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Rajkumar CA, Foley MJ, Ahmed-Jushuf F, Nowbar AN, Simader FA, Davies JR, O'Kane PD, Haworth P, Routledge H, Kotecha T, Gamma R, Clesham G, Williams R, Din J, Nijjer SS, Curzen N, Ruparelia N, Sinha M, Dungu JN, Ganesananthan S, Khamis R, Mughal L, Kinnaird T, Petraco R, Spratt JC, Sen S, Sehmi J, Collier DJ, Sohaib A, Keeble TR, Cole GD, Howard JP, Francis DP, Shun-Shin MJ, Al-Lamee RK. A Placebo-Controlled Trial of Percutaneous Coronary Intervention for Stable Angina. N Engl J Med 2023; 389:2319-2330. [PMID: 38015442 PMCID: PMC7615400 DOI: 10.1056/nejmoa2310610] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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] [Indexed: 11/29/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is frequently performed to reduce the symptoms of stable angina. Whether PCI relieves angina more than a placebo procedure in patients who are not receiving antianginal medication remains unknown. METHODS We conducted a double-blind, randomized, placebo-controlled trial of PCI in patients with stable angina. Patients stopped all antianginal medications and underwent a 2-week symptom assessment phase before randomization. Patients were then randomly assigned in a 1:1 ratio to undergo PCI or a placebo procedure and were followed for 12 weeks. The primary end point was the angina symptom score, which was calculated daily on the basis of the number of angina episodes that occurred on a given day, the number of antianginal medications prescribed on that day, and clinical events, including the occurrence of unblinding owing to unacceptable angina or acute coronary syndrome or death. Scores range from 0 to 79, with higher scores indicating worse health status with respect to angina. RESULTS A total of 301 patients underwent randomization: 151 to the PCI group and 150 to the placebo group. The mean (±SD) age was 64±9 years, and 79% were men. Ischemia was present in one cardiac territory in 242 patients (80%), in two territories in 52 patients (17%), and in three territories in 7 patients (2%). In the target vessels, the median fractional flow reserve was 0.63 (interquartile range, 0.49 to 0.75), and the median instantaneous wave-free ratio was 0.78 (interquartile range, 0.55 to 0.87). At the 12-week follow-up, the mean angina symptom score was 2.9 in the PCI group and 5.6 in the placebo group (odds ratio, 2.21; 95% confidence interval, 1.41 to 3.47; P<0.001). One patient in the placebo group had unacceptable angina leading to unblinding. Acute coronary syndromes occurred in 4 patients in the PCI group and in 6 patients in the placebo group. CONCLUSIONS Among patients with stable angina who were receiving little or no antianginal medication and had objective evidence of ischemia, PCI resulted in a lower angina symptom score than a placebo procedure, indicating a better health status with respect to angina. (Funded by the National Institute for Health and Care Research Imperial Biomedical Research Centre and others; ORBITA-2 ClinicalTrials.gov number, NCT03742050.).
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Affiliation(s)
- Christopher A Rajkumar
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Michael J Foley
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Fiyyaz Ahmed-Jushuf
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Alexandra N Nowbar
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Florentina A Simader
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - John R Davies
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Peter D O'Kane
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Peter Haworth
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Helen Routledge
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Tushar Kotecha
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Reto Gamma
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Gerald Clesham
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Rupert Williams
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Jehangir Din
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Sukhjinder S Nijjer
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Nick Curzen
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Neil Ruparelia
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Manas Sinha
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Jason N Dungu
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Sashiananthan Ganesananthan
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Ramzi Khamis
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Lal Mughal
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Tim Kinnaird
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Ricardo Petraco
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - James C Spratt
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Sayan Sen
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Joban Sehmi
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - David J Collier
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Afzal Sohaib
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Thomas R Keeble
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Graham D Cole
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - James P Howard
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Darrel P Francis
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Matthew J Shun-Shin
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
| | - Rasha K Al-Lamee
- From Imperial College London (C.A.R., M.J.F., F.A.-J., F.A.S., S.G., R.K., R.P., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Imperial College Healthcare NHS Trust (C.A.R., M.J.F., F.A.-J., F.A.S., S.S.N., S.G., R.K., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.), Barking Havering and Redbridge University Hospitals NHS Trust (A.N.N., A.S.), Royal Free London NHS Foundation Trust (T. Kotecha), St. George's University Hospitals NHS Foundation Trust (R.W., J.C.S.), St. George's University of London (J.C.S.), Queen Mary University of London (D.J.C., A.S.), and Barts Health NHS Trust (A.S.), London, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon (J.R.D., R.G., G.C., J.N.D., T.R.K.), Anglia Ruskin University, Chelmsford (J.R.D., G.C., T.R.K.), University Hospitals Dorset NHS Foundation Trust, Poole (P.D.O., J.D.), Portsmouth Hospitals University NHS Trust, Portsmouth (P.H.), Worcestershire Acute Hospitals NHS Trust, Worcester (H.R., L.M.), University Hospital Southampton NHS Foundation Trust and the University of Southampton, Southampton (N.C.), Royal Berkshire NHS Foundation Trust, Reading (N.R.), Salisbury NHS Foundation Trust, Salisbury (M.S.), Cardiff and Vale University Health Board, Cardiff (T. Kinnaird), Keele University, Keele (T. Kinnaird), Buckinghamshire Healthcare NHS Trust, Amersham (R.P.), and West Hertfordshire Hospitals NHS Trust, Watford (J.S.) - all in the United Kingdom
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2
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Mittal TK, Hothi SS, Venugopal V, Taleyratne J, O'Brien D, Adnan K, Sehmi J, Daskalopoulos G, Deshpande A, Elfawal S, Sharma V, Shahin RA, Yuan M, Schlosshan D, Walker A, Abdel Rahman SED, Sunderji I, Wagh S, Chow J, Masood M, Sharma S, Agrawal S, Duraikannu C, McAlindon E, Mirsadraee S, Nicol ED, Kelion AD. The Use and Efficacy of FFR-CT: Real-World Multicenter Audit of Clinical Data With Cost Analysis. JACC Cardiovasc Imaging 2023; 16:1056-1065. [PMID: 37052559 DOI: 10.1016/j.jcmg.2023.02.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Fractional flow reserve-computed tomography (FFR-CT) is endorsed by UK and U.S. chest pain guidelines, but its clinical effectiveness and cost benefit in real-world practice are unknown. OBJECTIVES The purpose of this study was to audit the use of FFR-CT in clinical practice against England's National Institute for Health and Care Excellence guidance and assess its diagnostic accuracy and cost. METHODS A multicenter audit was undertaken covering the 3 years when FFR-CT was centrally funded in England. For coronary computed tomographic angiograms (CCTAs) submitted for FFR-CT analysis, centers provided data on symptoms, CCTA and FFR-CT findings, and subsequent management. Audit standards included using FFR-CT only in patients with stable chest pain and equivocal stenosis (50%-69%). Diagnostic accuracy was evaluated against invasive FFR, when performed. Follow-up for nonfatal myocardial infarction and all-cause mortality was undertaken. The cost of an FFR-CT strategy was compared to alternative stress imaging pathways using cost analysis modeling. RESULTS A total of 2,298 CCTAs from 12 centers underwent FFR-CT analysis. Stable chest pain was the main symptom in 77%, and 40% had equivocal stenosis. Positive and negative predictive values of FFR-CT were 49% and 76%, respectively. A total of 46 events (2%) occurred over a mean follow-up period of 17 months; FFR-CT (cutoff: 0.80) was not predictive. The FFR-CT strategy costs £2,102 per patient compared with an average of £1,411 for stress imaging. CONCLUSIONS In clinical practice, the National Institute for Health and Care Excellence criteria for using FFR-CT were met in three-fourths of patients for symptoms and 40% for stenosis. FFR-CT had a low positive predictive value, making its use potentially more expensive than conventional stress imaging strategies.
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Affiliation(s)
- Tarun K Mittal
- Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
| | - Sandeep S Hothi
- Heart and Lung Centre, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom; Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
| | - Vinod Venugopal
- Cardiology, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
| | - John Taleyratne
- Cardiology, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
| | - David O'Brien
- Cardiology, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
| | - Kazi Adnan
- Cardiology, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
| | - Joban Sehmi
- Cardiology, West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | | | - Aparna Deshpande
- Radiology, University Hospitals of Leicester, Leicester, United Kingdom
| | - Sara Elfawal
- Radiology, University Hospitals of Leicester, Leicester, United Kingdom
| | - Vinoda Sharma
- Cardiology, Sandwell and West Birmingham Hospital, Birmingham, United Kingdom
| | - Rajai A Shahin
- Cardiology, Sandwell and West Birmingham Hospital, Birmingham, United Kingdom
| | - Mengshi Yuan
- Cardiology, Sandwell and West Birmingham Hospital, Birmingham, United Kingdom
| | | | - Andrew Walker
- Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | | | - Imran Sunderji
- Cardiology, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Sidhesh Wagh
- Cardiology, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Jocelyn Chow
- Radiology, Newcastle upon Tyne Hospitals, Newcastle, United Kingdom
| | - Mohammed Masood
- Radiology, Newcastle upon Tyne Hospitals, Newcastle, United Kingdom
| | - Sumeet Sharma
- Cardiology, Ashford and St Peter's Hospitals, Surrey, United Kingdom
| | - Sharad Agrawal
- Cardiology, South Tyneside and Sunderland NHS Trust, Sunderland, United Kingdom
| | - Chary Duraikannu
- Radiology, Countess of Chester Hospital, Chester, United Kingdom
| | - Elisa McAlindon
- Heart and Lung Centre, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom; Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
| | - Saeed Mirsadraee
- Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Edward D Nicol
- Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom
| | - Andrew D Kelion
- Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Hothi S, Mittal T, Duarte A, Venugopal V, Taleyratne D, O’Brien D, Adnan K, Sehmi J, Daskalopoulos G, Deshpande A, Elfawal S, Sharma V, Shahin R, Yuan M, Schlosshan D, Walker A, Rahman SED, Sunderji I, Wagh S, Beattie A, Chow J, Masood M, Sharma S, Agrawal S, Duraikannu C, McAlindon E, Mirsadraee S, Nicol E, Kelion A. 136 The use and efficacy of ffr-ct – a real-world multi-centre audit of clinical data and cost-analysis. IMAGING 2022. [DOI: 10.1136/heartjnl-2022-bcs.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Maclean E, Mahon C, Sehmi J, Kanaganayagam G, Ngee TT, Nicol E. CT Multivessel Aggregate Stenosis score: a novel point-of-care tool for predicting major adverse cardiac events. J Cardiovasc Comput Tomogr 2022; 16:350-354. [DOI: 10.1016/j.jcct.2022.01.005] [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] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
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Stowell C, Howard J, Cole G, Ananthan K, Demetrescu C, Pearce K, Rajani R, Sehmi J, Vimalesvaran K, Kanaganayagam S, Ghosh A, Chambers J, Rana B, Francis D, Shun-Shin M. Automated left ventricular dimension assessment using artificial intelligence. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and purpose
Artificial intelligence (AI) has the potential to greatly improve efficiency and reproducibility of quantification in echocardiography, but to gain widespread use it must both meet expert standards of excellence and have a transparent methodology. We developed an online platform to enable multiple collaborators to annotate medical images for training and validating neural networks.
Methods
Using our online collaborative platform 9 expert echocardiographers labelled 2056 images that comprised the training dataset. They labelled the four points from where the standard parasternal long axis (PLAX) measurements (interventricular septum, posterior wall, left ventricular dimension) would be made. Using these labelled images we trained a 2d convolutional neural network to replicate these labels. Separately, we curated an external validation dataset of the systolic and diastolic frames of 100 PLAX acquisitions. Each of these images were labelled twice by 13 different experts, and the average of the 26 measurements was taken as the consensus standard.
We then compared the individual experts and the AI measurements on the external validation dataset to the consensus standard, and calculated the precision standard deviation (SD) of the signed differences from the consensus standard.
Results
For diastolic septum thickness, the AI had a precision SD of 1.8 mm (ICC 0.81; 95% CI 0.73 to 0.97), compared with 2.0 mm for the individual experts (ICC 0.64; 95% CI 0.57 to 0.72). For diastolic posterior wall thickness, the AI had a precision SD 1.4 mm (ICC 0.54; 95% CI 0.38 to 0.66), and the individual experts 2.2 mm (ICC 0.37; 95% CI 0.29 to 0.46).
The AI's precision SD for left ventricular internal dimension was 3.5 mm (ICC 0.93, 95% CI 0.90 to 0.94), and for individual experts was 4.4mm (ICC 0.82, 95% CI 0.78 to 0.95). Both the experts and AI performed better in diastole than systole (precision SD AI 2.5mm vs 4.3mm, p<0.0001; experts 3.3mm vs 5.3mm, p<0.0001).
Conclusions
AI trained by a group of echocardiography experts was able to perform PLAX measurements which matched the reference standard more closely than any individual expert's own measurements.
This open, collaborative approach may be a model for the development of AI that is explainable to, and trusted by clinicians.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Imperil BRC ITMATDr Howard was additionally funded by Wellcome. Online collaborative platformResults of AI and experts
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Affiliation(s)
- C Stowell
- Imperial College London, NHLI, London, United Kingdom
| | - J Howard
- Imperial College London, NHLI, London, United Kingdom
| | - G Cole
- Imperial College London, NHLI, London, United Kingdom
| | - K Ananthan
- Imperial College London, London, United Kingdom
| | - C Demetrescu
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - K Pearce
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - R Rajani
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | | | - S Kanaganayagam
- Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - A Ghosh
- Barts Heart Centre, London, United Kingdom
| | - J Chambers
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - B Rana
- Hammersmith Hospital, London, United Kingdom
| | - D Francis
- Imperial College London, NHLI, London, United Kingdom
| | - M Shun-Shin
- Imperial College London, NHLI, London, United Kingdom
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Pyae PK, Navarra A, Webb R, Newland-Smith A, Vancheeswaran R, Sehmi J, Barlow A. Three-month cardiac outcomes of survivors of COVID-19 presenting to a district general hospital in West Hertfordshire, UK. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
COVID-19 is novel entity associated with significant morbidity and mortality. Most patients recover completely, however, a proportion describe persistent symptoms consistent with cardiopulmonary disturbance. The long-term cardiac and respiratory outcomes of COVID-19 are not known.
Purpose
The aim of this study was to undertake a comprehensive cardiopulmonary assessment of survivors of COVID-19 with post recovery symptoms. The cardiac findings are presented here.
Methods
Survivors of COVID-19 presenting to a general hospital in West Hertfordshire between 18 March 2020 and 15 May 2020, were reviewed at 3 months using a structured prespecified protocol. Patients with persistent symptoms and those admitted to the intensive care unit (ICU) were invited to attend a clinical assessment comprising an electrocardiogram (ECG), echocardiography, chest x-ray (CXR) and pulmonary function tests. At follow up, patients were categorised according to disease course: 1) monitored via a community based virtual hospital, 2) admitted for supplemental oxygen, 3) requiring non-invasive ventilation and 4) ICU admission.
Results
448 eligible patients were evaluated by telephone. 11 patients admitted to ICU and 147 patients with persistent symptoms were invited for further assessment. At presentation, hospitalised patients were older, had higher levels of obesity and increased rates of hypertension than those managed virtually (p<0.05). Among hospitalised patients, the degree of pulmonary infiltration on CXR was higher, ROX index for intubation lower, eGFR lower, C-reactive protein levels higher and lymphocyte counts lower, compared to those managed virtually (p<0.05). The prevalence of known respiratory conditions was higher among patients admitted to hospital, with a trend towards statistical significance (p=0.051). There were no differences in the prevalence of known cardiac disorders and other co-morbidities amongst both patient groups (table 1).
At follow up, CXR appearances were improved and similar among patients monitored virtually, those admitted for supplemental oxygen, those requiring non-invasive ventilation and those treated on ICU. There were no differences in heart rhythm and ECG parameters in the four patient groups. Left ventricular systolic and diastolic dimensions, Simpson's biplane ejection fraction, left atrial volume and left ventricular filling pressures were similar in all four patient groups. There were no differences in right ventricular dimensions, right ventricular fractional area change, tricuspid annular plane systolic excursion and pulmonary artery systolic pressures among patients irrespective of disease severity (table 2).
Conclusions
At 3 months, we identified no differences in ECG indices and echocardiographic parameters of left and right ventricular function among survivors of COVID-19, independent of disease course. The findings of this study argue against significant cardiac sequalae following COVID-19 infection.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P K Pyae
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | - A Navarra
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | - R Webb
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | - A Newland-Smith
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | - R Vancheeswaran
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | - J Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | - A Barlow
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
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7
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Stowell C, Howard J, Demetrescu C, Bhattacharyya S, Mangion K, Vimalesvaran K, Cole G, Rajani R, Sehmi J, Alzetani M, Zolgharni M, Rana B, Francis D, Shun-Shin M. Fully automated global longitudinal strain assessment using artificial intelligence developed and validated by a UK-wide echocardiography expert collaborative. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left ventricular longitudinal strain has been reported to deliver reproducibility, sensitivity and prognostic value over and above ejection fraction. However, it currently relies on uninspectable proprietary algorithms and suffers from a lack of widespread clinical use. Uptake may be improved by increasing user trust through greater transparency.
Purpose
We therefore developed a machine-learning based method, trained, and validated with accredited experts from our AI Echocardiography Collaborative. We make the dataset, code, and trained network freely available under an open-source license.
Methods
AI enables strain to be calculated without relying on speckle tracking by directly locating key points and borders across frames. Strain can then be calculated as the fractional shortening of the left ventricular perimeter. We first curated a dataset of 7523 images, including 2587 apical four chamber, each labelled by a single expert from our collaboration of 17 hospitals, using our online platform (Figure 1). Using both this dataset and a semi-supervised approach, we trained a 3d convolutional neural network to identify the annulus, apex, and the endocardial border throughout the cardiac cycle.
Separately, we constructed an external validation dataset of 100 apical 4 chamber video-loops. The systolic and diastolic frame were identified, and each image was separately labelled by 11 experts. From these labels we then derived the expert consensus strain for each of the 100 video loops. These experts also ordered all 100 echocardiograms by their visual grading of left ventricular longitudinal function. Finally, a single expert calculated strain using two different proprietary commercial packages (A and B).
Results
Consensus strain measurements (obtained by averaging individual assessments by the 11 experts) across the 100 cases ranged from −4% to −27%, with strong correlations with the individual experts and machine methods (Figure 2). Using each cases' consensus across experts as the gold standard, median error from consensus was 3.1% for individual experts, 3.4% for Propriety A, 2.6% for Proprietary B, 2.6% for our AI.
Using the visual grading of longitudinal strain as the reference, the 11 individual experts and 4 machine methods each showed significant correlation: coefficients ranged from 0.55 to 0.69 for experts, and for Proprietary A was 0.68, Proprietary B 0.69, and our AI 0.69.
