1
|
Knott K, Leinfelder S, Schultz R, Balzer A, Palisch AR. MRI spectrum of injuries to the thumb metacarpophalangeal joint ulnar collateral ligament with a proposed expanded classification of injuries in American football players. Skeletal Radiol 2023:10.1007/s00256-023-04539-6. [PMID: 38110778 DOI: 10.1007/s00256-023-04539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint are of both historic and modern interest for athletes and non-athletes alike. The thumb metacarpophalangeal joint requires stability in both flexion and extension utilizing a combination of static and dynamic stabilizers. This article reviews the magnetic resonance imaging categorization of thumb ulnar collateral ligament injuries and proposes two additional injury patterns seen in high-level and professional athletes who play American football. In addition to the direct magnetic resonance imaging findings in collateral ligament tears, secondary findings of rotation and subluxation can be seen at the thumb metacarpophalangeal joint due to the altered physiologic forces on the joint. Internal brace augmentation via suture tape of a traditional ulnar collateral ligament repair is a novel surgical technique that provides protection during initial healing and the ensuing remodeling phase following repair or reconstruction, resulting in a faster return to play.
Collapse
Affiliation(s)
- Kemp Knott
- Department of Radiology, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Stephen Leinfelder
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22098, USA
| | - Ryan Schultz
- Department of Radiology, University of Missouri, Columbia, MO, 65211, USA
| | - Anthony Balzer
- Department of Radiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Andrew R Palisch
- Department of Radiology, University of Missouri, Columbia, MO, 65211, USA
| |
Collapse
|
2
|
Shiwani H, Hughes RK, Camaioni C, Augusto JB, Knott K, Rosmini S, Burke L, Pierce I, Moon JC, Davies RH. Asymmetric septal thickening is observed in hypertrophic cardiomyopathy mutation carriers without left ventricular hypertrophy: insights from AI analysis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.011] [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: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Hughes is supported by the British Heart Foundation (grant number FS/17/82/33222).
Background
Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disease characterised by left ventricular hypertrophy (LVH), often, with asymmetric septal thickening. Despite the prevalence of inherited mutations present in >50% of cases, there is variable phenotypic expression in those with abnormal sarcomere protein genes. In individuals with abnormal genes but without LVH, we hypothesised that there is subtle asymmetric septal hypertrophy, detectable by the increased precision offered by an artificial intelligence (AI) tool for measuring wall thickness.
Purpose
We explored the septal-lateral ratio measured by AI in individuals with an identified genotype but no left ventricular hypertrophy as a component of sub-clinical HCM.
Methods
43 individuals with identified genotype, but no left ventricular hypertrophy (G+LVH-) and 97 age-, sex- and disease-matched controls underwent CMR. Patients were excluded if they had a maximum wall thickness (MWT) of ≥13mm. A clinically validated AI tool was used to measure the MWT, for each segment in the 16-segment AHA model. The septal-lateral ratio was calculated using the septal segment with the largest MWT and the lateral segment with the largest MWT.
Results
The mean septal-lateral ratio of the G+LVH- patients was 1.22 (SD 0.22) and the mean septal-lateral ratio of the matched controls was 1.14 (SD 0.15) with a statistically significant mean difference of 0.08 (p=0.01). There was no significant difference between the MWT of the G+LVH- patients at 10.3mm (SD 2.2) and healthy volunteers at 10.1mm (SD 1.8) (p = 0.61).
Conclusion
G+LVH- patients have a 7% increase in their septal-lateral ratio compared with age-matched controls despite the lack of difference in the MWT. Using increased precision offered by AI, early features of HCM can be observed in patients without overt LVH.
Collapse
Affiliation(s)
- H Shiwani
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - R K Hughes
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - C Camaioni
- Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - J B Augusto
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - S Rosmini
- Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - L Burke
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - I Pierce
- Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - R H Davies
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
3
|
Shiwani H, Hughes RK, Camaioni C, Augusto JB, Knott K, Rosmini S, Khoury S, Malcolmson J, Kellman P, Xue H, Burke L, Pierce I, Moon JC, Davies RH. Improving the diagnostic accuracy of apical hypertrophic cardiomyopathy using machine learning. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.009] [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
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Hughes is supported by the British Heart Foundation (grant number FS/17/82/33222).
