelerating single‐band (SB) perfusion MRI. Methods A MB data consistency method employing ESPIRiT maps and through‐plane coil information was developed. This data consistency method was combined with the temporal L + S constraint to form the slice‐L + S method. Slice‐L + S was compared to SB L + S and the sequential operations of split slice‐GRAPPA and SB L + S (seq‐SG‐L + S) using synthetic data formed from multislice SB images. Prospectively k‐t undersampled MB data were also acquired and reconstructed using seq‐SG‐L + S and slice‐L + S. Results Using synthetic data with total acceleration rates of 6–12, slice‐L + S outperformed SB L + S and seq‐SG‐L + S (N = 7 subjects) with respect to normalized RMSE and the structural similarity index (P < 0.05 for both). For the specific case with MB factor = 3 and rate 3 undersampling, or for SB imaging with rate 9 undersampling (N = 7 subjects), the normalized RMSE values were 0.037 ± 0.007, 0.042 ± 0.005, and 0.031 ± 0.004; and the structural similarity index values were 0.88 ± 0.03, 0.85 ± 0.03, and 0.89 ± 0.02 for SB L + S, seq‐SG‐L + S, and slice‐L + S, respectively (P < 0.05 for both). For prospectively undersampled MB data, slice‐L + S provided better image quality than seq‐SG‐L + S for rate 6 (N = 7) and rate 9 acceleration (N = 7) as scored by blinded experts. Conclusion Slice‐L + S outperformed SB‐L + S and seq‐SG‐L + S and provides 9 slice coverage of the left ventricle with a spatial resolution of 1.5 mm × 1.5 mm with good image quality.
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Affiliation(s)
- Changyu Sun
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia.,Department of Biomedical, Biological and Chemical Engineering, University of Missouri, Columbia, Missouri.,Department of Radiology, University of Missouri, Columbia, Missouri
| | - Austin Robinson
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Yu Wang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
| | - Kenneth C Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.,Department of Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Daniel Weller
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia.,Department of Radiology, University of Virginia Health System, Charlottesville, Virginia.,Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, Virginia
| | - Michael Salerno
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia.,Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.,Department of Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia.,Department of Radiology, University of Virginia Health System, Charlottesville, Virginia
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Wang J, Weller DS, Kramer CM, Salerno M. DEep learning-based rapid Spiral Image REconstruction (DESIRE) for high-resolution spiral first-pass myocardial perfusion imaging. NMR Biomed 2022; 35:e4661. [PMID: 34939246 DOI: 10.1002/nbm.4661] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
The objective of the current study was to develop and evaluate a DEep learning-based rapid Spiral Image REconstruction (DESIRE) technique for high-resolution spiral first-pass myocardial perfusion imaging with whole-heart coverage, to provide fast and accurate image reconstruction for both single-slice (SS) and simultaneous multislice (SMS) acquisitions. Three-dimensional U-Net-based image enhancement architectures were evaluated for high-resolution spiral perfusion imaging at 3 T. The SS and SMS MB = 2 networks were trained on SS perfusion images from 156 slices from 20 subjects. Structural similarity index (SSIM), peak signal-to-noise ratio (PSNR), and normalized root mean square error (NRMSE) were assessed, and prospective images were blindly graded by two experienced cardiologists (5: excellent; 1: poor). Excellent performance was demonstrated for the proposed technique. For SS, SSIM, PSNR, and NRMSE were 0.977 [0.972, 0.982], 42.113 [40.174, 43.493] dB, and 0.102 [0.080, 0.125], respectively, for the best network. For SMS MB = 2 retrospective data, SSIM, PSNR, and NRMSE were 0.961 [0.950, 0.969], 40.834 [39.619, 42.004] dB, and 0.107 [0.086, 0.133], respectively, for the best network. The image quality scores were 4.5 [4.1, 4.8], 4.5 [4.3, 4.6], 3.5 [3.3, 4], and 3.5 [3.3, 3.8] for SS DESIRE, SS L1-SPIRiT, MB = 2 DESIRE, and MB = 2 SMS-slice-L1-SPIRiT, respectively, showing no statistically significant difference (p = 1 and p = 1 for SS and SMS, respectively) between L1-SPIRiT and the proposed DESIRE technique. The network inference time was ~100 ms per dynamic perfusion series with DESIRE, while the reconstruction time of L1-SPIRiT with GPU acceleration was ~ 30 min. It was concluded that DESIRE enabled fast and high-quality image reconstruction for both SS and SMS MB = 2 whole-heart high-resolution spiral perfusion imaging.