Conclusions
Our open-source, vendor-independent AI-based strain measure automatically produces values that agree with expert consensus, as strongly as the individual experts do. It also agrees with the subjective visual ranking by longitudinal function. Our open-source AI strain performs at least as well as closed-source speckle-based approaches, and may enable increased clinical and research use of longitudinal strain.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Imperial BRC ITMAT.Dr Howard was additionally funded by Wellcome. Figure 1. Collaborative online platformFigure 2. Correlations between strain methods
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Affiliation(s)
- C Stowell
- Imperial College London, London, United Kingdom
| | - J Howard
- Imperial College London, London, United Kingdom
| | - C Demetrescu
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - K Mangion
- University of Glasgow, Glasgow, United Kingdom
| | | | - G Cole
- Imperial College London, London, United Kingdom
| | - R Rajani
- King's College London, London, United Kingdom
| | - J Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | - M Alzetani
- Luton and Dunstable University Hospital, Luton, United Kingdom
| | - M Zolgharni
- University of West London, London, United Kingdom
| | - B Rana
- Hammersmith Hospital, London, United Kingdom
| | - D Francis
- Imperial College London, London, United Kingdom
| | - M Shun-Shin
- Imperial College London, London, United Kingdom
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8
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Rajkumar CA, Shun-Shin M, Seligman H, Ahmad Y, Warisawa T, Cook CM, Howard JP, Ganesananthan S, Amarin L, Khan C, Ahmed A, Nowbar A, Foley M, Assomull R, Keenan NG, Sehmi J, Keeble TR, Davies JR, Tang KH, Gerber R, Cole G, O’Kane P, Sharp AS, Khamis R, Kanaganayagam G, Petraco R, Ruparelia N, Malik IS, Nijjer S, Sen S, Francis DP, Al-Lamee R. Placebo-Controlled Efficacy of Percutaneous Coronary Intervention for Focal and Diffuse Patterns of Stable Coronary Artery Disease. Circ Cardiovasc Interv 2021; 14:e009891. [PMID: 34340523 PMCID: PMC8366766 DOI: 10.1161/circinterventions.120.009891] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/25/2021] [Indexed: 01/22/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Christopher A. Rajkumar
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Matthew Shun-Shin
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Columbia University Medical Centre, New York–Presbyterian Hospital (Y.A.)
| | - Takayuki Warisawa
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- St. Marianna University School of Medicine, Yokohama, Japan (T.W.)
| | - Christopher M. Cook
- Essex Cardiothoracic Centre, Basildon, United Kingdom (C.M.C., T.R.K., J.R.D., K.H.T.)
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Sashiananthan Ganesananthan
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
| | - Laura Amarin
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
| | - Caitlin Khan
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
| | | | - Alexandra Nowbar
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Michael Foley
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Ravi Assomull
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Niall G. Keenan
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom (N.G.K., J.S.)
| | - Joban Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom (N.G.K., J.S.)
| | - Thomas R. Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom (C.M.C., T.R.K., J.R.D., K.H.T.)
- Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom (T.R.K., J.R.D.)
| | - John R. Davies
- Essex Cardiothoracic Centre, Basildon, United Kingdom (C.M.C., T.R.K., J.R.D., K.H.T.)
- Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom (T.R.K., J.R.D.)
| | - Kare H. Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom (C.M.C., T.R.K., J.R.D., K.H.T.)
| | - Robert Gerber
- East Sussex Healthcare NHS Trust, Hastings, United Kingdom (R.G.)
| | - Graham Cole
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Peter O’Kane
- Royal Bournemouth and Christchurch NHS Trust, Bournemouth, United Kingdom (P.O.)
| | - Andrew S.P. Sharp
- University Hospital of Wales, Cardiff, United Kingdom (A.S.P.S.)
- University of Exeter, United Kingdom (A.S.P.S.)
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Gajen Kanaganayagam
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Neil Ruparelia
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Iqbal S. Malik
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Darrel P. Francis
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.A.R., M.S.-S., H.S., Y.A., T.W., J.P.H., S.G., L.A., C.K., A.N., M.F., R.A., G.C., R.K., R.P., N.R., S.N., S.S., D.P.F., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.A.R., M.S.-S., H.S., J.P.H., A.N., M.F., R.A., G.C., R.K., G.K., R.P., N.R., I.S.M., S.N., S.S., D.P.F., R.A.-L.)
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Maclean E, Sehmi J, Kanaganayagam G, Nicol ED. Hypertension attenuates the prognostic value of coronary artery calcification scoring in low-risk patients. Heart 2021; 107:977-982. [PMID: 33109707 DOI: 10.1136/heartjnl-2020-317399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/26/2020] [Revised: 08/26/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES In outpatients with suspected ischaemic symptoms, we investigated the impact of risk factor profile on the prognostic value of coronary artery calcium scoring (CACS) and CT coronary angiography (CTCA). METHODS 772 consecutive patients underwent CACS and CTCA; 52 patients (6.7%) with significant coronary artery lesions underwent revascularisation within 60 days and were excluded. 720 remaining patients were followed up for 38.1±17.4 months. RESULTS Late presentation (after 60 days) major adverse cardiovascular events (MACEs) were recorded in 27 patients (3.8%). Hypertension was strongly associated with adverse outcomes (unadjusted HR 6.5 (2.9 to 14), p<0.001), and hypertensive patients had double the prevalence of non-calcified plaque versus normotensive individuals (30.2% vs 14.3%, p<0.001). Adjusting for confounders, severe stenosis at CTCA was predictive of MACE for normotensive and hypertensive patients (HR 9.6 (2.8 to 43.1), p<0.001, and HR 6.2 (2.4 to 16.1), p<0.001, respectively). CACS alone was not predictive of MACE throughout the cohort (HR 1.001 (0.9997 to 1.001), p=0.36) and when adjusting for confounders, a cut-off of CACS>400 predicted MACE in normotensive individuals (HR 10.6 (2.41 to 49.3), p<0.001) but not in hypertensive individuals (HR 1.3 (0.5 to 3.6), p=0.56). Zero calcium score did not mitigate the risk of MACE (HR 0.84 (0.39 to 1.8), p=0.65) and 13/27 patients (48.1%) who suffered MACE had a 0 calcium score; all had hypertension. CONCLUSIONS In low-risk patients with stable cardiovascular symptoms, CTCA provides important additive prognostic information over CACS, and CACS (including CACS>400) underestimated cardiovascular risk in patients with hypertension. This may relate to the increased prevalence of non-calcified plaque in these individuals.
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Affiliation(s)
- Edd Maclean
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Joban Sehmi
- Department of Cardiology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Gajen Kanaganayagam
- Imperial College London, International Centre for Circulatory Health, London, UK
| | - Edward David Nicol
- Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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Mathai S, Sehmi J, Auger D, L" Heureux C, Keenan NG. Role of T1 mapping in identification of convalescent Takotsubo cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Takotsubo cardiomyopathy remains an elusive entity to diagnose, especially with increasing time following the initial clinical event. Patients are often referred for cardiac MR, but when performed on a convalescent patient, the conventional CMR exam can be normal. However CMR elevated native T1 values on mapping may persist, aiding diagnosis.
Purpose
We sought to review a series of confirmed Takotsubo cases to evaluate which CMR features were most helpful in making a diagnosis.
Methods
We reviewed 2 years of CMR exams in our institution and identified 14 patients with a confirmed diagnosis of Takotsubo cardiomyopathy after a read of all clinical data by two consultant cardiologists. All of the 14 patients had a troponin positive cardiac event, unobstructed coronary arteries on invasive angiography and echocardiographic evidence of apical hypo/akinesia (or basal, in the non-apical variants) at the time of presentation. All CMR exams were performed at 1.5T. All included functional assessment, T1 mapping and late gadolinium enhancement(LGE). Some exams also included T2 mapping and STIR.
Results
All patients were female. The time interval between presentation and CMR exam varied from 24 hours to 2 years. 2 of the scans showed evidence of non-apical Takotsubo cardiomyopathy. At the time of CMR, only 7 patients(50%) had a residual regional wall motion abnormality, but 13 patients(93%) had a region of elevated native T1 (>1 myocardial segment). High signal was identified on STIR in 6(43%) and elevated native T2 in 10(71%). Of interest, we identified small areas of patchy LGE in 2 patients(14%).
Conclusion
Increased native T1 signal may be the only residual cardiac MRI marker of previous Takotsubo cardiomyopathy, persisting for months after the initial cardiac event, even after resolution of regional wall motion abnormalities and recovery of the left ventricular function. T1 mapping should be performed in CMR exams for Takotsubo cardiomyopathy to improve diagnostic yield.
Abstract Figure. CMR in convalescent Takotsubo
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Affiliation(s)
- S Mathai
- Watford General Hospital, Watford, United Kingdom of Great Britain & Northern Ireland
| | - J Sehmi
- Watford General Hospital, Watford, United Kingdom of Great Britain & Northern Ireland
| | - D Auger
- Watford General Hospital, Watford, United Kingdom of Great Britain & Northern Ireland
| | - C L" Heureux
- Watford General Hospital, Watford, United Kingdom of Great Britain & Northern Ireland
| | - NG Keenan
- Watford General Hospital, Watford, United Kingdom of Great Britain & Northern Ireland
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11
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Nielles-Vallespin S, Ferreira P, Scott A, Rajakulasingam R, Sehmi J, Gorodezky M, Kellman P, Xue H, Pennell D, Firmin D, Arai A, De Silva R. Diffusion tensor cardiovascular magnetic resonance predicts adverse remodelling after myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Changes in myocardial microstructure that underlie post-myocardial infarction (MI) left ventricular (LV) remodelling may contribute to progressive deterioration in cardiac function and increased risk of adverse clinical events. Diffusion Tensor Cardiovascular Magnetic Resonance (DT-CMR) derived parameters provide in vivo measures of helix angle (HA) and sheetlet angle (SA), which allow non-invasive characterization of microstructural dynamics associated with cardiac contraction.
Purpose
To evaluate the relationship between DT-CMR metrics of myocardial microstructure with the development of adverse LV remodelling and to determine the relationship between DT-CMR and strain post- MI.
Methods
We performed a longitudinal pre-clinical CMR study whereby DT-CMR, cine imaging and strain were acquired pre-MI and 3 days and 16 weeks post- MI in a pig model. HA (E1A), SA (E2A), and sheetlet angle mobility (ΔE2A = E2Asystole– E2Adiastole), as well as circumferential (Ecc) and radial (Err) strain were calculated at each timepoint and related to change in left ventricular end-diastolic volume (ΔLVEDV) and change in left ventricular end-systolic volume (ΔLVESV) between 3 days post-MI and 16 weeks post-MI. The translational value of this preclinical study was further assessed in six patients with chronic MI.
Results
ΔE2A over the whole LV (global ΔE2A) at 3 days post-MI correlated significantly with ΔLVEDV (R2=0.89, p=0.0013, Fig.1A;) and ΔLVESV (R2=0.81, p=0.0055, Fig.1B). Global Ecc at 3 days post-MI also correlated with both ΔLVEDV (R2=0.75, p=0.012, Fig.1C) and ΔLVESV (R2=0.71, p=0.018, Fig.1D). Global Err at 3 days post-MI did not show significant correlation with either ΔLVEDV (R2=0.32, p=0.19, Fig.1E) or ΔLVESV (R2=0.35, p=0.17, Fig.1F). Global ΔE2A correlated strongly with global Ecc 3 days post-MI (R2=0.9, p=0.00099, Fig.1G) but less strongly with global Err 3 days post-MI (R2=0.57, p=0.049, Fig.1H). Global ΔE2A at the chronic stage correlated significantly with ejection Fraction (EF), in both clinical (R2=0.87, p=0.007) and preclinical data (R2=0.87, p=0.0024). Global ΔE2A correlated well with LVEDV (clinical: R2=0.72, p=0.033; preclinical: R2=0.8, p=0.0066) and LVESV (clinical: R2=0.78, p=0.020; preclinical: R2=0.89, p=0.0013). In vivo E1A maps at 16 weeks post-MI and ex vivo DT-CMR demonstrated reduced right-handed helix angles in the endocardium of the infarct region.
Conclusion
ΔE2A measured at 3 day post-reperfused MI is strongly correlated with the development of increased end-systolic and end-diastolic volumes, and may therefore serve as a novel CMR early predictor of adverse LV remodelling after reperfused MI. Strong correlations between ΔE2A, LV volumes and EF in a small cohort of stable patients with remodelled hearts after chronic MI confirm the feasibility of performing these measurements in patients and the plausibility of further evaluation of ΔE2A as a predictor of adverse remodelling after reperfused MI.
Sheetlet mobility predicts volume change
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Institutes of Health by the Division of Intramural Research (NHLBI, NIH, DHHS); British Heart Foundation
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Affiliation(s)
| | | | - A Scott
- Imperial College London, London, United Kingdom
| | | | - J Sehmi
- Imperial College London, London, United Kingdom
| | - M Gorodezky
- Imperial College London, London, United Kingdom
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - D.J Pennell
- Imperial College London, London, United Kingdom
| | - D.N Firmin
- Imperial College London, London, United Kingdom
| | - A.E Arai
- Imperial College London, London, United Kingdom
| | - R De Silva
- Imperial College London, London, United Kingdom
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Rajkumar C, Shun-Shin M, Seligman H, Ahmad Y, Warisawa T, Cook C, Howard J, Amarin L, Nowbar A, Foley M, Assomull R, Keenan N, Sehmi J, Keeble T, Davies J, Tang K, Gerber R, Cole G, O'Kane P, Sharp A, Khamis R, Kanaganayagam G, Petraco R, Ruparelia N, Malik I, Nijjer S, Sen S, Francis D, Al-Lamee R. TCT CONNECT-385 Placebo-Controlled Efficacy of Percutaneous Coronary Intervention for Focal and Diffuse Patterns of Stable Coronary Artery Disease: A Secondary Analysis From ORBITA. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.407] [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: 11/15/2022]
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13
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Naderi H, Keenan N, Sehmi J. A 53-year-old man presenting with palpitations. Heart 2020; 106:1079-1114. [DOI: 10.1136/heartjnl-2019-316392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Qayyum S, Sehmi J, Auger D, Griguer A, Jain P, Khan M, Keenan N. 1641 Bicuspid pulmonary valve - an unusual cause of dilated pulmonary artery. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Dilated pulmonary artery is a common finding with a variety of possible aetiologies. We present a case of unexplained dilated pulmonary artery that was associated with bicuspid pulmonary valve identified by CMR.
Case Presentation
A 67-year-old female underwent mitral valve repair for severe mitral regurgitation. She had presented with breathlessness, and had severe mitral regurgitation due to a myxomatous valve with bileaflet prolapse, confirmed with TOE. Echo showed: normal LV dimensions, LVEF 66%. RV size and systolic function normal. Coronary angiography was normal and pulmonary hypertension was not present on right heart catheterization.
At postoperative follow up she was well and asymptomatic, with echo showing good LV systolic function, intact mitral valve repair, and normal systolic pulmonary artery pressures (36mmHg). New T wave inversion was identified across the precordial leads so a CMR was performed.
CMR showed normal LV volumes and function with no wall motion abnormality or LVH. There was no fibrosis or infarction in the late phase after Gadolinium contrast. The RV was dilated (73mm diameter at base) with normal systolic function. The main pulmonary artery was dilated at 42mm. Flow mapping showed no evidence of shunt (Qp:Qs = 1:1) and the atrial septum was intact. Pulmonary valve function was normal but the valve was bicuspid in morphology.
Discussion
Bicuspid pulmonary valve is a rare finding. In our case this was identified by CMR and was associated with a dilated pulmonary artery.
Bicuspid pulmonary valve is most commonly identified in the context of pulmonary valve stenosis. Isolated pulmonary valve stenosis is a rare finding; it is most often associated with other congenital defects like Fallot. Pulmonary stenosis has been associated with pulmonary artery aneurysm, attributed to hemodynamic changes caused by the stenotic valve. However as with bicuspid aortic valve it is recognized that the "post stenotic dilation" is part of the pathology of bicuspid valve and does not need the changed haemodynamics of a stenotic valve.
During embryogenesis neural crest cells are necessary for the normal development of the semilunar valves, the septation of the outflow tract into the aorta and pulmonary artery, and the remodeling of the aortic arch. Any defect in this migration can cause abnormalities or aneurysm of the aorta or pulmonary artery together with semilunar valve defects. A study of 3,861 donor hearts dissected at the European Homograft Bank revealed only four cases (0.1%) of bicuspid pulmonary valves.
Bicuspid pulmonary valve with normal function can be difficult to identify at echocardiography. It can be well visualized by CMR and this can be combined with an assessment of the pulmonary arteries. It should be remembered as a rarer cause of dilated pulmonary artery when other causes have been excluded.
Figure
A. Dilated MPA. B. Dilated RV. C. and D. Bicuspid pulmonary valve.
Abstract 1641 Figure. Dilated MPA. Bicuspid pulmonary valve
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Affiliation(s)
- S Qayyum
- West Hertfordshire NHS Trust, Greater London, United Kingdom of Great Britain & Northern Ireland
| | - J Sehmi
- West Hertfordshire NHS Trust, Greater London, United Kingdom of Great Britain & Northern Ireland
| | - D Auger
- West Hertfordshire NHS Trust, Greater London, United Kingdom of Great Britain & Northern Ireland
| | - A Griguer
- West Hertfordshire NHS Trust, Greater London, United Kingdom of Great Britain & Northern Ireland
| | - P Jain
- West Hertfordshire NHS Trust, Greater London, United Kingdom of Great Britain & Northern Ireland
| | - M Khan
- West Hertfordshire NHS Trust, Greater London, United Kingdom of Great Britain & Northern Ireland
| | - N Keenan
- West Hertfordshire NHS Trust, Greater London, United Kingdom of Great Britain & Northern Ireland
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15
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Al-Lamee RK, Shun-Shin MJ, Howard JP, Nowbar AN, Rajkumar C, Thompson D, Sen S, Nijjer S, Petraco R, Davies J, Keeble T, Tang K, Malik I, Bual N, Cook C, Ahmad Y, Seligman H, Sharp AS, Gerber R, Talwar S, Assomull R, Cole G, Keenan NG, Kanaganayagam G, Sehmi J, Wensel R, Harrell FE, Mayet J, Thom S, Davies JE, Francis DP. Dobutamine Stress Echocardiography Ischemia as a Predictor of the Placebo-Controlled Efficacy of Percutaneous Coronary Intervention in Stable Coronary Artery Disease: The Stress Echocardiography-Stratified Analysis of ORBITA. Circulation 2019; 140:1971-1980. [PMID: 31707827 PMCID: PMC6903430 DOI: 10.1161/circulationaha.119.042918] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Dobutamine stress echocardiography is widely used to test for ischemia in patients with stable coronary artery disease. In this analysis, we studied the ability of the prerandomization stress echocardiography score to predict the placebo-controlled efficacy of percutaneous coronary intervention (PCI) within the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina). METHODS One hundred eighty-three patients underwent dobutamine stress echocardiography before randomization. The stress echocardiography score is broadly the number of segments abnormal at peak stress, with akinetic segments counting double and dyskinetic segments counting triple. The ability of prerandomization stress echocardiography to predict the placebo-controlled effect of PCI on response variables was tested by using regression modeling. RESULTS At prerandomization, the stress echocardiography score was 1.56±1.77 in the PCI arm (n=98) and 1.61±1.73 in the placebo arm (n=85). There was a detectable interaction between prerandomization stress echocardiography score and the effect of PCI on angina frequency score with a larger placebo-controlled effect in patients with the highest stress echocardiography score (Pinteraction=0.031). With our sample size, we were unable to detect an interaction between stress echocardiography score and any other patient-reported response variables: freedom from angina (Pinteraction=0.116), physical limitation (Pinteraction=0.461), quality of life (Pinteraction=0.689), EuroQOL 5 quality-of-life score (Pinteraction=0.789), or between stress echocardiography score and physician-assessed Canadian Cardiovascular Society angina class (Pinteraction=0.693), and treadmill exercise time (Pinteraction=0.426). CONCLUSIONS The degree of ischemia assessed by dobutamine stress echocardiography predicts the placebo-controlled efficacy of PCI on patient-reported angina frequency. The greater the downstream stress echocardiography abnormality caused by a stenosis, the greater the reduction in symptoms from PCI. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02062593.