Introduction
The imaging criteria for diagnosis of apical hypertrophic cardiomyopathy (ApHCM) is a maximum wall thickness (MWT) ≥15mm. CMR enables detection of subtle phenotypic features (e.g. loss of apical tapering, cavity obliteration) and coupled with characteristic electrocardiogram changes, ApHCM can be diagnosed without overt hypertrophy. However, these patients are not captured by current diagnostic criteria.
Purpose
We sought to use a machine learning tool to quantify wall thickness and identify patients with ‘relative’ ApHCM that do not reach current diagnostic thresholds.
Methods
CMR images from 4118 healthy participants from the UK Biobank were segmented automatically with a clinically validated machine learning algorithm and wall thickness measured at all point in the myocardium by solving a solution to Laplace’s equation. MWT were pooled into 16 AHA segments and indexed to body surface area (BSA). The non-indexed and indexed segmental upper limit of normal was calculated as the mean + 3 standard deviations (the equivalent of 95% confidence interval after correcting for multiple [16] comparisons using the Bonferroni method).
Results
73 overt ApHCM subjects (MWT>15mm) and 31 relative ApHCM subjects underwent CMR scanning. In healthy controls, the non-indexed (and indexed) upper limits were calculated for the apical-anterior 10.2mm (5.2 mm/m2), apical-septal 11.1mm (5.6 mm/m2), apical-inferior 10.5mm (5.3 mm/m2) and apical-lateral 10.1mm (5.2 mm/m2) segments. With a non-indexed cut-off, all (73 of 73) overt ApHCM and 84% (26 of 31) relative ApHCM were classified as having an abnormally thick apex. 3% (127 of 4118) of the healthy UK Biobank cohort were classified as abnormal, as expected. Using an indexed cut-off, all overt ApHCM and 87% (27/31) relative ApHCM were classified as abnormal, and 3% (123 of 4118) of the healthy UK Biobank cohort were misclassified.
Conclusion
We can successfully classify 87% of relative ApHCM patients from a normative reference range derived from a large cohort of healthy patients – a significant improvement on existing methods. We show that the specificity and sensitivity is increased when MWT is indexed to BSA. For practical clinical application, we recommend a cut-off of 10mm or an indexed cut-off of 5mm/m2 in any apical segment to diagnose apical LVH. Overt and relative apical HCM examplesHealthy controls AHA maps (non-indexed)
Collapse
Affiliation(s)
- H Shiwani
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - R K Hughes
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - C Camaioni
- Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - J B Augusto
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - S Rosmini
- Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - S Khoury
- St George's University of London, Cardiovascular Clinical and Academic Group , London , United Kingdom of Great Britain & Northern Ireland
| | - J Malcolmson
- Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - H Xue
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - L Burke
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - I Pierce
- Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| | - R H Davies
- University College London , London , United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
4
|
Saberwal B, Patel K, Scully PR, Klotz E, Seraphim A, Augusto J, Vandermolen S, Knott K, Thornton GD, Haberland U, Sutcliffe J, Khanji MY, Moon JC, Treibel TA, Pugliese F. Computed tomography vs cardiovascular magnetic resonance imaging derived extracellular volume fraction in patients with stable new-onset chest pain. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0153] [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
Computed tomography (CT) is increasingly recognised as a diagnostic modality across a range of cardiovascular conditions and is now first-line for the investigation of stable new-onset chest pain. Determination of the myocardial extracellular volume fraction (ECV) has been shown to correlate well with the identification and prognostication of disease. Cardiovascular magnetic resonance (CMR) imaging remains the gold standard for the measurement of myocardial ECVCMR using T1-mapping, but there is increasing evidence for the use of ECV by cardiac CT (ECVCT).
Purpose
To assess the performance of ECVCT against the reference standard of ECVCMR.
Methods
Patients with a history of chest pain and no previously documented coronary disease referred for invasive angiography were recruited as part of the EVINCI Heart-QIT study. A cohort of these patients (n=33) underwent CMR at 1.5T (Siemens Aera, Siemens Healthcare, Erlangen/Germany) with T1 mapping of a mid-ventricular short axis slice (by MOdified Look-Locker Inversion recovery [MOLLI]) before and 15 minutes after a bolus of gadolinium contrast (0.1 mmol/kg gadoterate meglumine), followed by whole-heart ECVCT quantification (Somatom Force, Siemens Healthcare, Erlangen/Germany) using a 5-min post-iodine-contrast acquisition protocol. To account for data clustering on a patient level and volumetric discrepancy on a modality level, comparisons were made using mid-ventricular pooled ECVCT and ECVCMR. Bland-Altman analysis was used to determine the limits of agreement and identify systematic differences between both measures.