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Affiliation(s)
- Junyu Wang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel S Weller
- Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
- Departments of Medicine and Radiology, Stanford University Medical Center, Stanford, California, USA
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Hundley WG, Bluemke DA, Bogaert J, Flamm SD, Fontana M, Friedrich MG, Grosse-Wortmann L, Karamitsos TD, Kramer CM, Kwong RY, McConnell M, Nagel E, Neubauer S, Nijveldt R, Pennell DJ, Petersen SE, Raman SV, van Rossum A. Society for Cardiovascular Magnetic Resonance (SCMR) guidelines for reporting cardiovascular magnetic resonance examinations. J Cardiovasc Magn Reson 2022; 24:29. [PMID: 35484555 PMCID: PMC9052489 DOI: 10.1186/s12968-021-00827-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- W. Gregory Hundley
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, P.O. Box 980335, Richmond, VA 23298 USA
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI USA
| | - Jan Bogaert
- Department of Radiology, Medical Imaging Research Center, Leuven, Belgium
| | - Scott D. Flamm
- Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Matthias G. Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, Canada
- Department of Medicine, Heidelberg University, Heidelberg, Germany
| | - Lars Grosse-Wortmann
- The Labatt Family Heart Centre in the Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | | | - Christopher M. Kramer
- Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA USA
| | - Raymond Y. Kwong
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Michael McConnell
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Eike Nagel
- Institute for Experimental and Translational Cardio Vascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Robin Nijveldt
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Steffen E. Petersen
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Subha V. Raman
- Ohio State University Wexner Medical Center, Columbus, OH USA
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44
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Petersen SE, Friedrich MG, Leiner T, Elias MD, Ferreira VM, Fenski M, Flamm SD, Fogel M, Garg R, Halushka MK, Hays AG, Kawel-Boehm N, Kramer CM, Nagel E, Ntusi NA, Ostenfeld E, Pennell DJ, Raisi-Estabragh Z, Reeder SB, Rochitte CE, Starekova J, Suchá D, Tao Q, Schulz-Menger J, Bluemke DA. Cardiovascular Magnetic Resonance for Patients With COVID-19. JACC Cardiovasc Imaging 2022; 15:685-699. [PMID: 34656482 PMCID: PMC8514168 DOI: 10.1016/j.jcmg.2021.08.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
COVID-19 is associated with myocardial injury caused by ischemia, inflammation, or myocarditis. Cardiovascular magnetic resonance (CMR) is the noninvasive reference standard for cardiac function, structure, and tissue composition. CMR is a potentially valuable diagnostic tool in patients with COVID-19 presenting with myocardial injury and evidence of cardiac dysfunction. Although COVID-19-related myocarditis is likely infrequent, COVID-19-related cardiovascular histopathology findings have been reported in up to 48% of patients, raising the concern for long-term myocardial injury. Studies to date report CMR abnormalities in 26% to 60% of hospitalized patients who have recovered from COVID-19, including functional impairment, myocardial tissue abnormalities, late gadolinium enhancement, or pericardial abnormalities. In athletes post-COVID-19, CMR has detected myocarditis-like abnormalities. In children, multisystem inflammatory syndrome may occur 2 to 6 weeks after infection; associated myocarditis and coronary artery aneurysms are evaluable by CMR. At this time, our understanding of COVID-19-related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR. In this review, we summarize existing studies of CMR for patients with COVID-19 and present ongoing research. We also provide recommendations for clinical use of CMR for patients with acute symptoms or who are recovering from COVID-19.