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Affiliation(s)
- Rasha K. Al-Lamee
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Matthew J. Shun-Shin
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Alexandra N. Nowbar
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - David Thompson
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - John Davies
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, UK (J.D., T.K.)
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, UK (J.D., T.K.)
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.)
| | - Iqbal Malik
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Christopher Cook
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Robert Gerber
- East Sussex Healthcare NHS Trust, Hastings, UK (R.G.)
| | - Suneel Talwar
- Royal Bournemouth and Christchurch NHS Trust, UK (S. Talwar)
| | - Ravi Assomull
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Graham Cole
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Niall G. Keenan
- West Hertfordshire Hospitals NHS Trust, Watford, UK (N.G.K., J.S.)
| | - Gajen Kanaganayagam
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Joban Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, UK (N.G.K., J.S.)
| | - Roland Wensel
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Frank E. Harrell
- Vanderbilt University School of Medicine, Department of Biostatistics, Nashville, TN (F.E.H.)
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Simon Thom
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Justin E. Davies
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Darrel P. Francis
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
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16
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MacLean E, Sehmi J, Kanaganayagam GS, Ngee T, Nicol E. P2243CTCA alone demonstrates superior diagnostic accuracy, prognostic utility and is less expensive than CTCA combined with subsequent multi-modality functional imaging in patients with ischaemic symptoms. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The evaluation of suspected ischaemic symptoms incorporates multi-modality anatomical and functional imaging tests. The 2016 update to the UK's NICE guidelines recommends CT coronary angiogram (CTCA) first line in patients without known coronary artery disease. Additive multi-modality functional imaging may provide synergistic diagnostic and prognostic information.
Purpose
To investigate the diagnostic accuracy, prognostic utility and cost of CTCA combined with subsequent multi-modality functional testing versus (vs) CTCA alone.
Methods
772 consecutive patients were referred to a single UK tertiary centre with symptoms suggestive of ischaemia. 657 individuals (“CTCA group”) underwent CTCA alone, and 115 individuals (“Combined group”) underwent CTCA and then either perfusion cardiac MRI (n=25), stress echocardiogram (n=16), or myocardial perfusion scintigraphy (n=74). Patients underwent invasive angiography (n=79) +/− revascularisation at the discretion of the referring clinician. All readers and operators were aware of previous imaging findings. Revascularised patients (n=52) were excluded from long term follow-up. The remaining patients were followed-up for a mean of 38.1±17.4 months and the incidence of major adverse cardiovascular events (MACE) recorded. Costs were derived from the NICE guidelines.
Results
Baseline characteristics were similar between groups. The Combined group underwent significantly more invasive angiograms than the CTCA group (29.6% vs 6.8%, p=0.0001) with no significant difference in the rate of revascularisation (73% vs 67%, p=0.72). Mean time from CTCA to angiogram was significantly longer in the Combined group (81.2 vs 38.1 days, p=0.0001). Both sensitivity and specificity were lower in the Combined group than in the CTCA group (sensitivity: 70% vs 93%, specificity: 75% vs 100%). The rate of long term MACE was significantly higher in the Combined group (8.7% vs 2.6%, p=0.0026). Multivariate analysis of CTCA and functional imaging findings found that CTCA-derived four vessel aggregate stenosis score (0–12) was the strongest predictor of MACE for the whole cohort (OR 4.4, p<0.0001), and also for those with negative functional tests (OR 3.9, p<0.0001). Per patient, a combined strategy was more expensive than CTCA alone (£1551 vs £368, p=0.0001).
CTCA and functional data vs outcomes
Conclusions
Combining multi-modality functional testing with CTCA increased costs but did not improve diagnostic accuracy or long term outcomes. Further reductions in both MACE and unnecessary invasive angiography are desirable; CT-derived functional data such as FFRCT may be implicated.
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Affiliation(s)
- E MacLean
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - J Sehmi
- Royal Brompton Hospital, Cardiovascular Imaging, London, United Kingdom
| | - G S Kanaganayagam
- Royal Brompton Hospital, Cardiovascular Imaging, London, United Kingdom
| | - T Ngee
- Royal Brompton Hospital, Cardiovascular Imaging, London, United Kingdom
| | - E Nicol
- Royal Brompton Hospital, Cardiovascular Imaging, London, United Kingdom
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17
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Al-Lamee R, Howard JP, Shun-Shin MJ, Thompson D, Dehbi HM, Sen S, Nijjer S, Petraco R, Davies J, Keeble T, Tang K, Malik IS, Cook C, Ahmad Y, Sharp ASP, Gerber R, Baker C, Kaprielian R, Talwar S, Assomull R, Cole G, Keenan NG, Kanaganayagam G, Sehmi J, Wensel R, Harrell FE, Mayet J, Thom SA, Davies JE, Francis DP. Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Single-Vessel Coronary Artery Disease. Circulation 2019; 138:1780-1792. [PMID: 29789302 DOI: 10.1161/circulationaha.118.033801] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [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: 01/09/2023]
Abstract
BACKGROUND There are no data on how fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are associated with the placebo-controlled efficacy of percutaneous coronary intervention (PCI) in stable single-vessel coronary artery disease. METHODS We report the association between prerandomization invasive physiology within ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina), a placebo-controlled trial of patients who have stable angina with angiographically severe single-vessel coronary disease clinically eligible for PCI. Patients underwent prerandomization research FFR and iFR assessment. The operator was blinded to these values. Assessment of response variables, treadmill exercise time, stress echocardiography score, symptom frequency, and angina severity were performed at prerandomization and blinded follow-up. Effects were calculated by analysis of covariance. The ability of FFR and iFR to predict placebo-controlled changes in response variables was tested by using regression modeling. RESULTS Invasive physiology data were available in 196 patients (103 PCI and 93 placebo). At prerandomization, the majority had Canadian Cardiovascular Society class II or III symptoms (150/196, 76.5%). Mean FFR and iFR were 0.69±0.16 and 0.76±0.22, respectively; 97% had ≥1 positive ischemia tests. The estimated effect of PCI on between-arm prerandomization-adjusted total exercise time was 20.7 s (95% confidence interval [CI], -4.0 to 45.5; P=0.100) with no interaction of FFR ( Pinteraction=0.318) or iFR ( Pinteraction=0.523). PCI improved stress echocardiography score more than placebo (1.07 segment units; 95% CI, 0.70-1.44; P<0.00001). The placebo-controlled effect of PCI on stress echocardiography score increased progressively with decreasing FFR ( Pinteraction<0.00001) and decreasing iFR ( Pinteraction<0.00001). PCI did not improve angina frequency score significantly more than placebo (odds ratio, 1.64; 95% CI, 0.96-2.80; P=0.072) with no detectable evidence of interaction with FFR ( Pinteraction=0.849) or iFR ( Pinteraction=0.783). However, PCI resulted in more patient-reported freedom from angina than placebo (49.5% versus 31.5%; odds ratio, 2.47; 95% CI, 1.30-4.72; P=0.006) but neither FFR ( Pinteraction=0.693) nor iFR ( Pinteraction=0.761) modified this effect. CONCLUSIONS In patients with stable angina and severe single-vessel disease, the blinded effect of PCI was more clearly seen by stress echocardiography score and freedom from angina than change in treadmill exercise time. Moreover, the lower the FFR or iFR, the greater the magnitude of stress echocardiographic improvement caused by PCI. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02062593.
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Affiliation(s)
- Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - David Thompson
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.)
| | - Hakim-Moulay Dehbi
- Cancer Research UK and UCL Cancer Trials Centre, University College London (H.-M.D.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - John Davies
- Essex Cardiothoracic Centre, Basildon, United Kingdom (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, United Kingdom (J.D., T.K.)
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, United Kingdom (J.D., T.K.)
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom (J.D., T.K., K.T.)
| | - Iqbal S Malik
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Christopher Cook
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Robert Gerber
- East Sussex Healthcare NHS Trust, Hastings, United Kingdom (R.G.)
| | - Christopher Baker
- Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Suneel Talwar
- Royal Bournemouth and Christchurch NHS Trust, United Kingdom (S.T.)
| | | | - Graham Cole
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Niall G Keenan
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom (N.G.K.)
| | - Gajen Kanaganayagam
- Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Roland Wensel
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.)
| | - Frank E Harrell
- Vanderbilt University School of Medicine, Department of Biostatistics, Nashville, TN (F.E.H.)
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Simon A Thom
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.)
| | - Justin E Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
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18
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Corden B, Jarman J, Whiffin N, Tayal U, Buchan R, Sehmi J, Harper A, Midwinter W, Lascelles K, Markides V, Mason M, Baksi J, Pantazis A, Pennell DJ, Barton PJ, Prasad SK, Wong T, Cook SA, Ware JS. Association of Titin-Truncating Genetic Variants With Life-threatening Cardiac Arrhythmias in Patients With Dilated Cardiomyopathy and Implanted Defibrillators. JAMA Netw Open 2019; 2:e196520. [PMID: 31251381 PMCID: PMC6604081 DOI: 10.1001/jamanetworkopen.2019.6520] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/13/2019] [Indexed: 12/24/2022] Open
Abstract
Importance There is a need for better arrhythmic risk stratification in nonischemic dilated cardiomyopathy (DCM). Titin-truncating variants (TTNtvs) in the TTN gene are the most common genetic cause of DCM and may be associated with higher risk of arrhythmias in patients with DCM. Objective To determine if TTNtv status is associated with the development of life-threatening ventricular arrhythmia and new persistent atrial fibrillation in patients with DCM and implanted cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) devices. Design, Setting, and Participants This retrospective, multicenter cohort study recruited 148 patients with or without TTNtvs who had nonischemic DCM and ICD or CRT-D devices from secondary and tertiary cardiology clinics in the United Kingdom from February 1, 2011, to June 30, 2016, with a median (interquartile range) follow-up of 4.2 (2.1-6.5) years. Exclusion criteria were ischemic cardiomyopathy, primary valve disease, congenital heart disease, or a known or likely pathogenic variant in the lamin A/C gene. Analyses were performed February 1, 2017, to May 31, 2017. Main Outcome and Measures The primary outcome was time to first device-treated ventricular tachycardia of more than 200 beats/min or first device-treated ventricular fibrillation. Secondary outcome measures included time to first development of persistent atrial fibrillation. Results Of 148 patients recruited, 117 adult patients with nonischemic DCM and an ICD or CRT-D device (mean [SD] age, 56.9 [12.5] years; 76 [65.0%] men; 106 patients [90.6%] with primary prevention indications) were included. Having a TTNtv was associated with a higher risk of receiving appropriate ICD therapy (shock or antitachycardia pacing) for ventricular tachycardia or fibrillation (hazard ratio [HR], 4.9; 95% CI, 2.2-10.7; P < .001). This association was independent of all covariates, including midwall fibrosis measured by late gadolinium enhancement on cardiac magnetic resonance images (adjusted HR, 8.3; 95% CI, 1.8-37.6; P = .006). Having a TTNtv was also associated with the risk of receiving a shock (HR, 3.6; 95% CI, 1.1-11.6; P = .03). Individuals with a TTNtv and fibrosis had a greater rate of receiving appropriate device therapy than those with neither (HR, 16.6; 95% CI, 3.5-79.3; P < .001). Having a TTNtv was also a risk factor for developing new persistent atrial fibrillation (HR, 3.9; 95% CI, 1.3-12.0; P = .01). Conclusions and Relevance Having a TTNtv was an important risk factor for clinically significant arrhythmia in patients with DCM and ICD or CRT-D devices. Having a TTNtv, especially in combination with midwall fibrosis confirmed with cardiovascular magnetic resonance imaging, may provide a risk stratification approach for evaluating the need for ICD therapy in patients with DCM. This hypothesis should be tested in larger studies.
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Affiliation(s)
- Ben Corden
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
- Medical Research Council, London Institute for Medical Sciences, Imperial College London, London, United Kingdom
- National Heart Centre Singapore, Singapore
| | - Julian Jarman
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Nicola Whiffin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
- Medical Research Council, London Institute for Medical Sciences, Imperial College London, London, United Kingdom
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Rachel Buchan
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Joban Sehmi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Andrew Harper
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - William Midwinter
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Karen Lascelles
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Vias Markides
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mark Mason
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - John Baksi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Antonis Pantazis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Dudley J. Pennell
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Paul J. Barton
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Sanjay K. Prasad
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Tom Wong
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Stuart A. Cook
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Medical Research Council, London Institute for Medical Sciences, Imperial College London, London, United Kingdom
- National Heart Centre Singapore, Singapore
| | - James S. Ware
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
- Medical Research Council, London Institute for Medical Sciences, Imperial College London, London, United Kingdom
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19
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Naderi H, L"heureux C, Keenan N, Moore P, Sehmi J. P111Double chambered left ventricle. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez110.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Naderi
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - C L"heureux
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - N Keenan
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - P Moore
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J Sehmi
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
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20
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Zillikens MC, Demissie S, Hsu YH, Yerges-Armstrong LM, Chou WC, Stolk L, Livshits G, Broer L, Johnson T, Koller DL, Kutalik Z, Luan J, Malkin I, Ried JS, Smith AV, Thorleifsson G, Vandenput L, Hua Zhao J, Zhang W, Aghdassi A, Åkesson K, Amin N, Baier LJ, Barroso I, Bennett DA, Bertram L, Biffar R, Bochud M, Boehnke M, Borecki IB, Buchman AS, Byberg L, Campbell H, Campos Obanda N, Cauley JA, Cawthon PM, Cederberg H, Chen Z, Cho NH, Jin Choi H, Claussnitzer M, Collins F, Cummings SR, De Jager PL, Demuth I, Dhonukshe-Rutten RAM, Diatchenko L, Eiriksdottir G, Enneman AW, Erdos M, Eriksson JG, Eriksson J, Estrada K, Evans DS, Feitosa MF, Fu M, Garcia M, Gieger C, Girke T, Glazer NL, Grallert H, Grewal J, Han BG, Hanson RL, Hayward C, Hofman A, Hoffman EP, Homuth G, Hsueh WC, Hubal MJ, Hubbard A, Huffman KM, Husted LB, Illig T, Ingelsson E, Ittermann T, Jansson JO, Jordan JM, Jula A, Karlsson M, Khaw KT, Kilpeläinen TO, Klopp N, Kloth JSL, Koistinen HA, Kraus WE, Kritchevsky S, Kuulasmaa T, Kuusisto J, Laakso M, Lahti J, Lang T, Langdahl BL, Launer LJ, Lee JY, Lerch MM, Lewis JR, Lind L, Lindgren C, Liu Y, Liu T, Liu Y, Ljunggren Ö, Lorentzon M, Luben RN, Maixner W, McGuigan FE, Medina-Gomez C, Meitinger T, Melhus H, Mellström D, Melov S, Michaëlsson K, Mitchell BD, Morris AP, Mosekilde L, Newman A, Nielson CM, O'Connell JR, Oostra BA, Orwoll ES, Palotie A, Parker SCJ, Peacock M, Perola M, Peters A, Polasek O, Prince RL, Räikkönen K, Ralston SH, Ripatti S, Robbins JA, Rotter JI, Rudan I, Salomaa V, Satterfield S, Schadt EE, Schipf S, Scott L, Sehmi J, Shen J, Soo Shin C, Sigurdsson G, Smith S, Soranzo N, Stančáková A, Steinhagen-Thiessen E, Streeten EA, Styrkarsdottir U, Swart KMA, Tan ST, Tarnopolsky MA, Thompson P, Thomson CA, Thorsteinsdottir U, Tikkanen E, Tranah GJ, Tuomilehto J, van Schoor NM, Verma A, Vollenweider P, Völzke H, Wactawski-Wende J, Walker M, Weedon MN, Welch R, Wichmann HE, Widen E, Williams FMK, Wilson JF, Wright NC, Xie W, Yu L, Zhou Y, Chambers JC, Döring A, van Duijn CM, Econs MJ, Gudnason V, Kooner JS, Psaty BM, Spector TD, Stefansson K, Rivadeneira F, Uitterlinden AG, Wareham NJ, Ossowski V, Waterworth D, Loos RJF, Karasik D, Harris TB, Ohlsson C, Kiel DP. Erratum: Large meta-analysis of genome-wide association studies identifies five loci for lean body mass. Nat Commun 2017; 8:1414. [PMID: 29116125 PMCID: PMC5676783 DOI: 10.1038/s41467-017-01008-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands
| | - Serkalem Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Yi-Hsiang Hsu
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, 02115, USA
| | - Laura M Yerges-Armstrong
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Wen-Chi Chou
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Broad Institute, Cambridge, MA, 02142, USA
| | - Lisette Stolk
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands
| | - Gregory Livshits
- Sackler Faculty of Medicine, Department of Anatomy and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel.,Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - Linda Broer
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Toby Johnson
- Department of Medical Genetics, University of Lausanne, Lausanne, 1011, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland.,Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Daniel L Koller
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Zoltán Kutalik
- Department of Medical Genetics, University of Lausanne, Lausanne, 1011, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland.,Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Ida Malkin
- Sackler Faculty of Medicine, Department of Anatomy and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Janina S Ried