Results
A total of 33 patients (70% male, mean age 56.8±12.6yr) underwent the combined CMR and CT. ECVCMR and ECVCT were then analysed retrospectively (Figure 1). The average pooled ECV for the 6 mid-ventricular segments for CMR and CT were (27.6±2.4 and 26.8±2.2 respectively). Bland-Altman analysis demonstrated a marginally higher CMR-ECV (0.8±2.1) vs CT-ECV, which is in keeping with the longer delay-time encountered in CMR protocols (Figure 2).
Conclusions
ECVCT obtained from 5-minute post-contrast CT protocols show good agreement with ECVCMR in a stable chest pain patient cohort.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Siemens Helthineers Educational Grant Figure 1. CMR (L) and CT (R) ECV mapsFigure 2. Bland-Altman plot
Collapse
Affiliation(s)
- B Saberwal
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | - K Patel
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - P R Scully
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - E Klotz
- Siemens Healthineers, Forchheim, Germany
| | - A Seraphim
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - J Augusto
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - S Vandermolen
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | - K Knott
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - G D Thornton
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | | | - J Sutcliffe
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | - M Y Khanji
- Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| | - J C Moon
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - T A Treibel
- University College Hospital, Institute of cardiovascular sciences, London, United Kingdom
| | - F Pugliese
- Queen Mary University of London, Barts Heart Centre, Advanced Cardiovascular Imaging, London, United Kingdom
| |
Collapse
|
5
|
Seraphim A, Knott K, Menacho K, Augusto J, Davies R, Joy G, Hui X, Treibel T, Cooper J, Petersen S, Fontana M, Hughes A, Moon J, Manisty C, Kellman P. Comparison of the prognostic value of stress and rest pulmonary transit time estimation using myocardial perfusion CMR. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.017] [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
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
Background
Pulmonary transit time (PTT) is a quantitative biomarker of cardiopulmonary status. Rest PTT was previously shown to predict outcomes in specific disease models, but clinical adoption is hindered but challenges in data acquisition. Whether evaluation of PTT during stress encodes incremental prognostic information has not been previously investigated as scale.
Objectives
To compare the prognostic value of stress and rest PTT derived from a fully automated, in-line method of estimation using perfusion CMR, in a large patient cohort.
Methods
A retrospective two-center study of patients referred clinically for adenosine stress myocardial perfusion assessment using CMR. Analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically, allowing the in-line estimation of both rest and stress PTT. Association with major adverse cardiovascular events (MACE) was evaluated. MACE was defined as a composite outcome of myocardial infarction, stroke, heart failure admission and ventricular tachycardia or appropriate ICD treatment (including ICD shock and/or anti-tachycardia pacing).
Results
985 patients (67% male, median age 62 years (IQR 52,71)) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR 54-69). Median stress PTT was shorter than rest PTT 6.2 (IQR 5.1, 7.7) seconds versus 7.7 (IQR, 6.4, 9.2) seconds. Stress and rest PTT were highly correlated (r = 0.69; p < 0.001). Stress PTT also correlated with LVEF (r=-0.37), stress MBF (r=-0.31), LVEDVi (r = 0.24), LA area index (r = 0.32) (p < 0.001 for all). Over a median follow-up period of 28.6 (IQR, 22.6 35,7) months, MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both rest and stress PTT, independently predicted MACE, but not all-cause mortality. For every 1xSD (2.39s) increase in rest PTT the adjusted hazard ratio (HR) for MACE was 1.43 (95% CI 1.10-1.85, p = 0.007). The hazard ratio for one standard deviation (2.64s) increase in stress PTT was 1.34 (95% CI 1.048-1.723; p = 0.020) after adjusting for age, LVEF, hypertension, diabetes, sex and presence of LGE
Conclusions
In this 2-center study of 985 patients, we deploy a fully automated method of PTT estimation using perfusion mapping with CMR and show that both stress and rest PTT are independently associated with adverse cardiovascular outcomes. In this patient cohort, there is no clear incremental prognostic value of stress PTT, over its evaluation during rest.