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Affiliation(s)
- Steffen E. Petersen
- William Harvey Research Institute, National Institute for Health Research Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom,Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Matthias G. Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Tim Leiner
- University Medical Center Utrecht, Department of Radiology, Utrecht, the Netherlands,Mayo Clinic, Department of Radiology, Rochester, Minnestoa, USA
| | - Matthew D. Elias
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford National Institute for Health Research Biomedical Research Centre, University of Oxford, United Kingdom
| | - Maximilian Fenski
- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Working Group on Cardiac Magnetic Resonance, Experimental Clinical Research Centre, Berlin, Germany,Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany,Deutsches Zentrum für Herz-Kreislaufforschung-Partnersite-Berlin, Berlin, Germany
| | - Scott D. Flamm
- Cardiovascular Imaging, Imaging and Heart, Vascular, and Thoracic Institutes, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Fogel
- Department of Pediatrics (Cardiology) and Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ria Garg
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Marc K. Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Chur, Switzerland,Institute for Diagnostic Interventional Pediatric Radiology, Inselspital, Bern, University Hospital of Bern, Switzerland
| | - Christopher M. Kramer
- Cardiovascular Division, Departments of Medicine and Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Center for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt AM Main, Germany
| | - Ntobeko A.B. Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa,Groote Schuur Hospital, Cape Town, South Africa,Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden,Skåne University Hospital, Lund, Sweden
| | - Dudley J. Pennell
- National Heart and Lung Institute, Imperial College, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, National Institute for Health Research Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom,Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Scott B. Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Carlos E. Rochitte
- Heart Institute, InCor, University of São Paulo Medical School and Heart Hospital, Hospital do Coração, São Paulo, Brazil
| | - Jitka Starekova
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Dominika Suchá
- University Medical Center Utrecht, Department of Radiology, Utrecht, the Netherlands
| | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands,Division of Imaging Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanette Schulz-Menger
- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Working Group on Cardiac Magnetic Resonance, Experimental Clinical Research Centre, Berlin, Germany,Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany,Deutsches Zentrum für Herz-Kreislaufforschung-Partnersite-Berlin, Berlin, Germany
| | - David A. Bluemke
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wisconsin, USA,Address for correspondence: Dr David A. Bluemke, University of Wisconsin School of Medicine and Public Health, 600 Highland Drive, Madison, Wisconsin 53792, USA
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45
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Rodriguez Lozano PF, Rrapo Kaso E, Bourque JM, Morsy M, Taylor AM, Villines TC, Kramer CM, Salerno M. Cardiovascular Imaging for Ischemic Heart Disease in Women: Time for a Paradigm Shift. JACC Cardiovasc Imaging 2022; 15:1488-1501. [PMID: 35331658 PMCID: PMC9355915 DOI: 10.1016/j.jcmg.2022.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
Abstract
Heart disease is the leading cause of death among men and women. Women have a unique phenotype of ischemic heart disease with less calcified lesions, more nonobstructive plaques, and a higher prevalence of microvascular disease compared with men, which may explain in part why current risk models to detect obstructive coronary artery disease (CAD) may not work as well in women. This paper summarizes the sex differences in the functional and anatomical assessment of CAD in women presenting with stable chest pain and provides an approach for using multimodality imaging for the evaluation of suspected ischemic heart disease in women in accordance to the recently published American Heart Association/American College of Cardiology guidelines for the evaluation and diagnosis of chest pain. A paradigm shift in the approach to imaging ischemic heart disease women is needed including updated risk models, a more profound understanding of CAD in women where nonobstructive disease is more prevalent, and algorithms focused on the evaluation of ischemia with nonobstructive CAD and myocardial infarction with nonobstructive CAD.
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Affiliation(s)
- Patricia F Rodriguez Lozano
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Elona Rrapo Kaso
- Department of Medicine, Cardiovascular Division, Orlando VA Medical Center, Orlando, Florida, USA
| | - Jamieson M Bourque
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mohamed Morsy
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Angela M Taylor
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Todd C Villines
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA; Stanford University Medical Center, Cardiovascular Medicine, Stanford, California, USA.