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Albert V Smith
- Icelandic Heart Association, Kopavogur, 201, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | | | - Liesbeth Vandenput
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Weihua Zhang
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College, London, SW7 2AZ, UK.,Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK
| | - Ali Aghdassi
- Department of Medicine A, University of Greifswald, Greifswald, 17489, Germany
| | - Kristina Åkesson
- Department of Clinical Sciences, Lund University, Malmö, 22362, Sweden.,Department of Orthopedics, Skåne University Hospital, Malmö, S-205 02, Sweden
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Leslie J Baier
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Inês Barroso
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK.,NIHR Cambridge Biomedical Research Centre, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 OQQ, UK.,Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, CB2 OQQ, UK
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics, Institutes of Neurogenetics and Experimental & Integrative Genomics, University of Lübeck, Lübeck, 23562, Germany.,School of Public Health, Faculty of Medicine, Imperial College London, London, W6 8RP, UK
| | - Rainer Biffar
- Centre of Oral Health, Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University of Greifswald, Greifswald, 17489, Germany
| | - Murielle Bochud
- Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ingrid B Borecki
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St Louis, MO, 63110, USA.,Division of Biostatistics, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | | | - Jane A Cauley
- Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Henna Cederberg
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85714, USA
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Youngtong-Gu, Suwon, 16499, Korea
| | - Hyung Jin Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju Si, Korea
| | - Melina Claussnitzer
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Broad Institute, Cambridge, MA, 02142, USA.,Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, 02139, USA.,Institute of Human Genetics, MRI, Technische Universität München, Munich, 81675, Germany.,Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Francis Collins
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Philip L De Jager
- Harvard Medical School, Boston, MA, 02115, USA.,Program in Translational NeuroPsychiatric Genomics, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Ilja Demuth
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 13353, Germany.,Institute of Medical and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, 13353, Germany
| | | | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, H3A 0G1, Canada.,Regional Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Anke W Enneman
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Mike Erdos
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, 00014, Finland.,Unit of General Practice, Helsinki University Central Hospital, Helsinki, 00014, Finland.,Folkhalsan Research Centre, Helsinki, 00250, Finland.,Vasa Central Hospital, Vasa, 65130, Finland.,National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Joel Eriksson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Karol Estrada
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Daniel S Evans
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Mao Fu
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Melissa Garcia
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Christian Gieger
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Thomas Girke
- Institute for Integrative Genome Biology, University of California, Riverside, CA, 92521, USA.,Department of Botany and Plant Sciences, University of California, Riverside, CA, 92521, USA
| | - Nicole L Glazer
- Departments of Medicine and Epidemiology, Boston University School of Medicine and Public Health, Boston, MA, 02118, USA
| | - Harald Grallert
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Department of Botany and Plant Sciences, University of California, Riverside, CA, 92521, USA.,German Center for Diabetes Research (DZD), Neuherberg, Germany.,CCG Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, 85764, Germany.,CCG Nutrigenomics and Type 2 Diabetes. Helmholtz Zentrum München, Neuherberg, 85764, Germany
| | - Jagvir Grewal
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Bok-Ghee Han
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Chungcheongbuk-do, 28159, Korea
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Caroline Hayward
- MRC Human Genetics Unit, IGMM, University of Edinburgh, Edinburgh, Scotland, EH4 2XU, UK
| | - Albert Hofman
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Eric P Hoffman
- Department of Pharmaceutical Sciences, SUNY Binghamton, Binghamton, NY, 13902, USA
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, 17487, Germany
| | - Wen-Chi Hsueh
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Monica J Hubal
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC, 20052, USA.,Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC, 20052, USA
| | - Alan Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Kim M Huffman
- Division of Rheumatology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Lise B Husted
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Thomas Illig
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Department of Human Genetics, Hannover Medical School, Hannover, 30625, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, 30625, Germany
| | - Erik Ingelsson
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Till Ittermann
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - John-Olov Jansson
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 405 30, Sweden
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27517, USA
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Magnus Karlsson
- Department of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital SUS, Malmö, 22362, Sweden
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Tuomas O Kilpeläinen
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, 2100, Denmark.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Norman Klopp
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, 30625, Germany
| | | | - Heikki A Koistinen
- Department of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland.,Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland.,Department of Health, National Institute for Health and Welfare, Helsinki, 00271, Finland.,Minerva Foundation Institute for Medical Research, Helsinki, 00290, Finland
| | - William E Kraus
- Division of Cardiology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Teemu Kuulasmaa
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Johanna Kuusisto
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, FI00014, Finland
| | - Thomas Lang
- University of California San Francisco, San Francisco, CA, 94143, USA
| | - Bente L Langdahl
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Jong-Young Lee
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Chungcheongbuk-do, 28159, Korea
| | - Markus M Lerch
- Department of Medicine A, University of Greifswald, Greifswald, 17489, Germany
| | - Joshua R Lewis
- School of Medicine and Pharmacology, University of Western Australia, Perth, 6009, Australia.,Centre for Kidney Research, School of Public Health, University of Sydney, Sydney, 2006, Australia
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Cecilia Lindgren
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, OX3 7BN, UK
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, 27517, USA
| | - Tian Liu
- Max Planck Institute for Molecular Genetics, Berlin, 14195, Germany.,Max Planck Institute for Human Development, Berlin, 14195, Germany
| | - Youfang Liu
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27517, USA
| | - Östen Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Mattias Lorentzon
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - William Maixner
- Regional Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Fiona E McGuigan
- Department of Clinical Sciences, Lund University, Malmö, 22362, Sweden
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Thomas Meitinger
- Institute of Human Genetics, MRI, Technische Universität München, Munich, 81675, Germany.,Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Dan Mellström
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Simon Melov
- Buck Institute for Research on Aging, Novato, CA, 94945, USA.,Leonard Davis School of Gerontology, University of Southern California, LA, CA, 90089, USA
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Braxton D Mitchell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, 21201, USA
| | - Andrew P Morris
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, OX3 7BN, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - Leif Mosekilde
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Anne Newman
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | | | - Jeffrey R O'Connell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ben A Oostra
- Department of Clinical Genetics, Erasmus MC, Rotterdam, 300 CA, The Netherlands.,Centre for Medical Systems Biology and Netherlands Consortium on Healthy Aging, Leiden, RC2300, The Netherlands
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Department of Medical Genetics, University of Helsinki and University Central Hospital, Helsinki, FI00014, Finland
| | - Stephen C J Parker
- Human Genetics and Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Munro Peacock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, 00271, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Diabetes and Obesity Research Program, University of Helsinki, Helsinki, FI00014, Finland.,Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Ozren Polasek
- Faculty of Medicine, Department of Public Health, University of Split, Split, 21000, Croatia
| | - Richard L Prince
- School of Medicine and Pharmacology, University of Western Australia, Perth, 6009, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gardiner Hospital, Perth, 6009, Australia
| | - Katri Räikkönen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, FI00014, Finland
| | - Stuart H Ralston
- Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, Scotland, EH4 2XU, UK
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Hjelt Institute, University of Helsinki, Helsinki, Finland.,Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK
| | - John A Robbins
- Department of Medicine, University of California at Davis, Sacramento, CA, 95817, USA
| | - Jerome I Rotter
- Institute for Translational Genomic and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor UCLA Medical Center, Torrance, CA, 90502, USA
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Eric E Schadt
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sabine Schipf
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - Laura Scott
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joban Sehmi
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Jian Shen
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Gunnar Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,Department of Endocrinology and Metabolism, Landspitali, The National University Hospital of Iceland, Reykjavik, 101, Iceland
| | - Shad Smith
- Center for Translational Pain Medicine, Department of Anesthiology, Duke University Medical Center, Durham, NC, 27110, USA
| | - Nicole Soranzo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK
| | - Alena Stančáková
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Elisabeth Steinhagen-Thiessen
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 13353, Germany
| | - Elizabeth A Streeten
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Geriatric Research and Education Clinical Center (GRECC) - Veterans Administration Medical Center, Baltimore, MD, 21201, USA
| | | | - Karin M A Swart
- Department of Epidemiology and Biostatistics, and the EMGO Institute, VU University Medical Center, Amsterdam, BT1081, The Netherlands
| | - Sian-Tsung Tan
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Mark A Tarnopolsky
- Department of Medicine, McMaster University Medical Center, Hamilton, ON, Canada, L8N 3Z5
| | - Patricia Thompson
- Department of Pathology, Stony Brook School of Medicine, Stony Brook, NY, 11794, USA
| | - Cynthia A Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85714, USA
| | - Unnur Thorsteinsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,deCODE Genetics, Reykjavik, 101, Iceland
| | - Emmi Tikkanen
- National Institute for Health and Welfare, Helsinki, 00271, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, Scotland, EH4 2XU, UK
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Jaakko Tuomilehto
- Vasa Central Hospital, Vasa, 65130, Finland.,Department of Neuroscience and Preventive Medicine, Danube-University Krems, Krems, 3500, Austria.,Diabetes Research Group, King Abdulaziz University, Jeddah, 12589, Saudi Arabia.,Dasman Diabetes Institute, Dasman, 15462, Kuwait
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, and the EMGO Institute, VU University Medical Center, Amsterdam, BT1081, The Netherlands
| | - Arjun Verma
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK
| | - Peter Vollenweider
- Department of Medicine and Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH-1011, Switzerland
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Ryan Welch
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - H-Erich Wichmann
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology, Ludwig-Maximilians-Universität, Munich, 81377, Germany.,Institute of Medical Statistics and Epidemiology, Technical University, Munich, 81675, Germany
| | - Elisabeth Widen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - James F Wilson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK.,MRC Human Genetics Unit, IGMM, University of Edinburgh, Edinburgh, Scotland, EH4 2XU, UK
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Weijia Xie
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Yanhua Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - John C Chambers
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College, London, SW7 2AZ, UK.,Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, SW3 6NP, UK.,Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Angela Döring
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands.,Centre for Medical Systems Biology and Netherlands Consortium on Healthy Aging, Leiden, RC2300, The Netherlands
| | - Michael J Econs
- Department of Medicine and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, 201, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | - Jaspal S Kooner
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK.,Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Bruce M Psaty
- Departments of Medicine, Epidemiology, and Health Services, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, 98101, USA.,Kaiser Permanente Washington Health Research Institute, Washington, Seattle, WA, 98101, USA
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - Kari Stefansson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,deCODE Genetics, Reykjavik, 101, Iceland
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Vicky Ossowski
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Dawn Waterworth
- Medical Genetics, GlaxoSmithKline, Philadelphia, PA, 19112, USA
| | - Ruth J F Loos
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK.,The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Institute of Child Health and Development, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,The Genetics of Obesity and Related Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - David Karasik
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, 1311502, Israel
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Claes Ohlsson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Douglas P Kiel
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA. .,Harvard Medical School, Boston, MA, 02115, USA. .,Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
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Zillikens MC, Demissie S, Hsu YH, Yerges-Armstrong LM, Chou WC, Stolk L, Livshits G, Broer L, Johnson T, Koller DL, Kutalik Z, Luan J, Malkin I, Ried JS, Smith AV, Thorleifsson G, Vandenput L, Hua Zhao J, Zhang W, Aghdassi A, Åkesson K, Amin N, Baier LJ, Barroso I, Bennett DA, Bertram L, Biffar R, Bochud M, Boehnke M, Borecki IB, Buchman AS, Byberg L, Campbell H, Campos Obanda N, Cauley JA, Cawthon PM, Cederberg H, Chen Z, Cho NH, Jin Choi H, Claussnitzer M, Collins F, Cummings SR, De Jager PL, Demuth I, Dhonukshe-Rutten RAM, Diatchenko L, Eiriksdottir G, Enneman AW, Erdos M, Eriksson JG, Eriksson J, Estrada K, Evans DS, Feitosa MF, Fu M, Garcia M, Gieger C, Girke T, Glazer NL, Grallert H, Grewal J, Han BG, Hanson RL, Hayward C, Hofman A, Hoffman EP, Homuth G, Hsueh WC, Hubal MJ, Hubbard A, Huffman KM, Husted LB, Illig T, Ingelsson E, Ittermann T, Jansson JO, Jordan JM, Jula A, Karlsson M, Khaw KT, Kilpeläinen TO, Klopp N, Kloth JSL, Koistinen HA, Kraus WE, Kritchevsky S, Kuulasmaa T, Kuusisto J, Laakso M, Lahti J, Lang T, Langdahl BL, Launer LJ, Lee JY, Lerch MM, Lewis JR, Lind L, Lindgren C, Liu Y, Liu T, Liu Y, Ljunggren Ö, Lorentzon M, Luben RN, Maixner W, McGuigan FE, Medina-Gomez C, Meitinger T, Melhus H, Mellström D, Melov S, Michaëlsson K, Mitchell BD, Morris AP, Mosekilde L, Newman A, Nielson CM, O'Connell JR, Oostra BA, Orwoll ES, Palotie A, Parker SCJ, Peacock M, Perola M, Peters A, Polasek O, Prince RL, Räikkönen K, Ralston SH, Ripatti S, Robbins JA, Rotter JI, Rudan I, Salomaa V, Satterfield S, Schadt EE, Schipf S, Scott L, Sehmi J, Shen J, Soo Shin C, Sigurdsson G, Smith S, Soranzo N, Stančáková A, Steinhagen-Thiessen E, Streeten EA, Styrkarsdottir U, Swart KMA, Tan ST, Tarnopolsky MA, Thompson P, Thomson CA, Thorsteinsdottir U, Tikkanen E, Tranah GJ, Tuomilehto J, van Schoor NM, Verma A, Vollenweider P, Völzke H, Wactawski-Wende J, Walker M, Weedon MN, Welch R, Wichmann HE, Widen E, Williams FMK, Wilson JF, Wright NC, Xie W, Yu L, Zhou Y, Chambers JC, Döring A, van Duijn CM, Econs MJ, Gudnason V, Kooner JS, Psaty BM, Spector TD, Stefansson K, Rivadeneira F, Uitterlinden AG, Wareham NJ, Ossowski V, Waterworth D, Loos RJF, Karasik D, Harris TB, Ohlsson C, Kiel DP. Large meta-analysis of genome-wide association studies identifies five loci for lean body mass. Nat Commun 2017; 8:80. [PMID: 28724990 PMCID: PMC5517526 DOI: 10.1038/s41467-017-00031-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 05/02/2017] [Indexed: 12/25/2022] Open
Abstract
Lean body mass, consisting mostly of skeletal muscle, is important for healthy aging. We performed a genome-wide association study for whole body (20 cohorts of European ancestry with n = 38,292) and appendicular (arms and legs) lean body mass (n = 28,330) measured using dual energy X-ray absorptiometry or bioelectrical impedance analysis, adjusted for sex, age, height, and fat mass. Twenty-one single-nucleotide polymorphisms were significantly associated with lean body mass either genome wide (p < 5 × 10−8) or suggestively genome wide (p < 2.3 × 10−6). Replication in 63,475 (47,227 of European ancestry) individuals from 33 cohorts for whole body lean body mass and in 45,090 (42,360 of European ancestry) subjects from 25 cohorts for appendicular lean body mass was successful for five single-nucleotide polymorphisms in/near HSD17B11, VCAN, ADAMTSL3, IRS1, and FTO for total lean body mass and for three single-nucleotide polymorphisms in/near VCAN, ADAMTSL3, and IRS1 for appendicular lean body mass. Our findings provide new insight into the genetics of lean body mass. Lean body mass is a highly heritable trait and is associated with various health conditions. Here, Kiel and colleagues perform a meta-analysis of genome-wide association studies for whole body lean body mass and find five novel genetic loci to be significantly associated.