Figure 1. Stress and Rest Pulmonary Transit Time estimation using myocardial perfusion CMR
Figure 2. Event-free survival curves for major adverse cardiovascular events (Heart failure hospitalization, myocardial infarction, stroke and ventricular tachycardia/ICD treatment) according to mean rest PTT (8.05seconds) and mean stress PTT (6.7seconds). Log-rank for both p < 0.05
Collapse
Affiliation(s)
- A Seraphim
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Menacho
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Augusto
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - G Joy
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - X Hui
- National Institutes of Health, Bethesda, United States of America
| | - T Treibel
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Cooper
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Petersen
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Hughes
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| |
Collapse
|
6
|
Thornton G, Shetye A, Knott K, Razvi Y, Vimalesvaran K, Kurdi H, Artico J, Yousef S, Antonakaki D, Kellman P, Knight D, Cole GD, Moon JC, Fontana M, Treibel TA. Myocardial perfusion after COVID-19 infection: No persisting impaired myocardial blood flow in surviving patients. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC8344937 DOI: 10.1093/ehjci/jeab090.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Background Acute myocardial damage is common in hospitalized patients with severe COVID-19, with evidence of myocardial infarction and myocarditis demonstrated on cardiovascular magnetic resonance (CMR). Post-mortem studies have also implicated microvascular thrombosis, which may cause persistent microvascular disease. Purpose To determine the long-term coronary sequelae in recovered COVID-19 using multiparametric CMR including state-of-the-art inline quantitative stress myocardial blood flow (sMBF) mapping to assess global and regional sMBF. Methods Prospective, multicentre observational study of recovered COVID-19 patients scanned at three London CMR units. Results were compared to a propensity-matched, pre-COVID chest pain cohort (104 patients referred for perfusion CMR, with subsequently demonstrated unobstructed coronary arteries) and 27 healthy volunteers (HV). Perfusion image analysis was performed using a novel artificial intelligence approach deriving global and regional stress and rest MBF with a cut-off of >2.25mL/g/min signifying normal sMBF and <1.82mL/g/min abnormal sMBF (Kotecha JCVI 2019). Results 104 recovered, post-COVID patients (median age 62 years, 76% male; 89[87%] hospitalised, 41/89[46%] requiring ICU) underwent adenosine-stress perfusion CMR at a median 131(IQR 43-179) days from COVID-19 diagnosis. Median LVEF was 67% (IQR 60-71%; 12 (11.5%) with impaired LVEF), 51 patients (49%) had late gadolinium enhancement (LGE); 18% infarct-pattern and 33% non-ischaemic LGE. Global stress MBF in post-COVID patients was no different to age-, sex- and co-morbidities-matched controls (2.57 ± 0.77 vs. 2.40 ± 0.75 ml/g/min, p = 0.11, Figure 1), though lower than HV (3.00 ± 0.76 ml/g/min, p = 0.001). Post-COVID, multivariate predictors of low sMBF were male sex (OR 0.57, 95%CI 0.41-0.80, p = 0.001) and hypertension (OR 0.67, 95%CI 0.51-0.88, p = 0.004), but not COVID-19 disease severity (ICU admission) or presence of scar (ischemic/non-ischemic). 21/42 with reduced sMBF (<2.25mL/g/min) had regional perfusion defects consistent with epicardial coronary disease. Conclusions COVID-19 survivors do not demonstrate evidence of reduced global MBF by CMR compared to risk factor matched controls. Stress perfusion CMR identifies etiology of acute myocardial damage (infarction/myocarditis) and presence of occult coronary ischemia.