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46
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Mehta NK, Schumann C, Davogustto G, Cluckey A, Harmon E, France J, Mangrum JM, Mason P, Mazimba S, Malhotra R, Bilchick K, Darby A, Salerno M, Kramer CM, Stevenson W. Utility of Ischemia Testing Prior to Ablation for Sustained Monomorphic Ventricular Tachycardia. J Innov Card Rhythm Manag 2022; 13:4908-4914. [PMID: 35317206 PMCID: PMC8930013 DOI: 10.19102/icrm.2022.130301] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/22/2021] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to determine the relationship between ischemia testing prior to ablation for sustained monomorphic ventricular tachycardia (VT) (SMVT) and post-ablation mortality and VT recurrence. As SMVT is generally caused by myocardial scar and not active ischemia, the utility of ischemia testing prior to SMVT ablation is unclear. Patients who underwent ablation for SMVT at 2 tertiary care centers between January 2016 and July 2018 were included in a retrospective study. A Kaplan-Meier survival analysis was performed, stratifying patients by pre-ablation ischemia testing for the endpoints of mortality and VT recurrence. A Cox multivariable regression analysis was performed to identify predictors of post-ablation VT recurrence. A total of 163 patients were included, with 46 (28%) patients undergoing ischemia testing prior to ablation. Only 5 of the 46 patients (11%) received revascularization pre-ablation. After a median follow-up period of 625 days (interquartile range, 292-982 days) following ablation, 97 of 163 patients (60%) had VT recurrence, and 32 patients (20%) had died. There was no difference in mortality or VT recurrence between patients who did or did not experience ischemia testing or revascularization. In the multivariable regression analysis, predictors of VT recurrence were the number of anti-arrhythmics failed, non-ischemic cardiomyopathy, sex, and cardiac magnetic resonance imaging pre-ablation. Neither ischemia testing nor revascularization was a significant predictor of VT recurrence in univariable or multivariable regression analysis. In conclusion, ischemia testing is frequently ordered prior to SMVT ablation but infrequently leads to revascularization and is not associated with post-ablation outcomes. The findings support adopting an individualized approach rather than performing routine ischemia testing.
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Affiliation(s)
- Nishaki K. Mehta
- Division of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, USA,Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA,Address correspondence to: Nishaki K. Mehta, MD, FHRS, Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, 3601 West 13 Mile Road, MI 48073, USA.
| | - Christopher Schumann
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Giovanni Davogustto
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew Cluckey
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evan Harmon
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Joshua France
- Division of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - James M. Mangrum
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Pamela Mason
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Sula Mazimba
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Rohit Malhotra
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Kenneth Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Andrew Darby
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Michael Salerno
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA,Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA,Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA,Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA,Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA
| | - William Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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47
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Lozano PR, Kohli K, Robinson A, Xie Y, Zhao F, Sadri V, Gooden S, Samaee M, Thim A, Morsy M, Klibanov A, Kramer CM, Hossack J, Yoganathan AP. FUNCTIONAL EFFECTS OF THERAPEUTIC ULTRASOUND FOR CALCIFIC DEGENERATIVE MITRAL STENOSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02679-1] [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: 11/29/2022]
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48
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Kramer CM, Bilchick KC. Defibrillator or No Defibrillator With CRT: That Is the Question for CMR. J Am Coll Cardiol 2022; 79:679-681. [PMID: 35177197 DOI: 10.1016/j.jacc.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA.
| | - Kenneth C Bilchick
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
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49
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Kramer CM, DiMarco JP, Kolm P, Ho CY, Desai MY, Kwong RY, Dolman SF, Desvigne-Nickens P, Geller N, Kim DY, Maron MS, Appelbaum E, Jerosch-Herold M, Friedrich MG, Schulz-Menger J, Piechnik SK, Mahmod M, Jacoby D, White J, Chiribiri A, Helms A, Choudhury L, Michels M, Bradlow W, Salerno M, Dawson DK, Weinsaft JW, Berry C, Nagueh SF, Buccarelli-Ducci C, Owens A, Casadei B, Watkins H, Weintraub WS, Neubauer S. Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR. JACC Clin Electrophysiol 2021; 7:1376-1386. [PMID: 34217663 PMCID: PMC8605982 DOI: 10.1016/j.jacep.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy. BACKGROUND Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping. METHODS All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event. RESULTS Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 ± 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk. CONCLUSIONS The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted.
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Affiliation(s)
| | - John P DiMarco
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Paul Kolm
- MedStar Health Research Institute, Washington, DC, USA
| | - Carolyn Y Ho
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | - Nancy Geller
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | | | | | | | - Jeanette Schulz-Menger
- Charité Experimental Clinical Research Center and Helios Clinics Berlin-Buch, Berlin, Germany
| | | | | | | | - James White
- University of Calgary, Calgary, Alberta, Canada
| | | | - Adam Helms
- University of Michigan, Anne Arbor, Michigan, USA
| | | | | | | | - Michael Salerno
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | - Colin Berry
- University of Glasgow, Glasgow, United Kingdom
| | | | | | - Anjali Owens
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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50
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Kramer CM, Ferrari V. In Memoriam, Nathaniel M. Reichek, MD, 1941–2021. J Cardiovasc Magn Reson 2021. [PMCID: PMC8515769 DOI: 10.1186/s12968-021-00804-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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