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Affiliation(s)
- M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands
| | - Serkalem Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Yi-Hsiang Hsu
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, 02115, USA
| | - Laura M Yerges-Armstrong
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Wen-Chi Chou
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Broad Institute, Cambridge, MA, 02142, USA
| | - Lisette Stolk
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands
| | - Gregory Livshits
- Sackler Faculty of Medicine, Department of Anatomy and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel.,Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - Linda Broer
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Toby Johnson
- Department of Medical Genetics, University of Lausanne, Lausanne, 1011, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland.,Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Daniel L Koller
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Zoltán Kutalik
- Department of Medical Genetics, University of Lausanne, Lausanne, 1011, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland.,Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Ida Malkin
- Sackler Faculty of Medicine, Department of Anatomy and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Janina S Ried
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Albert V Smith
- Icelandic Heart Association, Kopavogur, 201, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | | | - Liesbeth Vandenput
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Weihua Zhang
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College, London, SW7 2AZ, UK.,Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK
| | - Ali Aghdassi
- Department of Medicine A, University of Greifswald, Greifswald, 17489, Germany
| | - Kristina Åkesson
- Department of Clinical Sciences, Lund University, Malmö, 22362, Sweden.,Department of Orthopedics, Skåne University Hospital, Malmö, S-205 02, Sweden
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Leslie J Baier
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Inês Barroso
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK.,NIHR Cambridge Biomedical Research Centre, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 OQQ, UK.,Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, CB2 OQQ, UK
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics, Institutes of Neurogenetics and Experimental & Integrative Genomics, University of Lübeck, Lübeck, 23562, Germany.,School of Public Health, Faculty of Medicine, Imperial College London, London, W6 8RP, UK
| | - Rainer Biffar
- Centre of Oral Health, Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University of Greifswald, Greifswald, 17489, Germany
| | - Murielle Bochud
- Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ingrid B Borecki
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St Louis, MO, 63110, USA.,Division of Biostatistics, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | | | - Jane A Cauley
- Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Henna Cederberg
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85714, USA
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Youngtong-Gu, Suwon, 16499, Korea
| | - Hyung Jin Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju Si, Korea
| | - Melina Claussnitzer
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Broad Institute, Cambridge, MA, 02142, USA.,Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, 02139, USA.,Institute of Human Genetics, MRI, Technische Universität München, Munich, 81675, Germany.,Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Francis Collins
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Philip L De Jager
- Harvard Medical School, Boston, MA, 02115, USA.,Program in Translational NeuroPsychiatric Genomics, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Ilja Demuth
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 13353, Germany.,Institute of Medical and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, 13353, Germany
| | | | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, H3A 0G1, Canada.,Regional Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Anke W Enneman
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Mike Erdos
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, 00014, Finland.,Unit of General Practice, Helsinki University Central Hospital, Helsinki, 00014, Finland.,Folkhalsan Research Centre, Helsinki, 00250, Finland.,Vasa Central Hospital, Vasa, 65130, Finland.,National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Joel Eriksson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Karol Estrada
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Daniel S Evans
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Mao Fu
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Melissa Garcia
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Christian Gieger
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Thomas Girke
- Institute for Integrative Genome Biology, University of California, Riverside, CA, 92521, USA.,Department of Botany and Plant Sciences, University of California, Riverside, CA, 92521, USA
| | - Nicole L Glazer
- Departments of Medicine and Epidemiology, Boston University School of Medicine and Public Health, Boston, MA, 02118, USA
| | - Harald Grallert
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Department of Botany and Plant Sciences, University of California, Riverside, CA, 92521, USA.,German Center for Diabetes Research (DZD), Neuherberg, Germany.,CCG Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, 85764, Germany.,CCG Nutrigenomics and Type 2 Diabetes. Helmholtz Zentrum München, Neuherberg, 85764, Germany
| | - Jagvir Grewal
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Bok-Ghee Han
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Chungcheongbuk-do, 28159, Korea
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Caroline Hayward
- MRC Human Genetics Unit, IGMM, University of Edinburgh, Edinburgh, Scotland, EH4 2XU, UK
| | - Albert Hofman
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Eric P Hoffman
- Department of Pharmaceutical Sciences, SUNY Binghamton, Binghamton, NY, 13902, USA
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, 17487, Germany
| | - Wen-Chi Hsueh
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Monica J Hubal
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC, 20052, USA.,Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC, 20052, USA
| | - Alan Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Kim M Huffman
- Division of Rheumatology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Lise B Husted
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Thomas Illig
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Department of Human Genetics, Hannover Medical School, Hannover, 30625, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, 30625, Germany
| | - Erik Ingelsson
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Till Ittermann
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - John-Olov Jansson
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 405 30, Sweden
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27517, USA
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Magnus Karlsson
- Department of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital SUS, Malmö, 22362, Sweden
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Tuomas O Kilpeläinen
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, 2100, Denmark.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Norman Klopp
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, 30625, Germany
| | | | - Heikki A Koistinen
- Department of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland.,Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland.,Department of Health, National Institute for Health and Welfare, Helsinki, 00271, Finland.,Minerva Foundation Institute for Medical Research, Helsinki, 00290, Finland
| | - William E Kraus
- Division of Cardiology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Teemu Kuulasmaa
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Johanna Kuusisto
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, FI00014, Finland
| | - Thomas Lang
- University of California San Francisco, San Francisco, CA, 94143, USA
| | - Bente L Langdahl
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Jong-Young Lee
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Chungcheongbuk-do, 28159, Korea
| | - Markus M Lerch
- Department of Medicine A, University of Greifswald, Greifswald, 17489, Germany
| | - Joshua R Lewis
- School of Medicine and Pharmacology, University of Western Australia, Perth, 6009, Australia.,Centre for Kidney Research, School of Public Health, University of Sydney, Sydney, 2006, Australia
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Cecilia Lindgren
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, OX3 7BN, UK
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, 27517, USA
| | - Tian Liu
- Max Planck Institute for Molecular Genetics, Berlin, 14195, Germany.,Max Planck Institute for Human Development, Berlin, 14195, Germany
| | - Youfang Liu
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27517, USA
| | - Östen Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Mattias Lorentzon
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - William Maixner
- Regional Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Fiona E McGuigan
- Department of Clinical Sciences, Lund University, Malmö, 22362, Sweden
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Thomas Meitinger
- Institute of Human Genetics, MRI, Technische Universität München, Munich, 81675, Germany.,Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Dan Mellström
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Simon Melov
- Buck Institute for Research on Aging, Novato, CA, 94945, USA.,Leonard Davis School of Gerontology, University of Southern California, LA, CA, 90089, USA
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Braxton D Mitchell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, 21201, USA
| | - Andrew P Morris
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, OX3 7BN, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - Leif Mosekilde
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Anne Newman
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | | | - Jeffrey R O'Connell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ben A Oostra
- Department of Clinical Genetics, Erasmus MC, Rotterdam, 300 CA, The Netherlands.,Centre for Medical Systems Biology and Netherlands Consortium on Healthy Aging, Leiden, RC2300, The Netherlands
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Department of Medical Genetics, University of Helsinki and University Central Hospital, Helsinki, FI00014, Finland
| | - Stephen C J Parker
- Human Genetics and Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Munro Peacock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, 00271, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Diabetes and Obesity Research Program, University of Helsinki, Helsinki, FI00014, Finland.,Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Ozren Polasek
- Faculty of Medicine, Department of Public Health, University of Split, Split, 21000, Croatia
| | - Richard L Prince
- School of Medicine and Pharmacology, University of Western Australia, Perth, 6009, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gardiner Hospital, Perth, 6009, Australia
| | - Katri Räikkönen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, FI00014, Finland
| | - Stuart H Ralston
- Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, Scotland, EH4 2XU, UK
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Hjelt Institute, University of Helsinki, Helsinki, Finland.,Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK
| | - John A Robbins
- Department of Medicine, University of California at Davis, Sacramento, CA, 95817, USA
| | - Jerome I Rotter
- Institute for Translational Genomic and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor UCLA Medical Center, Torrance, CA, 90502, USA
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Eric E Schadt
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sabine Schipf
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - Laura Scott
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joban Sehmi
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Jian Shen
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Gunnar Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,Department of Endocrinology and Metabolism, Landspitali, The National University Hospital of Iceland, Reykjavik, 101, Iceland
| | - Shad Smith
- Center for Translational Pain Medicine, Department of Anesthiology, Duke University Medical Center, Durham, NC, 27110, USA
| | - Nicole Soranzo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK
| | - Alena Stančáková
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Elisabeth Steinhagen-Thiessen
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 13353, Germany
| | - Elizabeth A Streeten
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Geriatric Research and Education Clinical Center (GRECC) - Veterans Administration Medical Center, Baltimore, MD, 21201, USA
| | | | - Karin M A Swart
- Department of Epidemiology and Biostatistics, and the EMGO Institute, VU University Medical Center, Amsterdam, BT1081, The Netherlands
| | - Sian-Tsung Tan
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Mark A Tarnopolsky
- Department of Medicine, McMaster University Medical Center, Hamilton, ON, Canada, L8N 3Z5
| | - Patricia Thompson
- Department of Pathology, Stony Brook School of Medicine, Stony Brook, NY, 11794, USA
| | - Cynthia A Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85714, USA
| | - Unnur Thorsteinsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,deCODE Genetics, Reykjavik, 101, Iceland
| | - Emmi Tikkanen
- National Institute for Health and Welfare, Helsinki, 00271, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, Scotland, EH4 2XU, UK
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Jaakko Tuomilehto
- Vasa Central Hospital, Vasa, 65130, Finland.,Department of Neuroscience and Preventive Medicine, Danube-University Krems, Krems, 3500, Austria.,Diabetes Research Group, King Abdulaziz University, Jeddah, 12589, Saudi Arabia.,Dasman Diabetes Institute, Dasman, 15462, Kuwait
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, and the EMGO Institute, VU University Medical Center, Amsterdam, BT1081, The Netherlands
| | - Arjun Verma
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK
| | - Peter Vollenweider
- Department of Medicine and Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH-1011, Switzerland
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Ryan Welch
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - H-Erich Wichmann
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology, Ludwig-Maximilians-Universität, Munich, 81377, Germany.,Institute of Medical Statistics and Epidemiology, Technical University, Munich, 81675, Germany
| | - Elisabeth Widen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - James F Wilson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK.,MRC Human Genetics Unit, IGMM, University of Edinburgh, Edinburgh, Scotland, EH4 2XU, UK
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Weijia Xie
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Yanhua Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - John C Chambers
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College, London, SW7 2AZ, UK.,Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, SW3 6NP, UK.,Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Angela Döring
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands.,Centre for Medical Systems Biology and Netherlands Consortium on Healthy Aging, Leiden, RC2300, The Netherlands
| | - Michael J Econs
- Department of Medicine and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, 201, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | - Jaspal S Kooner
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK.,Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Bruce M Psaty
- Departments of Medicine, Epidemiology, and Health Services, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, 98101, USA.,Kaiser Permanente Washington Health Research Institute, Washington, Seattle, WA, 98101, USA
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - Kari Stefansson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,deCODE Genetics, Reykjavik, 101, Iceland
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Vicky Ossowski
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Dawn Waterworth
- Medical Genetics, GlaxoSmithKline, Philadelphia, PA, 19112, USA
| | - Ruth J F Loos
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK.,The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Institute of Child Health and Development, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,The Genetics of Obesity and Related Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - David Karasik
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, 1311502, Israel
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Claes Ohlsson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Douglas P Kiel
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA. .,Harvard Medical School, Boston, MA, 02115, USA. .,Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
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22
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Vassiliou V, Anita S, Malley T, Raphael CE, Tayal U, Ali A, Sehmi J, Bilal H, Mathew GL, Smith GC, Symmonds K, Greiser A, Spottiswoode BS, Alpendurada F, Auger D, Pennell DJ, Gatehouse P, Prasad S. Systolic T1 mapping for estimation of myocardial diffuse fibrosis. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032320 DOI: 10.1186/1532-429x-18-s1-q52] [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: 11/10/2022] Open
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23
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Ahmed N, Mansoor A, Sehmi J, Gomez K, Sethi A. The Effects of Angiotensin II Signaling Blockade on Platelet Activity in Subjects with Hypertension. Curr Hypertens Rev 2015; 11:116-22. [DOI: 10.2174/157340211102150731114920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 07/06/2014] [Accepted: 08/24/2014] [Indexed: 11/22/2022]
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24
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Wood AR, Esko T, Yang J, Vedantam S, Pers TH, Gustafsson S, Chu AY, Estrada K, Luan J, Kutalik Z, Amin N, Buchkovich ML, Croteau-Chonka DC, Day FR, Duan Y, Fall T, Fehrmann R, Ferreira T, Jackson AU, Karjalainen J, Lo KS, Locke AE, Mägi R, Mihailov E, Porcu E, Randall JC, Scherag A, Vinkhuyzen AAE, Westra HJ, Winkler TW, Workalemahu T, Zhao JH, Absher D, Albrecht E, Anderson D, Baron J, Beekman M, Demirkan A, Ehret GB, Feenstra B, Feitosa MF, Fischer K, Fraser RM, Goel A, Gong J, Justice AE, Kanoni S, Kleber ME, Kristiansson K, Lim U, Lotay V, Lui JC, Mangino M, Mateo Leach I, Medina-Gomez C, Nalls MA, Nyholt DR, Palmer CD, Pasko D, Pechlivanis S, Prokopenko I, Ried JS, Ripke S, Shungin D, Stancáková A, Strawbridge RJ, Sung YJ, Tanaka T, Teumer A, Trompet S, van der Laan SW, van Setten J, Van Vliet-Ostaptchouk JV, Wang Z, Yengo L, Zhang W, Afzal U, Arnlöv J, Arscott GM, Bandinelli S, Barrett A, Bellis C, Bennett AJ, Berne C, Blüher M, Bolton JL, Böttcher Y, Boyd HA, Bruinenberg M, Buckley BM, Buyske S, Caspersen IH, Chines PS, Clarke R, Claudi-Boehm S, Cooper M, Daw EW, De Jong PA, Deelen J, Delgado G, Denny JC, Dhonukshe-Rutten R, Dimitriou M, Doney ASF, Dörr M, Eklund N, Eury E, Folkersen L, Garcia ME, Geller F, Giedraitis V, Go AS, Grallert H, Grammer TB, Gräßler J, Grönberg H, de Groot LCPGM, Groves CJ, Haessler J, Hall P, Haller T, Hallmans G, Hannemann A, Hartman CA, Hassinen M, Hayward C, Heard-Costa NL, Helmer Q, Hemani G, Henders AK, Hillege HL, Hlatky MA, Hoffmann W, Hoffmann P, Holmen O, Houwing-Duistermaat JJ, Illig T, Isaacs A, James AL, Jeff J, Johansen B, Johansson Å, Jolley J, Juliusdottir T, Junttila J, Kho AN, Kinnunen L, Klopp N, Kocher T, Kratzer W, Lichtner P, Lind L, Lindström J, Lobbens S, Lorentzon M, Lu Y, Lyssenko V, Magnusson PKE, Mahajan A, Maillard M, McArdle WL, McKenzie CA, McLachlan S, McLaren PJ, Menni C, Merger S, Milani L, Moayyeri A, Monda KL, Morken MA, Müller G, Müller-Nurasyid M, Musk AW, Narisu N, Nauck M, Nolte IM, Nöthen MM, Oozageer L, Pilz S, Rayner NW, Renstrom F, Robertson NR, Rose LM, Roussel R, Sanna S, Scharnagl H, Scholtens S, Schumacher FR, Schunkert H, Scott RA, Sehmi J, Seufferlein T, Shi J, Silventoinen K, Smit JH, Smith AV, Smolonska J, Stanton AV, Stirrups K, Stott DJ, Stringham HM, Sundström J, Swertz MA, Syvänen AC, Tayo BO, Thorleifsson G, Tyrer JP, van Dijk S, van Schoor NM, van der Velde N, van Heemst D, van Oort FVA, Vermeulen SH, Verweij N, Vonk JM, Waite LL, Waldenberger M, Wennauer R, Wilkens LR, Willenborg C, Wilsgaard T, Wojczynski MK, Wong A, Wright AF, Zhang Q, Arveiler D, Bakker SJL, Beilby J, Bergman RN, Bergmann S, Biffar R, Blangero J, Boomsma DI, Bornstein SR, Bovet P, Brambilla P, Brown MJ, Campbell H, Caulfield MJ, Chakravarti A, Collins R, Collins FS, Crawford DC, Cupples LA, Danesh J, de Faire U, den Ruijter HM, Erbel R, Erdmann J, Eriksson JG, Farrall M, Ferrannini E, Ferrières J, Ford I, Forouhi NG, Forrester T, Gansevoort RT, Gejman PV, Gieger C, Golay A, Gottesman O, Gudnason V, Gyllensten U, Haas DW, Hall AS, Harris TB, Hattersley AT, Heath AC, Hengstenberg C, Hicks AA, Hindorff LA, Hingorani AD, Hofman A, Hovingh GK, Humphries SE, Hunt SC, Hypponen E, Jacobs KB, Jarvelin MR, Jousilahti P, Jula AM, Kaprio J, Kastelein JJP, Kayser M, Kee F, Keinanen-Kiukaanniemi SM, Kiemeney LA, Kooner JS, Kooperberg C, Koskinen S, Kovacs P, Kraja AT, Kumari M, Kuusisto J, Lakka TA, Langenberg C, Le Marchand L, Lehtimäki T, Lupoli S, Madden PAF, Männistö S, Manunta P, Marette A, Matise TC, McKnight B, Meitinger T, Moll FL, Montgomery GW, Morris AD, Morris AP, Murray JC, Nelis M, Ohlsson C, Oldehinkel AJ, Ong KK, Ouwehand WH, Pasterkamp G, Peters A, Pramstaller PP, Price JF, Qi L, Raitakari OT, Rankinen T, Rao DC, Rice TK, Ritchie M, Rudan I, Salomaa V, Samani NJ, Saramies J, Sarzynski MA, Schwarz PEH, Sebert S, Sever P, Shuldiner AR, Sinisalo J, Steinthorsdottir V, Stolk RP, Tardif JC, Tönjes A, Tremblay A, Tremoli E, Virtamo J, Vohl MC, Amouyel P, Asselbergs FW, Assimes TL, Bochud M, Boehm BO, Boerwinkle E, Bottinger EP, Bouchard C, Cauchi S, Chambers JC, Chanock SJ, Cooper RS, de Bakker PIW, Dedoussis G, Ferrucci L, Franks PW, Froguel P, Groop LC, Haiman CA, Hamsten A, Hayes MG, Hui J, Hunter DJ, Hveem K, Jukema JW, Kaplan RC, Kivimaki M, Kuh D, Laakso M, Liu Y, Martin NG, März W, Melbye M, Moebus S, Munroe PB, Njølstad I, Oostra BA, Palmer CNA, Pedersen NL, Perola M, Pérusse L, Peters U, Powell JE, Power C, Quertermous T, Rauramaa R, Reinmaa E, Ridker PM, Rivadeneira F, Rotter JI, Saaristo TE, Saleheen D, Schlessinger D, Slagboom PE, Snieder H, Spector TD, Strauch K, Stumvoll M, Tuomilehto J, Uusitupa M, van der Harst P, Völzke H, Walker M, Wareham NJ, Watkins H, Wichmann HE, Wilson JF, Zanen P, Deloukas P, Heid IM, Lindgren CM, Mohlke KL, Speliotes EK, Thorsteinsdottir U, Barroso I, Fox CS, North KE, Strachan DP, Beckmann JS, Berndt SI, Boehnke M, Borecki IB, McCarthy MI, Metspalu A, Stefansson K, Uitterlinden AG, van Duijn CM, Franke L, Willer CJ, Price AL, Lettre G, Loos RJF, Weedon MN, Ingelsson E, O'Connell JR, Abecasis GR, Chasman DI, Goddard ME, Visscher PM, Hirschhorn JN, Frayling TM. Defining the role of common variation in the genomic and biological architecture of adult human height. Nat Genet 2014; 46:1173-86. [PMID: 25282103 PMCID: PMC4250049 DOI: 10.1038/ng.3097] [Citation(s) in RCA: 1192] [Impact Index Per Article: 119.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/29/2014] [Indexed: 12/17/2022]
Abstract
Using genome-wide data from 253,288 individuals, we identified 697 variants at genome-wide significance that together explained one-fifth of the heritability for adult height. By testing different numbers of variants in independent studies, we show that the most strongly associated ∼2,000, ∼3,700 and ∼9,500 SNPs explained ∼21%, ∼24% and ∼29% of phenotypic variance. Furthermore, all common variants together captured 60% of heritability. The 697 variants clustered in 423 loci were enriched for genes, pathways and tissue types known to be involved in growth and together implicated genes and pathways not highlighted in earlier efforts, such as signaling by fibroblast growth factors, WNT/β-catenin and chondroitin sulfate-related genes. We identified several genes and pathways not previously connected with human skeletal growth, including mTOR, osteoglycin and binding of hyaluronic acid. Our results indicate a genetic architecture for human height that is characterized by a very large but finite number (thousands) of causal variants.