Collapse
Affiliation(s)
- G Thornton
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Shetye
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- King"s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - Y Razvi
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - K Vimalesvaran
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - H Kurdi
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J Artico
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Yousef
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - D Antonakaki
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Heart Lung and Blood Institute, Bethesda, United States of America
| | - D Knight
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - GD Cole
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - TA Treibel
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
7
|
Bhuva AN, D'Silva A, Torlasco C, Nadarajan N, Jones S, Boubertakh R, Van Zalen J, Scully P, Knott K, Benedetti G, Augusto JB, Bastiaenen R, Lloyd G, Sharma S, Moon JC, Parker KH, Manisty CH, Hughes AD. Non-invasive assessment of ventriculo-arterial coupling using aortic wave intensity analysis combining central blood pressure and phase-contrast cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2021; 21:805-813. [PMID: 31501858 DOI: 10.1093/ehjci/jez227] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/01/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Wave intensity analysis (WIA) in the aorta offers important clinical and mechanistic insight into ventriculo-arterial coupling, but is difficult to measure non-invasively. We performed WIA by combining standard cardiovascular magnetic resonance (CMR) flow-velocity and non-invasive central blood pressure (cBP) waveforms. METHODS AND RESULTS Two hundred and six healthy volunteers (age range 21-73 years, 47% male) underwent sequential phase contrast CMR (Siemens Aera 1.5 T, 1.97 × 1.77 mm2, 9.2 ms temporal resolution) and supra-systolic oscillometric cBP measurement (200 Hz). Velocity (U) and central pressure (P) waveforms were aligned using the waveform foot, and local wave speed was calculated both from the PU-loop (c) and the sum of squares method (cSS). These were compared with CMR transit time derived aortic arch pulse wave velocity (PWVtt). Associations were examined using multivariable regression. The peak intensity of the initial compression wave, backward compression wave, and forward decompression wave were 69.5 ± 28, -6.6 ± 4.2, and 6.2 ± 2.5 × 104 W/m2/cycle2, respectively; reflection index was 0.10 ± 0.06. PWVtt correlated with c or cSS (r = 0.60 and 0.68, respectively, P < 0.01 for both). Increasing age decade and female sex were independently associated with decreased forward compression wave (-8.6 and -20.7 W/m2/cycle2, respectively, P < 0.01) and greater wave reflection index (0.02 and 0.03, respectively, P < 0.001). CONCLUSION This novel non-invasive technique permits straightforward measurement of wave intensity at scale. Local wave speed showed good agreement with PWVtt, and correlation was stronger using the cSS than the PU-loop. Ageing and female sex were associated with poorer ventriculo-arterial coupling in healthy individuals.
Collapse
Affiliation(s)
- Anish N Bhuva
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - A D'Silva
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - C Torlasco
- IRCCS, Istituto Auxologico Italiano, Via Ludovico Ariosto 13, 20145 Milan, Italy, Italy
| | - N Nadarajan
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK
| | - S Jones
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK
| | - R Boubertakh
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - J Van Zalen
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - P Scully
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - K Knott
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - G Benedetti
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - J B Augusto
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - Rachel Bastiaenen
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - G Lloyd
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - S Sharma
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - J C Moon
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - K H Parker
- Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - C H Manisty
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London WC1E 7HB, UK
| |
Collapse
|
8
|
Knott K, Toslak IE, Siddique F, Joyce C, Shah R, Lomasney L. Radiographic evaluation of reactive osteitis in traumatic injury of sacroiliac joints. Clin Imaging 2021; 76:175-179. [PMID: 33957383 DOI: 10.1016/j.clinimag.2021.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/31/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES After traumatic Sacroiliac (SI) joint injury, follow up radiographic imaging can demonstrate subchondral bone resorption resembling inflammatory sacroiliitis. No studies have described the incidence of marginal SI post-traumatic osteitis, the probable temporal relationship to the initial traumatic injury, or the possible effect of unilateral hardware fixation on the contralateral SI joint. METHODS A Level 1 trauma center imaging database was queried to identify patients with pelvic bony trauma between 2005 and 2017 with CT baseline preserved SI cortication and unilateral/bilateral traumatic SI diastasis. Serial radiographs were retrospectively evaluated by 2 musculoskeletal-trained radiologists at initial, 6 weeks, 3 months and 6 months following trauma, with documentation of diastasis, subchondral resorption, and operative fixation. RESULTS 206 SI joints in 106 total patients met inclusion criteria. There was a statistically significant association between injury and presence of resorption at 6 weeks post-trauma for the right SI joint only. There was no other statistically significant relationship between injury and presence of resorption at any other post-trauma evaluation. There was no statistical relationship between resorption and surgical fixation. There was a statistically significant increased incidence of resorption in the post-traumatic population when compared to an atraumatic population undergoing CT pelvis study for non-SI related indications as well as compared to the incidence of inflammatory sacroiliitis in a general population. CONCLUSIONS This study confirms an incidence of sub-acute subchondral bone resorption following traumatic joint injury above that expected for a general, non-traumatic population. Accurate interpretation of this traumatic finding minimizes inappropriate consultation and intervention for inflammatory sacroiliitis.