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Affiliation(s)
- Andrew R Wood
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tonu Esko
- 1] Estonian Genome Center, University of Tartu, Tartu, Estonia. [2] Division of Endocrinology, Genetics and Basic and Translational Obesity Research, Boston Children's Hospital, Boston, Massachusetts, USA. [3] Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA. [4] Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Jian Yang
- 1] Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia. [2] University of Queensland Diamantina Institute, Translation Research Institute, Brisbane, Queensland, Australia
| | - Sailaja Vedantam
- 1] Division of Endocrinology, Genetics and Basic and Translational Obesity Research, Boston Children's Hospital, Boston, Massachusetts, USA. [2] Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA
| | - Tune H Pers
- 1] Division of Endocrinology, Genetics and Basic and Translational Obesity Research, Boston Children's Hospital, Boston, Massachusetts, USA. [2] Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA. [3] Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA. [4] Center for Biological Sequence Analysis, Department of Systems Biology, Technical University of Denmark, Lyngby, Denmark
| | - Stefan Gustafsson
- 1] Science for Life Laboratory, Uppsala University, Uppsala, Sweden. [2] Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Audrey Y Chu
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Karol Estrada
- 1] Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA. [2] Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. [3] Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jian'an Luan
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Zoltán Kutalik
- 1] Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. [2] Swiss Institute of Bioinformatics, Lausanne, Switzerland. [3] Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
| | - Najaf Amin
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martin L Buchkovich
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Damien C Croteau-Chonka
- 1] Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA. [2] Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Felix R Day
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Yanan Duan
- Department of Genetics, Division of Statistical Genomics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tove Fall
- 1] Science for Life Laboratory, Uppsala University, Uppsala, Sweden. [2] Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden. [3] Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rudolf Fehrmann
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Teresa Ferreira
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Anne U Jackson
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Juha Karjalainen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ken Sin Lo
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Adam E Locke
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Reedik Mägi
- 1] Estonian Genome Center, University of Tartu, Tartu, Estonia. [2] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Evelin Mihailov
- 1] Estonian Genome Center, University of Tartu, Tartu, Estonia. [2] Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Eleonora Porcu
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, Cagliari, Italy
| | - Joshua C Randall
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Wellcome Trust Sanger Institute, Hinxton, UK
| | - André Scherag
- 1] Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany. [2] Clinical Epidemiology, Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Anna A E Vinkhuyzen
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Harm-Jan Westra
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas W Winkler
- Department of Genetic Epidemiology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Tsegaselassie Workalemahu
- Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Jing Hua Zhao
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Devin Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Eva Albrecht
- Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Denise Anderson
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Jeffrey Baron
- Section on Growth and Development, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, US National Institutes of Health, Bethesda, Maryland, USA
| | - Marian Beekman
- 1] Netherlands Consortium for Healthy Aging (NCHA), Leiden University Medical Center, Leiden, the Netherlands. [2] Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ayse Demirkan
- 1] Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands. [2] Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Georg B Ehret
- 1] Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. [2] Department of Specialties of Internal Medicine, Division of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Bjarke Feenstra
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mary F Feitosa
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Krista Fischer
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Ross M Fraser
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Anuj Goel
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Jian Gong
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Anne E Justice
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stavroula Kanoni
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marcus E Kleber
- 1] Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany. [2] Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
| | | | - Unhee Lim
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Vaneet Lotay
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julian C Lui
- Section on Growth and Development, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, US National Institutes of Health, Bethesda, Maryland, USA
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Irene Mateo Leach
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carolina Medina-Gomez
- 1] Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. [2] Netherlands Consortium for Healthy Aging (NCHA), Rotterdam, the Netherlands. [3] Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Michael A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, US National Institutes of Health, Bethesda, Maryland, USA
| | - Dale R Nyholt
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Cameron D Palmer
- 1] Division of Endocrinology, Genetics and Basic and Translational Obesity Research, Boston Children's Hospital, Boston, Massachusetts, USA. [2] Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA
| | - Dorota Pasko
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sonali Pechlivanis
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Inga Prokopenko
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK. [3] Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, London, UK
| | - Janina S Ried
- Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Stephan Ripke
- 1] Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. [2] Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA
| | - Dmitry Shungin
- 1] Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University Diabetes Center, Skåne University Hospital, Malmö, Sweden. [2] Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden. [3] Department of Odontology, Umeå University, Umeå, Sweden
| | - Alena Stancáková
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Rona J Strawbridge
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yun Ju Sung
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Toshiko Tanaka
- Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland, USA
| | - Alexander Teumer
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Stella Trompet
- 1] Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. [2] Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sander W van der Laan
- Experimental Cardiology Laboratory, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jessica van Setten
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jana V Van Vliet-Ostaptchouk
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Zhaoming Wang
- 1] DZHK (Deutsches Zentrum für Herz-Kreislaufforschung-German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany. [2] Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany. [3] Division of Cancer Epidemiology and Genetics, National Cancer Institute, US National Institutes of Health, Bethesda, Maryland, USA. [4] Core Genotyping Facility, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland, USA
| | - Loïc Yengo
- 1] CNRS UMR 8199, Lille, France. [2] European Genomic Institute for Diabetes, Lille, France. [3] Université de Lille 2, Lille, France
| | - Weihua Zhang
- 1] Ealing Hospital National Health Service (NHS) Trust, Middlesex, UK. [2] Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Uzma Afzal
- 1] Ealing Hospital National Health Service (NHS) Trust, Middlesex, UK. [2] Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Johan Arnlöv
- 1] Science for Life Laboratory, Uppsala University, Uppsala, Sweden. [2] Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden. [3] School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Gillian M Arscott
- PathWest Laboratory Medicine of Western Australia, Nedlands, Western Australia, Australia
| | | | - Amy Barrett
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Claire Bellis
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Amanda J Bennett
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Christian Berne
- Department of Medical Sciences, Endocrinology, Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Matthias Blüher
- 1] Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany. [2] Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Jennifer L Bolton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Yvonne Böttcher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Heather A Boyd
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Marcel Bruinenberg
- LifeLines, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Brendan M Buckley
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Steven Buyske
- 1] Department of Statistics and Biostatistics, Rutgers University, Piscataway, New Jersy, USA. [2] Department of Genetics, Rutgers University, Piscataway, New Jersey, USA
| | - Ida H Caspersen
- Department of Biology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Peter S Chines
- Genome Technology Branch, National Human Genome Research Institute, US National Institutes of Health, Bethesda, Maryland, USA
| | - Robert Clarke
- Clinical Trial Service Unit, Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Simone Claudi-Boehm
- Division of Endocrinology, Diabetes and Metabolism, Ulm University Medical Centre, Ulm, Germany
| | - Matthew Cooper
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - E Warwick Daw
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Pim A De Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joris Deelen
- 1] Netherlands Consortium for Healthy Aging (NCHA), Leiden University Medical Center, Leiden, the Netherlands. [2] Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Graciela Delgado
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Josh C Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Maria Dimitriou
- Department of Dietetics-Nutrition, Harokopio University, Athens, Greece
| | - Alex S F Doney
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Marcus Dörr
- 1] DZHK (Deutsches Zentrum für Herz-Kreislaufforschung-German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany. [2] Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Niina Eklund
- 1] National Institute for Health and Welfare, Helsinki, Finland. [2] Institute for Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Elodie Eury
- 1] CNRS UMR 8199, Lille, France. [2] European Genomic Institute for Diabetes, Lille, France. [3] Université de Lille 2, Lille, France
| | - Lasse Folkersen
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Melissa E Garcia
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, US National Institutes of Health, Bethesda, Maryland, USA
| | - Frank Geller
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Alan S Go
- Kaiser Permanente, Division of Research, Oakland, California, USA
| | - Harald Grallert
- 1] Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. [2] Research Unit of Molecular Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. [3] German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Tanja B Grammer
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Gräßler
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Christopher J Groves
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Jeffrey Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Toomas Haller
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Goran Hallmans
- Unit of Nutritional Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Catharina A Hartman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maija Hassinen
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Nancy L Heard-Costa
- 1] National Heart, Lung, and Blood Institute, Framingham Heart Study, Framingham, Massachusetts, USA. [2] Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Quinta Helmer
- 1] Netherlands Consortium for Healthy Aging (NCHA), Leiden University Medical Center, Leiden, the Netherlands. [2] Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands. [3] Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, the Netherlands
| | - Gibran Hemani
- 1] Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia. [2] University of Queensland Diamantina Institute, Translation Research Institute, Brisbane, Queensland, Australia
| | - Anjali K Henders
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Hans L Hillege
- 1] Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. [2] Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mark A Hlatky
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Wolfgang Hoffmann
- 1] DZHK (Deutsches Zentrum für Herz-Kreislaufforschung-German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany. [2] Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Per Hoffmann
- 1] Department of Biomedicine, Division of Medical Genetics, University of Basel, Basel, Switzerland. [2] Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany. [3] Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Oddgeir Holmen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jeanine J Houwing-Duistermaat
- 1] Netherlands Consortium for Healthy Aging (NCHA), Leiden University Medical Center, Leiden, the Netherlands. [2] Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas Illig
- 1] Research Unit of Molecular Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. [2] Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Aaron Isaacs
- 1] Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands. [2] Center for Medical Systems Biology, Leiden, the Netherlands
| | - Alan L James
- 1] Department of Pulmonary Physiology and Sleep Medicine, Nedlands, Western Australia, Australia. [2] School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Janina Jeff
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Berit Johansen
- Department of Biology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Åsa Johansson
- Department of Immunology, Genetics and Pathology, SciLifeLab, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Jennifer Jolley
- 1] Department of Haematology, University of Cambridge, Cambridge, UK. [2] NHS Blood and Transplant, Cambridge, UK
| | | | | | - Abel N Kho
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leena Kinnunen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Norman Klopp
- 1] Research Unit of Molecular Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. [2] Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Thomas Kocher
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology and Endodontology, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Medical Centre, Ulm, Germany
| | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Jaana Lindström
- National Institute for Health and Welfare, Helsinki, Finland
| | - Stéphane Lobbens
- 1] CNRS UMR 8199, Lille, France. [2] European Genomic Institute for Diabetes, Lille, France. [3] Université de Lille 2, Lille, France
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yingchang Lu
- 1] Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. [2] Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Marc Maillard
- Service of Nephrology, Department of Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Wendy L McArdle
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Colin A McKenzie
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Stela McLachlan
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul J McLaren
- 1] Global Health Institute, Department of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland. [2] Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sigrun Merger
- Division of Endocrinology, Diabetes and Metabolism, Ulm University Medical Centre, Ulm, Germany
| | - Lili Milani
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Alireza Moayyeri
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Keri L Monda
- 1] Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. [2] Center for Observational Research, Amgen, Inc., Thousand Oaks, California, USA
| | - Mario A Morken
- Genome Technology Branch, National Human Genome Research Institute, US National Institutes of Health, Bethesda, Maryland, USA
| | - Gabriele Müller
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martina Müller-Nurasyid
- 1] Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. [2] Department of Medicine I, University Hospital Großhadern, Ludwig Maximilians Universität, Munich, Germany. [3] Chair of Genetic Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians Universität, Neuherberg, Germany. [4] DZHK (Deutsches Forschungszentrum für Herz-Kreislauferkrankungen-German Research Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
| | - Arthur W Musk
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Narisu Narisu
- Genome Technology Branch, National Human Genome Research Institute, US National Institutes of Health, Bethesda, Maryland, USA
| | - Matthias Nauck
- 1] DZHK (Deutsches Zentrum für Herz-Kreislaufforschung-German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany. [2] Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ilja M Nolte
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Markus M Nöthen
- 1] Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany. [2] Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Laticia Oozageer
- Ealing Hospital National Health Service (NHS) Trust, Middlesex, UK
| | - Stefan Pilz
- 1] Department of Epidemiology and Biostatistics, Institute for Research in Extramural Medicine (EMGO) Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands. [2] Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Nigel W Rayner
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Wellcome Trust Sanger Institute, Hinxton, UK. [3] Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Frida Renstrom
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University Diabetes Center, Skåne University Hospital, Malmö, Sweden
| | - Neil R Robertson
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Lynda M Rose
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ronan Roussel
- 1] Diabetology-Endocrinology-Nutrition, Public Hospital System of the City of Paris (AP-HP), Bichat Hospital, Paris, France. [2] INSERM U872, Centre de Recherche des Cordeliers, Paris, France. [3] Paris Diderot University, Paris, France
| | - Serena Sanna
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, Cagliari, Italy
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Salome Scholtens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Fredrick R Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Heribert Schunkert
- 1] DZHK (Deutsches Forschungszentrum für Herz-Kreislauferkrankungen-German Research Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany. [2] Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Robert A Scott
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Joban Sehmi
- 1] Ealing Hospital National Health Service (NHS) Trust, Middlesex, UK. [2] Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Thomas Seufferlein
- Department of Internal Medicine I, Ulm University Medical Centre, Ulm, Germany
| | - Jianxin Shi
- National Cancer Institute, Bethesda, Maryland, USA
| | | | - Johannes H Smit
- 1] EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands. [2] Department of Psychiatry, Neuroscience Campus, VU University Amsterdam, Amsterdam, the Netherlands
| | - Albert Vernon Smith
- 1] Icelandic Heart Association, Kopavogur, Iceland. [2] University of Iceland, Reykjavik, Iceland
| | - Joanna Smolonska
- 1] Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. [2] Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alice V Stanton
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Stirrups
- 1] Wellcome Trust Sanger Institute, Hinxton, UK. [2] William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK
| | - Heather M Stringham
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Johan Sundström
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Morris A Swertz
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ann-Christine Syvänen
- 1] Science for Life Laboratory, Uppsala University, Uppsala, Sweden. [2] Department of Medical Sciences, Molecular Medicine, Uppsala University, Uppsala, Sweden
| | - Bamidele O Tayo
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University of Chicago, Maywood, Illinois, USA
| | | | | | - Suzanne van Dijk
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Institute for Research in Extramural Medicine (EMGO) Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Nathalie van der Velde
- 1] Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. [2] Section of Geriatrics, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Diana van Heemst
- 1] Netherlands Consortium for Healthy Aging (NCHA), Leiden University Medical Center, Leiden, the Netherlands. [2] Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Floor V A van Oort
- Department of Child and Adolescent Psychiatry, Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sita H Vermeulen
- 1] Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands. [2] Department of Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Niek Verweij
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Judith M Vonk
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lindsay L Waite
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Roman Wennauer
- Department of Clinical Chemistry, Ulm University Medical Centre, Ulm, Germany
| | - Lynne R Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Christina Willenborg
- 1] DZHK (Deutsches Forschungszentrum für Herz-Kreislauferkrankungen-German Research Centre for Cardiovascular Research), partner site Hamburg-Lubeck-Kiel, Lubeck, Germany. [2] Institut für Integrative und Experimentelle Genomik, Universität zu Lübeck, Lübeck, Germany
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Tromsø, Tromsø, Norway
| | - Mary K Wojczynski
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Alan F Wright
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Qunyuan Zhang
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dominique Arveiler
- Department of Epidemiology and Public Health, University of Strasbourg, Faculty of Medicine, Strasbourg, France
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - John Beilby
- 1] PathWest Laboratory Medicine of Western Australia, Nedlands, Western Australia, Australia. [2] Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Richard N Bergman
- Cedars-Sinai Diabetes and Obesity Research Institute, Los Angeles, California, USA
| | - Sven Bergmann
- 1] Swiss Institute of Bioinformatics, Lausanne, Switzerland. [2] Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
| | - Reiner Biffar
- Department of Prosthetic Dentistry, Gerostomatology and Dental Materials, University Medicine Greifswald, Greifswald, Germany
| | - John Blangero
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Dorret I Boomsma
- Biological Psychology, VU University Amsterdam, Amsterdam, the Netherlands
| | - Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Pascal Bovet
- 1] Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland. [2] Ministry of Health, Victoria, Republic of Seychelles
| | - Paolo Brambilla
- Laboratory Medicine, Hospital of Desio, Department of Health Sciences, University of Milano, Bicocca, Italy
| | - Morris J Brown
- Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Mark J Caulfield
- 1] Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. [2] Barts and The London Genome Centre, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Aravinda Chakravarti
- Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rory Collins
- Clinical Trial Service Unit, Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Francis S Collins
- Genome Technology Branch, National Human Genome Research Institute, US National Institutes of Health, Bethesda, Maryland, USA
| | - Dana C Crawford
- 1] Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA. [2] Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee, USA
| | - L Adrienne Cupples
- 1] National Heart, Lung, and Blood Institute, Framingham Heart Study, Framingham, Massachusetts, USA. [2] Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ulf de Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hester M den Ruijter
- 1] Experimental Cardiology Laboratory, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands. [2] Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Raimund Erbel
- Clinic of Cardiology, West German Heart Centre, University Hospital Essen, Essen, Germany
| | - Jeanette Erdmann
- 1] DZHK (Deutsches Forschungszentrum für Herz-Kreislauferkrankungen-German Research Centre for Cardiovascular Research), partner site Hamburg-Lubeck-Kiel, Lubeck, Germany. [2] Institut für Integrative und Experimentelle Genomik, Universität zu Lübeck, Lübeck, Germany
| | - Johan G Eriksson
- 1] National Institute for Health and Welfare, Helsinki, Finland. [2] Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland. [3] Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
| | - Martin Farrall
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Ele Ferrannini
- 1] Department of Internal Medicine, University of Pisa, Pisa, Italy. [2] National Research Council (CNR) Institute of Clinical Physiology, University of Pisa, Pisa, Italy
| | - Jean Ferrières
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK
| | - Nita G Forouhi
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Terrence Forrester
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pablo V Gejman
- NorthShore University HealthSystem, University of Chicago, Evanston, Illinois, USA
| | - Christian Gieger
- Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Alain Golay
- Service of Therapeutic Education for Diabetes, Obesity and Chronic Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Omri Gottesman
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vilmundur Gudnason
- 1] Icelandic Heart Association, Kopavogur, Iceland. [2] University of Iceland, Reykjavik, Iceland
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology, SciLifeLab, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - David W Haas
- Department of Medicine, Pharmacology, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Alistair S Hall
- Leeds MRC Medical Bioinformatics Centre, University of Leeds, Leeds, UK
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, US National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, UK
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christian Hengstenberg
- 1] DZHK (Deutsches Forschungszentrum für Herz-Kreislauferkrankungen-German Research Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany. [2] Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Andrew A Hicks
- Center for Biomedicine, European Academy Bozen, Bolzano (EURAC), Bolzano, Italy (affiliated institute of the University of Lübeck, Lübeck, Germany)
| | - Lucia A Hindorff
- Division of Genomic Medicine, National Human Genome Research Institute, US National Institutes of Health, Bethesda, Maryland, USA
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
| | - Albert Hofman
- 1] Netherlands Consortium for Healthy Aging (NCHA), Rotterdam, the Netherlands. [2] Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences, University College London, London, UK
| | - Steven C Hunt
- Cardiovascular Genetics Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Elina Hypponen
- 1] School of Population Health, University of South Australia, Adelaide, South Australia, Australia. [2] Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia. [3] South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia. [4] Centre for Paediatric Epidemiology and Biostatistics, University College London Institute of Child Health, London, UK
| | - Kevin B Jacobs
- 1] Division of Cancer Epidemiology and Genetics, National Cancer Institute, US National Institutes of Health, Bethesda, Maryland, USA. [2] Core Genotyping Facility, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland, USA
| | - Marjo-Riitta Jarvelin
- 1] Department of Epidemiology and Biostatistics, Imperial College London, London, UK. [2] National Institute for Health and Welfare, Oulu, Finland. [3] MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK. [4] Unit of Primary Care, Oulu University Hospital, Oulu, Finland. [5] Biocenter Oulu, University of Oulu, Oulu, Finland. [6] Institute of Health Sciences, University of Oulu, Oulu, Finland
| | | | - Antti M Jula
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko Kaprio
- 1] National Institute for Health and Welfare, Helsinki, Finland. [2] Institute for Molecular Medicine, University of Helsinki, Helsinki, Finland. [3] Hjelt Institute Department of Public Health, University of Helsinki, Helsinki, Finland
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Manfred Kayser
- 1] Netherlands Consortium for Healthy Aging (NCHA), Rotterdam, the Netherlands. [2] Department of Forensic Molecular Biology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Frank Kee
- UK Clinical Research Collaboration Centre of Excellence for Public Health (Northern Ireland), Queens University of Belfast, Belfast, UK
| | - Sirkka M Keinanen-Kiukaanniemi
- 1] Faculty of Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland. [2] Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Lambertus A Kiemeney
- 1] Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands. [2] Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jaspal S Kooner
- 1] Ealing Hospital National Health Service (NHS) Trust, Middlesex, UK. [2] Imperial College Healthcare NHS Trust, London, UK. [3] National Heart and Lung Institute, Imperial College London, London, UK
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Seppo Koskinen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Peter Kovacs
- 1] Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany. [2] Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Aldi T Kraja
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Meena Kumari
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Johanna Kuusisto
- Department of Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Timo A Lakka
- 1] Kuopio Research Institute of Exercise Medicine, Kuopio, Finland. [2] Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland. [3] Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Claudia Langenberg
- 1] Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK. [2] Department of Epidemiology and Public Health, University College London, London, UK
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and School of Medicine, University of Tampere, Tampere, Finland
| | - Sara Lupoli
- 1] Department of Health Sciences, University of Milano, Milan, Italy. [2] Fondazione Filarete, Milan, Italy
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Satu Männistö
- National Institute for Health and Welfare, Helsinki, Finland
| | - Paolo Manunta
- 1] Division of Nephrology and Dialysis, San Raffaele Scientific Institute, Milan, Italy. [2] Università Vita-Salute San Raffaele, Milan, Italy
| | - André Marette
- 1] Institut Universitaire de Cardiologie et de Pneumologie de Québec, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada. [2] Institute of Nutrition and Functional Foods, Laval University, Quebec City, Quebec, Canada
| | - Tara C Matise
- Department of Genetics, Rutgers University, Piscataway, New Jersey, USA
| | - Barbara McKnight
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Thomas Meitinger
- DZHK (Deutsches Forschungszentrum für Herz-Kreislauferkrankungen-German Research Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
| | - Frans L Moll
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Grant W Montgomery
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Andrew D Morris
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew P Morris
- 1] Estonian Genome Center, University of Tartu, Tartu, Estonia. [2] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [3] Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Mari Nelis
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Albertine J Oldehinkel
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ken K Ong
- 1] Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK. [2] MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Willem H Ouwehand
- 1] Department of Haematology, University of Cambridge, Cambridge, UK. [2] NHS Blood and Transplant, Cambridge, UK
| | - Gerard Pasterkamp
- Experimental Cardiology Laboratory, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annette Peters
- 1] Research Unit of Molecular Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. [2] DZHK (Deutsches Forschungszentrum für Herz-Kreislauferkrankungen-German Research Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany. [3] Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Peter P Pramstaller
- 1] Center for Biomedicine, European Academy Bozen, Bolzano (EURAC), Bolzano, Italy (affiliated institute of the University of Lübeck, Lübeck, Germany). [2] Department of Neurology, General Central Hospital, Bolzano, Italy
| | - Jackie F Price
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Lu Qi
- 1] Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. [2] Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Olli T Raitakari
- 1] Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland. [2] Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Tuomo Rankinen
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - D C Rao
- 1] Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA. [2] Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA. [3] Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Treva K Rice
- 1] Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA. [2] Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marylyn Ritchie
- Center for Systems Genomics, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Igor Rudan
- 1] Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK. [2] Croatian Centre for Global Health, Faculty of Medicine, University of Split, Split, Croatia
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Nilesh J Samani
- 1] Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK. [2] National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | | | - Mark A Sarzynski
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Peter E H Schwarz
- 1] Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. [2] Paul Langerhans Institute Dresden, German Center for Diabetes Research (DZD), Dresden, Germany
| | - Sylvain Sebert
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Peter Sever
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - Alan R Shuldiner
- 1] Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA. [2] Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA. [3] Geriatric Research and Education Clinical Center, Vetrans Administration Medical Center, Baltimore, Maryland, USA
| | - Juha Sinisalo
- Helsinki University Central Hospital Heart and Lung Center, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Ronald P Stolk
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jean-Claude Tardif
- 1] Montreal Heart Institute, Montreal, Quebec, Canada. [2] Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anke Tönjes
- 1] Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany. [2] Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Angelo Tremblay
- Department of Kinesiology, Laval University, Quebec City, Quebec, Canada
| | - Elena Tremoli
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano and Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Jarmo Virtamo
- National Institute for Health and Welfare, Helsinki, Finland
| | - Marie-Claude Vohl
- 1] Institute of Nutrition and Functional Foods, Laval University, Quebec City, Quebec, Canada. [2] Department of Food Science and Nutrition, Laval University, Quebec City, Quebec, Canada
| | - Philippe Amouyel
- Institut Pasteur de Lille, INSERM U744, Université de Lille 2, Lille, France
| | - Folkert W Asselbergs
- 1] Institute of Cardiovascular Science, University College London, London, UK. [2] Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands. [3] Durrer Center for Cardiogenetic Research, Interuniversity Cardiology Institute Netherlands-Netherlands Heart Institute, Utrecht, the Netherlands
| | - Themistocles L Assimes
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Murielle Bochud
- 1] Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland. [2] Ministry of Health, Victoria, Republic of Seychelles
| | - Bernhard O Boehm
- 1] Division of Endocrinology, Diabetes and Metabolism, Ulm University Medical Centre, Ulm, Germany. [2] Lee Kong Chian School of Medicine, Imperial College London and Nanyang Technological University, Singapore
| | - Eric Boerwinkle
- Health Science Center at Houston, University of Texas, Houston, Texas, USA
| | - Erwin P Bottinger
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Stéphane Cauchi
- 1] CNRS UMR 8199, Lille, France. [2] European Genomic Institute for Diabetes, Lille, France. [3] Université de Lille 2, Lille, France
| | - John C Chambers
- 1] Ealing Hospital National Health Service (NHS) Trust, Middlesex, UK. [2] Department of Epidemiology and Biostatistics, Imperial College London, London, UK. [3] Imperial College Healthcare NHS Trust, London, UK
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, US National Institutes of Health, Bethesda, Maryland, USA
| | - Richard S Cooper
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University of Chicago, Maywood, Illinois, USA
| | - Paul I W de Bakker
- 1] Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands. [2] Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. [3] Department of Epidemiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - George Dedoussis
- Department of Dietetics-Nutrition, Harokopio University, Athens, Greece
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland, USA
| | - Paul W Franks
- 1] Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA. [2] Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University Diabetes Center, Skåne University Hospital, Malmö, Sweden. [3] Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
| | - Philippe Froguel
- 1] Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, London, UK. [2] CNRS UMR 8199, Lille, France. [3] European Genomic Institute for Diabetes, Lille, France. [4] Université de Lille 2, Lille, France
| | - Leif C Groop
- 1] Institute for Molecular Medicine, University of Helsinki, Helsinki, Finland. [2] Lund University Diabetes Centre, Lund University, Malmö, Sweden. [3] Diabetes and Endocrinology Unit, Department of Clinical Science, Lund University, Malmö, Sweden
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anders Hamsten
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Geoffrey Hayes
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennie Hui
- 1] PathWest Laboratory Medicine of Western Australia, Nedlands, Western Australia, Australia. [2] Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia. [3] School of Population Health, University of South Australia, Adelaide, South Australia, Australia. [4] Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - David J Hunter
- 1] Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. [2] Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA. [3] Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Kristian Hveem
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - J Wouter Jukema
- 1] Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. [2] Durrer Center for Cardiogenetic Research, Interuniversity Cardiology Institute Netherlands-Netherlands Heart Institute, Utrecht, the Netherlands. [3] Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, the Netherlands
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine. Belfer, New York, USA
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Markku Laakso
- Department of Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Yongmei Liu
- Center for Human Genetics, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Winfried März
- 1] Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Heidelberg, Germany. [2] Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. [3] Synlab Academy, Synlab Services, Mannheim, Germany
| | - Mads Melbye
- 1] Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark. [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Patricia B Munroe
- 1] Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. [2] Barts and The London Genome Centre, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Tromsø, Tromsø, Norway
| | - Ben A Oostra
- 1] Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands. [2] Center for Medical Systems Biology, Leiden, the Netherlands. [3] Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Colin N A Palmer
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markus Perola
- 1] Estonian Genome Center, University of Tartu, Tartu, Estonia. [2] National Institute for Health and Welfare, Helsinki, Finland. [3] Institute for Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Louis Pérusse
- 1] Institute of Nutrition and Functional Foods, Laval University, Quebec City, Quebec, Canada. [2] Department of Kinesiology, Laval University, Quebec City, Quebec, Canada
| | - Ulrike Peters
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joseph E Powell
- 1] Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia. [2] University of Queensland Diamantina Institute, Translation Research Institute, Brisbane, Queensland, Australia
| | - Chris Power
- Centre for Paediatric Epidemiology and Biostatistics, University College London Institute of Child Health, London, UK
| | - Thomas Quertermous
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rainer Rauramaa
- 1] Kuopio Research Institute of Exercise Medicine, Kuopio, Finland. [2] Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Eva Reinmaa
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Paul M Ridker
- 1] Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. [2] Harvard Medical School, Boston, Massachusetts, USA
| | - Fernando Rivadeneira
- 1] Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. [2] Netherlands Consortium for Healthy Aging (NCHA), Rotterdam, the Netherlands. [3] Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute at Harbor-University of California, Los Angeles Medical Center, Torrance, California, USA
| | - Timo E Saaristo
- 1] Finnish Diabetes Association, Tampere, Finland. [2] Pirkanmaa Hospital District, Tampere, Finland
| | - Danish Saleheen
- 1] Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. [2] Center for Non-Communicable Diseases, Karatchi, Pakistan. [3] Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Schlessinger
- Laboratory of Genetics, National Institute on Aging, Baltimore, Maryland, USA
| | - P Eline Slagboom
- 1] Netherlands Consortium for Healthy Aging (NCHA), Leiden University Medical Center, Leiden, the Netherlands. [2] Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Harold Snieder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Konstantin Strauch
- 1] Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. [2] Chair of Genetic Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians Universität, Neuherberg, Germany
| | - Michael Stumvoll
- 1] Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany. [2] Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Jaakko Tuomilehto
- 1] National Institute for Health and Welfare, Helsinki, Finland. [2] Instituto de Investigacion Sanitaria del Hospital Universario La Paz (IdiPAZ), Madrid, Spain. [3] Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia. [4] Centre for Vascular Prevention, Danube University Krems, Krems, Austria
| | - Matti Uusitupa
- 1] Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland. [2] Research Unit, Kuopio University Hospital, Kuopio, Finland
| | - Pim van der Harst
- 1] Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. [2] Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. [3] Durrer Center for Cardiogenetic Research, Interuniversity Cardiology Institute Netherlands-Netherlands Heart Institute, Utrecht, the Netherlands
| | - Henry Völzke
- 1] DZHK (Deutsches Zentrum für Herz-Kreislaufforschung-German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany. [2] Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Nicholas J Wareham
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Hugh Watkins
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - H-Erich Wichmann
- 1] Chair of Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians Universität, Munich, Germany. [2] Klinikum Großhadern, Munich, Germany. [3] Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - James F Wilson
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Pieter Zanen
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Panos Deloukas
- 1] Wellcome Trust Sanger Institute, Hinxton, UK. [2] William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. [3] King Abdulaziz University, Jeddah, Saudi Arabia
| | - Iris M Heid
- 1] Department of Genetic Epidemiology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany. [2] Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Cecilia M Lindgren
- 1] Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA. [2] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Karen L Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elizabeth K Speliotes
- 1] Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA. [2] Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Unnur Thorsteinsdottir
- 1] deCODE Genetics, Amgen, Inc., Reykjavik, Iceland. [2] Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Inês Barroso
- 1] Wellcome Trust Sanger Institute, Hinxton, UK. [2] University of Cambridge Metabolic Research Laboratories, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK. [3] NIHR Cambridge Biomedical Research Centre, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Caroline S Fox
- National Heart, Lung, and Blood Institute, Framingham Heart Study, Framingham, Massachusetts, USA
| | - Kari E North
- 1] Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. [2] Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David P Strachan
- Division of Population Health Sciences and Education, St George's, University of London, London, UK
| | - Jacques S Beckmann
- 1] Swiss Institute of Bioinformatics, Lausanne, Switzerland. [2] Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland. [3] Service of Medical Genetics, CHUV University Hospital, Lausanne, Switzerland
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, US National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Boehnke
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ingrid B Borecki
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mark I McCarthy
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK. [3] Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andres Metspalu
- 1] Estonian Genome Center, University of Tartu, Tartu, Estonia. [2] Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Kari Stefansson
- 1] deCODE Genetics, Amgen, Inc., Reykjavik, Iceland. [2] Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - André G Uitterlinden
- 1] Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. [2] Netherlands Consortium for Healthy Aging (NCHA), Rotterdam, the Netherlands. [3] Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cornelia M van Duijn
- 1] Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands. [2] Netherlands Consortium for Healthy Aging (NCHA), Rotterdam, the Netherlands. [3] Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands. [4] Center for Medical Systems Biology, Leiden, the Netherlands
| | - Lude Franke
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cristen J Willer
- 1] Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA. [2] Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA. [3] Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Alkes L Price
- 1] Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA. [2] Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA. [3] Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Guillaume Lettre
- 1] Montreal Heart Institute, Montreal, Quebec, Canada. [2] Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Ruth J F Loos
- 1] Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK. [2] Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. [3] Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA. [4] Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Erik Ingelsson
- 1] Science for Life Laboratory, Uppsala University, Uppsala, Sweden. [2] Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden. [3] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Jeffrey R O'Connell
- 1] Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA. [2] Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Goncalo R Abecasis
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel I Chasman
- 1] Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. [2] Harvard Medical School, Boston, Massachusetts, USA
| | - Michael E Goddard
- 1] Biosciences Research Division, Department of Primary Industries, Melbourne, Victoria, Australia. [2] Department of Food and Agricultural Systems, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter M Visscher
- 1] Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia. [2] University of Queensland Diamantina Institute, Translation Research Institute, Brisbane, Queensland, Australia
| | - Joel N Hirschhorn
- 1] Division of Endocrinology, Genetics and Basic and Translational Obesity Research, Boston Children's Hospital, Boston, Massachusetts, USA. [2] Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA. [3] Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
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Chambers JC, Abbott J, Zhang W, Turro E, Scott WR, Tan ST, Afzal U, Afaq S, Loh M, Lehne B, O'Reilly P, Gaulton KJ, Pearson RD, Li X, Lavery A, Vandrovcova J, Wass MN, Miller K, Sehmi J, Oozageer L, Kooner IK, Al-Hussaini A, Mills R, Grewal J, Panoulas V, Lewin AM, Northwood K, Wander GS, Geoghegan F, Li Y, Wang J, Aitman TJ, McCarthy MI, Scott J, Butcher S, Elliott P, Kooner JS. The South Asian genome. PLoS One 2014; 9:e102645. [PMID: 25115870 PMCID: PMC4130493 DOI: 10.1371/journal.pone.0102645] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 06/21/2014] [Indexed: 12/15/2022] Open
Abstract
The genetic sequence variation of people from the Indian subcontinent who comprise one-quarter of the world's population, is not well described. We carried out whole genome sequencing of 168 South Asians, along with whole-exome sequencing of 147 South Asians to provide deeper characterisation of coding regions. We identify 12,962,155 autosomal sequence variants, including 2,946,861 new SNPs and 312,738 novel indels. This catalogue of SNPs and indels amongst South Asians provides the first comprehensive map of genetic variation in this major human population, and reveals evidence for selective pressures on genes involved in skin biology, metabolism, infection and immunity. Our results will accelerate the search for the genetic variants underlying susceptibility to disorders such as type-2 diabetes and cardiovascular disease which are highly prevalent amongst South Asians.
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Affiliation(s)
- John C. Chambers
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- MRC-HPA Centre for Environment and Health, Imperial College London, Norfolk Place, London, United Kingdom
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | - James Abbott
- Centre for Integrative Systems Biology and Bioinformatics, Imperial College London, London, United Kingdom
| | - Weihua Zhang
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | - Ernest Turro
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- Computational Biology and Statistics, University of Cambridge, Cambridge, United Kingdom
| | - William R. Scott
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Sian-Tsung Tan
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
- NHLI, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Uzma Afzal
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Saima Afaq
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Marie Loh
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Benjamin Lehne
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Paul O'Reilly
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Kyle J. Gaulton
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Richard D. Pearson
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Xinzhong Li
- Institute of Clinical Sciences, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals NHS Trust, London, United Kingdom
| | - Anita Lavery
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Jana Vandrovcova
- MRC Clinical Sciences Centre, Imperial College London, London, United Kingdom
| | - Mark N. Wass
- Centre for Integrative Systems Biology and Bioinformatics, Imperial College London, London, United Kingdom
| | - Kathryn Miller
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | - Joban Sehmi
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
- NHLI, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | | | | | - Abtehale Al-Hussaini
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Rebecca Mills
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | - Jagvir Grewal
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | | | - Alexandra M. Lewin
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Korrinne Northwood
- MRC Clinical Sciences Centre, Imperial College London, London, United Kingdom
| | - Gurpreet S. Wander
- Hero DMC Heart Institute, Dayanand Medical College and Hospital, Ludhiana, India
| | - Frank Geoghegan
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | | | | | - Timothy J. Aitman
- MRC Clinical Sciences Centre, Imperial College London, London, United Kingdom
| | - Mark I. McCarthy
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Churchill Hospital, Oxford, United Kingdom
- Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | - James Scott
- NHLI, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Sarah Butcher
- Centre for Integrative Systems Biology and Bioinformatics, Imperial College London, London, United Kingdom
| | - Paul Elliott
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- MRC-HPA Centre for Environment and Health, Imperial College London, Norfolk Place, London, United Kingdom
| | - Jaspal S. Kooner
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
- NHLI, Imperial College London, Hammersmith Hospital, London, United Kingdom
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Mahajan A, Go MJ, Zhang W, Below JE, Gaulton KJ, Ferreira T, Horikoshi M, Johnson AD, Ng MCY, Prokopenko I, Saleheen D, Wang X, Zeggini E, Abecasis GR, Adair LS, Almgren P, Atalay M, Aung T, Baldassarre D, Balkau B, Bao Y, Barnett AH, Barroso I, Basit A, Been LF, Beilby J, Bell GI, Benediktsson R, Bergman RN, Boehm BO, Boerwinkle E, Bonnycastle LL, Burtt N, Cai Q, Campbell H, Carey J, Cauchi S, Caulfield M, Chan JCN, Chang LC, Chang TJ, Chang YC, Charpentier G, Chen CH, Chen H, Chen YT, Chia KS, Chidambaram M, Chines PS, Cho NH, Cho YM, Chuang LM, Collins FS, Cornelis MC, Couper DJ, Crenshaw AT, van Dam RM, Danesh J, Das D, de Faire U, Dedoussis G, Deloukas P, Dimas AS, Dina C, Doney AS, Donnelly PJ, Dorkhan M, van Duijn C, Dupuis J, Edkins S, Elliott P, Emilsson V, Erbel R, Eriksson JG, Escobedo J, Esko T, Eury E, Florez JC, Fontanillas P, Forouhi NG, Forsen T, Fox C, Fraser RM, Frayling TM, Froguel P, Frossard P, Gao Y, Gertow K, Gieger C, Gigante B, Grallert H, Grant GB, Grrop LC, Groves CJ, Grundberg E, Guiducci C, Hamsten A, Han BG, Hara K, Hassanali N, Hattersley AT, Hayward C, Hedman AK, Herder C, Hofman A, Holmen OL, Hovingh K, Hreidarsson AB, Hu C, Hu FB, Hui J, Humphries SE, Hunt SE, Hunter DJ, Hveem K, Hydrie ZI, Ikegami H, Illig T, Ingelsson E, Islam M, Isomaa B, Jackson AU, Jafar T, James A, Jia W, Jöckel KH, Jonsson A, Jowett JBM, Kadowaki T, Kang HM, Kanoni S, Kao WHL, Kathiresan S, Kato N, Katulanda P, Keinanen-Kiukaanniemi KM, Kelly AM, Khan H, Khaw KT, Khor CC, Kim HL, Kim S, Kim YJ, Kinnunen L, Klopp N, Kong A, Korpi-Hyövälti E, Kowlessur S, Kraft P, Kravic J, Kristensen MM, Krithika S, Kumar A, Kumate J, Kuusisto J, Kwak SH, Laakso M, Lagou V, Lakka TA, Langenberg C, Langford C, Lawrence R, Leander K, Lee JM, Lee NR, Li M, Li X, Li Y, Liang J, Liju S, Lim WY, Lind L, Lindgren CM, Lindholm E, Liu CT, Liu JJ, Lobbens S, Long J, Loos RJF, Lu W, Luan J, Lyssenko V, Ma RCW, Maeda S, Mägi R, Männisto S, Matthews DR, Meigs JB, Melander O, Metspalu A, Meyer J, Mirza G, Mihailov E, Moebus S, Mohan V, Mohlke KL, Morris AD, Mühleisen TW, Müller-Nurasyid M, Musk B, Nakamura J, Nakashima E, Navarro P, Ng PK, Nica AC, Nilsson PM, Njølstad I, Nöthen MM, Ohnaka K, Ong TH, Owen KR, Palmer CNA, Pankow JS, Park KS, Parkin M, Pechlivanis S, Pedersen NL, Peltonen L, Perry JRB, Peters A, Pinidiyapathirage JM, Platou CG, Potter S, Price JF, Qi L, Radha V, Rallidis L, Rasheed A, Rathman W, Rauramaa R, Raychaudhuri S, Rayner NW, Rees SD, Rehnberg E, Ripatti S, Robertson N, Roden M, Rossin EJ, Rudan I, Rybin D, Saaristo TE, Salomaa V, Saltevo J, Samuel M, Sanghera DK, Saramies J, Scott J, Scott LJ, Scott RA, Segrè AV, Sehmi J, Sennblad B, Shah N, Shah S, Shera AS, Shu XO, Shuldiner AR, Sigurđsson G, Sijbrands E, Silveira A, Sim X, Sivapalaratnam S, Small KS, So WY, Stančáková A, Stefansson K, Steinbach G, Steinthorsdottir V, Stirrups K, Strawbridge RJ, Stringham HM, Sun Q, Suo C, Syvänen AC, Takayanagi R, Takeuchi F, Tay WT, Teslovich TM, Thorand B, Thorleifsson G, Thorsteinsdottir U, Tikkanen E, Trakalo J, Tremoli E, Trip MD, Tsai FJ, Tuomi T, Tuomilehto J, Uitterlinden AG, Valladares-Salgado A, Vedantam S, Veglia F, Voight BF, Wang C, Wareham NJ, Wennauer R, Wickremasinghe AR, Wilsgaard T, Wilson JF, Wiltshire S, Winckler W, Wong TY, Wood AR, Wu JY, Wu Y, Yamamoto K, Yamauchi T, Yang M, Yengo L, Yokota M, Young R, Zabaneh D, Zhang F, Zhang R, Zheng W, Zimmet PZ, Altshuler D, Bowden DW, Cho YS, Cox NJ, Cruz M, Hanis CL, Kooner J, Lee JY, Seielstad M, Teo YY, Boehnke M, Parra EJ, Chambers JC, Tai ES, McCarthy MI, Morris AP. Genome-wide trans-ancestry meta-analysis provides insight into the genetic architecture of type 2 diabetes susceptibility. Nat Genet 2014; 46:234-44. [PMID: 24509480 PMCID: PMC3969612 DOI: 10.1038/ng.2897] [Citation(s) in RCA: 777] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 01/17/2014] [Indexed: 11/18/2022]
Abstract
To further understanding of the genetic basis of type 2 diabetes (T2D) susceptibility, we aggregated published meta-analyses of genome-wide association studies (GWAS) including 26,488 cases and 83,964 controls of European, East Asian, South Asian, and Mexican and Mexican American ancestry. We observed significant excess in directional consistency of T2D risk alleles across ancestry groups, even at SNPs demonstrating only weak evidence of association. By following up the strongest signals of association from the trans-ethnic meta-analysis in an additional 21,491 cases and 55,647 controls of European ancestry, we identified seven novel T2D susceptibility loci. Furthermore, we observed considerable improvements in fine-mapping resolution of common variant association signals at several T2D susceptibility loci. These observations highlight the benefits of trans-ethnic GWAS for the discovery and characterisation of complex trait loci, and emphasize an exciting opportunity to extend insight into the genetic architecture and pathogenesis of human diseases across populations of diverse ancestry.
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Tan ST, Scott W, Panoulas V, Sehmi J, Zhang W, Scott J, Elliott P, Chambers J, Kooner JS. Coronary heart disease in Indian Asians. Glob Cardiol Sci Pract 2014; 2014:13-23. [PMID: 25054115 PMCID: PMC4104373 DOI: 10.5339/gcsp.2014.4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/11/2014] [Accepted: 02/19/2014] [Indexed: 12/16/2022] Open
Abstract
The Indian Asian population accounts for a fifth of all global deaths from coronary heart disease (CHD). CHD deaths on the Indian subcontinent have doubled since 1990, and are predicted to rise a further 50% by 2030. Reasons underlying the increased CHD mortality among Indian Asians remain unknown. Although conventional cardiovascular risk factors contribute to CHD in Indian Asians as in other populations, these do not account for their increased risk. Type-2 diabetes, insulin resistance and related metabolic disturbances are more prevalent amongst Indian Asians than Europeans, and have been proposed as major determinants of higher CHD risk among Indian Asians. However, this view is not supported by prospective data. Genome-wide association studies have not identified differences in allele frequencies or effect sizes in known loci to explain the increased CHD risk in Indian Asians. Limited knowledge of mechanisms underlying higher CHD risk amongst Indian Asians presents a major obstacle to reducing the burden of CHD in this population. Systems biology approaches such as genomics, epigenomics, metabolomics and transcriptomics, provide a non-biased approach for discovery of novel biomarkers and disease pathways underlying CHD. Incorporation of these ‘omic’ approaches in prospective Indian Asian cohorts such as the London Life Sciences Population Study (LOLIPOP) provide an exciting opportunity for the identification of new risk factors underlying CHD in this high risk population.
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Affiliation(s)
| | | | | | | | | | - James Scott
- NHLI, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
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28
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van der Harst P, Zhang W, Mateo Leach I, Rendon A, Verweij N, Sehmi J, Paul DS, Elling U, Allayee H, Li X, Radhakrishnan A, Tan ST, Voss K, Weichenberger CX, Albers CA, Al-Hussani A, Asselbergs FW, Ciullo M, Danjou F, Dina C, Esko T, Evans DM, Franke L, Gögele M, Hartiala J, Hersch M, Holm H, Hottenga JJ, Kanoni S, Kleber ME, Lagou V, Langenberg C, Lopez LM, Lyytikäinen LP, Melander O, Murgia F, Nolte IM, O'Reilly PF, Padmanabhan S, Parsa A, Pirastu N, Porcu E, Portas L, Prokopenko I, Ried JS, Shin SY, Tang CS, Teumer A, Traglia M, Ulivi S, Westra HJ, Yang J, Zhao JH, Anni F, Abdellaoui A, Attwood A, Balkau B, Bandinelli S, Bastardot F, Benyamin B, Boehm BO, Cookson WO, Das D, de Bakker PIW, de Boer RA, de Geus EJC, de Moor MH, Dimitriou M, Domingues FS, Döring A, Engström G, Eyjolfsson GI, Ferrucci L, Fischer K, Galanello R, Garner SF, Genser B, Gibson QD, Girotto G, Gudbjartsson DF, Harris SE, Hartikainen AL, Hastie CE, Hedblad B, Illig T, Jolley J, Kähönen M, Kema IP, Kemp JP, Liang L, Lloyd-Jones H, Loos RJF, Meacham S, Medland SE, Meisinger C, Memari Y, Mihailov E, Miller K, Moffatt MF, Nauck M, Novatchkova M, Nutile T, Olafsson I, Onundarson PT, Parracciani D, Penninx BW, Perseu L, Piga A, Pistis G, Pouta A, Puc U, Raitakari O, Ring SM, Robino A, Ruggiero D, Ruokonen A, Saint-Pierre A, Sala C, Salumets A, Sambrook J, Schepers H, Schmidt CO, Silljé HHW, Sladek R, Smit JH, Starr JM, Stephens J, Sulem P, Tanaka T, Thorsteinsdottir U, Tragante V, van Gilst WH, van Pelt LJ, van Veldhuisen DJ, Völker U, Whitfield JB, Willemsen G, Winkelmann BR, Wirnsberger G, Algra A, Cucca F, d'Adamo AP, Danesh J, Deary IJ, Dominiczak AF, Elliott P, Fortina P, Froguel P, Gasparini P, Greinacher A, Hazen SL, Jarvelin MR, Khaw KT, Lehtimäki T, Maerz W, Martin NG, Metspalu A, Mitchell BD, Montgomery GW, Moore C, Navis G, Pirastu M, Pramstaller PP, Ramirez-Solis R, Schadt E, Scott J, Shuldiner AR, Smith GD, Smith JG, Snieder H, Sorice R, Spector TD, Stefansson K, Stumvoll M, Tang WHW, Toniolo D, Tönjes A, Visscher PM, Vollenweider P, Wareham NJ, Wolffenbuttel BHR, Boomsma DI, Beckmann JS, Dedoussis GV, Deloukas P, Ferreira MA, Sanna S, Uda M, Hicks AA, Penninger JM, Gieger C, Kooner JS, Ouwehand WH, Soranzo N, Chambers JC. Seventy-five genetic loci influencing the human red blood cell. Nature 2012; 492:369-75. [PMID: 23222517 DOI: 10.1038/nature11677] [Citation(s) in RCA: 245] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 10/15/2012] [Indexed: 11/09/2022]
Abstract
Anaemia is a chief determinant of global ill health, contributing to cognitive impairment, growth retardation and impaired physical capacity. To understand further the genetic factors influencing red blood cells, we carried out a genome-wide association study of haemoglobin concentration and related parameters in up to 135,367 individuals. Here we identify 75 independent genetic loci associated with one or more red blood cell phenotypes at P < 10(-8), which together explain 4-9% of the phenotypic variance per trait. Using expression quantitative trait loci and bioinformatic strategies, we identify 121 candidate genes enriched in functions relevant to red blood cell biology. The candidate genes are expressed preferentially in red blood cell precursors, and 43 have haematopoietic phenotypes in Mus musculus or Drosophila melanogaster. Through open-chromatin and coding-variant analyses we identify potential causal genetic variants at 41 loci. Our findings provide extensive new insights into genetic mechanisms and biological pathways controlling red blood cell formation and function.
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Affiliation(s)
- Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
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Chambers JC, Tan ST, Zhang WH, Sehmi J, Al-Hussaini A, Ramasamy M, Scott J, Elliott P, Kooner JS. 114 Whole genome sequencing to identify genetic variants underlying cardiovascular disease among Indian Asians. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tan ST, Sehmi J, Al-Hussaini A, Ala-Korpela M, Elliott P, Chambers JC, Kooner JS. 151 Nuclear magnetic resonance profiling of serum identifies novel biomarker associated with coronary atherosclerosis. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chambers JC, Zhang W, Sehmi J, Li X, Wass MN, Van der Harst P, Holm H, Sanna S, Kavousi M, Baumeister SE, Coin LJ, Deng G, Gieger C, Heard-Costa NL, Hottenga JJ, Kühnel B, Kumar V, Lagou V, Liang L, Luan J, Vidal PM, Mateo Leach I, O'Reilly PF, Peden JF, Rahmioglu N, Soininen P, Speliotes EK, Yuan X, Thorleifsson G, Alizadeh BZ, Atwood LD, Borecki IB, Brown MJ, Charoen P, Cucca F, Das D, de Geus EJC, Dixon AL, Döring A, Ehret G, Eyjolfsson GI, Farrall M, Forouhi NG, Friedrich N, Goessling W, Gudbjartsson DF, Harris TB, Hartikainen AL, Heath S, Hirschfield GM, Hofman A, Homuth G, Hyppönen E, Janssen HLA, Johnson T, Kangas AJ, Kema IP, Kühn JP, Lai S, Lathrop M, Lerch MM, Li Y, Liang TJ, Lin JP, Loos RJF, Martin NG, Moffatt MF, Montgomery GW, Munroe PB, Musunuru K, Nakamura Y, O'Donnell CJ, Olafsson I, Penninx BW, Pouta A, Prins BP, Prokopenko I, Puls R, Ruokonen A, Savolainen MJ, Schlessinger D, Schouten JNL, Seedorf U, Sen-Chowdhry S, Siminovitch KA, Smit JH, Spector TD, Tan W, Teslovich TM, Tukiainen T, Uitterlinden AG, Van der Klauw MM, Vasan RS, Wallace C, Wallaschofski H, Wichmann HE, Willemsen G, Würtz P, Xu C, Yerges-Armstrong LM, Abecasis GR, Ahmadi KR, Boomsma DI, Caulfield M, Cookson WO, van Duijn CM, Froguel P, Matsuda K, McCarthy MI, Meisinger C, Mooser V, Pietiläinen KH, Schumann G, Snieder H, Sternberg MJE, Stolk RP, Thomas HC, Thorsteinsdottir U, Uda M, Waeber G, Wareham NJ, Waterworth DM, Watkins H, Whitfield JB, Witteman JCM, Wolffenbuttel BHR, Fox CS, Ala-Korpela M, Stefansson K, Vollenweider P, Völzke H, Schadt EE, Scott J, Järvelin MR, Elliott P, Kooner JS. Genome-wide association study identifies loci influencing concentrations of liver enzymes in plasma. Nat Genet 2011; 43:1131-8. [PMID: 22001757 PMCID: PMC3482372 DOI: 10.1038/ng.970] [Citation(s) in RCA: 410] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 09/12/2011] [Indexed: 12/15/2022]
Abstract
Concentrations of liver enzymes in plasma are widely used as indicators of liver disease. We carried out a genome-wide association study in 61,089 individuals, identifying 42 loci associated with concentrations of liver enzymes in plasma, of which 32 are new associations (P = 10(-8) to P = 10(-190)). We used functional genomic approaches including metabonomic profiling and gene expression analyses to identify probable candidate genes at these regions. We identified 69 candidate genes, including genes involved in biliary transport (ATP8B1 and ABCB11), glucose, carbohydrate and lipid metabolism (FADS1, FADS2, GCKR, JMJD1C, HNF1A, MLXIPL, PNPLA3, PPP1R3B, SLC2A2 and TRIB1), glycoprotein biosynthesis and cell surface glycobiology (ABO, ASGR1, FUT2, GPLD1 and ST3GAL4), inflammation and immunity (CD276, CDH6, GCKR, HNF1A, HPR, ITGA1, RORA and STAT4) and glutathione metabolism (GSTT1, GSTT2 and GGT), as well as several genes of uncertain or unknown function (including ABHD12, EFHD1, EFNA1, EPHA2, MICAL3 and ZNF827). Our results provide new insight into genetic mechanisms and pathways influencing markers of liver function.
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Affiliation(s)
- John C Chambers
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, UK.
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Sehmi J, Salaheen D, Yeo Y, Zhang W, Das D, McCarthy MI, Tai ES, Danesh J, Kooner J, Chambers J. 71 A genome-wide association study in Indian Asians identifies four susceptibility loci for type-2 diabetes. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chambers JC, Zhang W, Zabaneh D, Sehmi J, Jain P, McCarthy MI, Froguel P, Ruokonen A, Balding D, Jarvelin MR, Scott J, Elliott P, Kooner JS. Common genetic variation near melatonin receptor MTNR1B contributes to raised plasma glucose and increased risk of type 2 diabetes among Indian Asians and European Caucasians. Diabetes 2009; 58:2703-8. [PMID: 19651812 PMCID: PMC2768158 DOI: 10.2337/db08-1805] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Fasting plasma glucose and risk of type 2 diabetes are higher among Indian Asians than among European and North American Caucasians. Few studies have investigated genetic factors influencing glucose metabolism among Indian Asians. RESEARCH DESIGN AND METHODS We carried out genome-wide association studies for fasting glucose in 5,089 nondiabetic Indian Asians genotyped with the Illumina Hap610 BeadChip and 2,385 Indian Asians (698 with type 2 diabetes) genotyped with the Illumina 300 BeadChip. Results were compared with findings in 4,462 European Caucasians. RESULTS We identified three single nucleotide polymorphisms (SNPs) associated with glucose among Indian Asians at P < 5 x 10(-8), all near melatonin receptor MTNR1B. The most closely associated was rs2166706 (combined P = 2.1 x 10(-9)), which is in moderate linkage disequilibrium with rs1387153 (r(2) = 0.60) and rs10830963 (r(2) = 0.45), both previously associated with glucose in European Caucasians. Risk allele frequency and effect sizes for rs2166706 were similar among Indian Asians and European Caucasians: frequency 46.2 versus 45.0%, respectively (P = 0.44); effect 0.05 (95% CI 0.01-0.08) versus 0.05 (0.03-0.07 mmol/l), respectively, higher glucose per allele copy (P = 0.84). SNP rs2166706 was associated with type 2 diabetes in Indian Asians (odds ratio 1.21 [95% CI 1.06-1.38] per copy of risk allele; P = 0.006). SNPs at the GCK, GCKR, and G6PC2 loci were also associated with glucose among Indian Asians. Risk allele frequencies of rs1260326 (GCKR) and rs560887 (G6PC2) were higher among Indian Asians compared with European Caucasians. CONCLUSIONS Common genetic variation near MTNR1B influences blood glucose and risk of type 2 diabetes in Indian Asians. Genetic variation at the MTNR1B, GCK, GCKR, and G6PC2 loci may contribute to abnormal glucose metabolism and related metabolic disturbances among Indian Asians.
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Affiliation(s)
- John C. Chambers
- Department of Epidemiology and Public Health, Imperial College London, London, U.K
| | - Weihua Zhang
- Department of Epidemiology and Public Health, Imperial College London, London, U.K
| | - Delilah Zabaneh
- Department of Epidemiology and Public Health, Imperial College London, London, U.K
| | - Joban Sehmi
- National Heart and Lung Institute, Imperial College London, London, U.K
| | - Piyush Jain
- National Heart and Lung Institute, Imperial College London, London, U.K
| | - Mark I. McCarthy
- Oxford Centre for Diabetes, Endocrinology and Metabolism and Oxford National Institute for Health Research, Biomedical Research Centre, Oxford, U.K
| | - Philippe Froguel
- Section of Genomic Medicine, Imperial College London, London, U.K., and the Centre National de la Recherche Scientifique, 8090-Institute of Biology, Pasteur Institute, Lille, France
- UMR 8090-Institute of Biology, Pasteur Institute, Lille, France
| | - Aimo Ruokonen
- Department of Clinical Sciences/Clinical Chemistry, University Hospital Oulu, Oulu, Finland
| | - David Balding
- Department of Epidemiology and Public Health, Imperial College London, London, U.K
| | - Marjo-Riitta Jarvelin
- Department of Epidemiology and Public Health, Imperial College London, London, U.K
- Institute of Health Sciences and Biocenter Oulu, University of Oulu, Oulu, Finland, and Department of Child and Adolescent Health, National Institute of Health and Welfare, Helsinki, Finland
| | - James Scott
- National Heart and Lung Institute, Imperial College London, London, U.K
| | - Paul Elliott
- Department of Epidemiology and Public Health, Imperial College London, London, U.K
| | - Jaspal S. Kooner
- National Heart and Lung Institute, Imperial College London, London, U.K
- Corresponding author: Jaspal S. Kooner,
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Halligan E, Bible J, Sehmi J, Dunn H, Tong W, MacMahon E. PIV-36 Performance of the Qiagen Resplex II ver. 2.0 & ver. 3.0 multiplex assays for the detection of (H1N1V) pandemic influenza A in a London teaching hospital. J Clin Virol 2009. [PMCID: PMC7128969 DOI: 10.1016/s1386-6532(09)70132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ramble J, Bible J, Halligan E, Dunn H, Sehmi J, Tong C, MacMahon E. PXII-24 Analysis of rhinovirus/enterovirus infections associated with paediatric hospitalisations. J Clin Virol 2009. [DOI: 10.1016/s1386-6532(09)70275-6] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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