Collapse
Affiliation(s)
- Kemp Knott
- Department of Radiology, Baylor College of Medicine, One Baylor Plaza, BCM 360, Houston, TX 77030, United States of America
| | - Iclal Erdem Toslak
- Department of Radiology, Antalya Training and Research Hospital, Varlik Mahallesi Kazim Karabekir Cd., 07100 Antalya, Turkey
| | - Faizah Siddique
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153, United States of America
| | - Cara Joyce
- Clinical Research Office, Loyola University Chicago Health Sciences Division, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States of America
| | - Ricki Shah
- United Imaging Consultants, 5800 Foxridge Dr, Mission, KS 66202, United States of America
| | - Laurie Lomasney
- Departments of Radiology and Orthopaedic Surgery and Rehabilitation, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153, United States of America.
| |
Collapse
|
9
|
Seraphim A, Knott K, Beirne AM, Augusto J, Menacho K, Joy G, Artico J, Bhuva A, Torii R, Triebel T, Xue H, Moon J, Jones D, Kellman P, Manisty C. Use of quantitative myocardial perfusion mapping by CMR for characterisation of ischaemia in patients post coronary artery bypass graft surgery. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.295] [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
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
Background
Quantitative myocardial perfusion mapping using Cardiac Magnetic Resonance (CMR) imaging is used for evaluation of ischaemia in the context of native vessel coronary disease, but its diagnostic performance in patients with grafts is not well established. Perfusion defects are often detected in these patients, but whether these are a consequence of a technical limitation (delayed contrast arrival from graft conduits) or a true reflection of reduced myocardial blood flow is unclear.
Methods
39 patients undergoing stress perfusion CMR with previous coronary artery bypass graft (CABG) surgery, unobstructed left internal mammary artery (LIMA) grafts to the left anterior descending (LAD) artery on coronary angiography and no CMR evidence of prior LAD infarction were included. Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) were evaluated with quantitative perfusion mapping and the factors determining MBF in the LIMA-LAD territory (AHA segments 1,2,7,8,13,14), including the impact of delayed contrast arrival through the LIMA graft were evaluated.
Results
In 28 out of 39 cases a myocardial perfusion defect was reported on visual assessment in LIMA-LAD myocardial territory, despite the presence of unobstructed LIMA graft and no LAD infarction. Chronic total occlusion (CTO) of the native LAD was an independent predictor of stress MBF (B=-0.36, p =0.027) and the strongest predictor of MPR (B=-0.55, p 0.005) within the LIMA-LAD myocardial territory after adjusting for age, left ventricular (LV) ejection fraction, and presence of diabetes. CTO of the native LAD was associated with a reduction in stress MBF in the basal myocardial segments (-0.57ml/g/min, p = 0.002) but had no effect on the MBF of apical segments (-0.31ml/g/min, p = 0.084). Increasing the maximum value for allowable arterial delay (TA) of contrast in the quantitative mapping algorithm resulted in a small increase in myocardial blood flow in the LIMA-LAD territory both at stress (0.07 ± 0.08ml/g/min, p < 0.001) and rest (0.06 ± 0.05ml/g/min, p < 0.001).
Conclusions
Perfusion defects detected in LIMA-LAD subtended territories are common despite graft patency. These defects are likely to represent genuine reduction in MBF, resulting from native LAD coronary occlusion. Prolonged contrast transit time associated with LIMA grafts results in small underestimation of MBF as measured by quantitative CMR perfusion mapping, but does not account for the degree of MBF reduction seen in these patients.
Figure 1. Study patient with unobstructed LIMA to LAD graft and evidence of inducible perfusion defect in LIMA-LAD territories. (A): First pass perfusion CMR imaging. (B): Perfusion mapping showing reduced stress MBF in mid antero-septum (0.85ml/g/min) compared to the apical septum (1.65ml/g/min). (C): Late gadolinium enhancement showing no evidence of previous infarction. (D,E): Coronary angiography demonstrating unobstructed LIMA graft (D) and anastomosis site (E).
Abstract Figure 1.
Collapse
Affiliation(s)
- A Seraphim
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - AM Beirne
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Augusto
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Menacho
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - G Joy
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Artico
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A Bhuva
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - R Torii
- University College London, Department of Mechanical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - T Triebel
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - J Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - D Jones
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - C Manisty
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
10
|
Knott K, Seraphim A, Augusto JB, Camaioni C, Kotecha T, Xue H, Joy G, Bhuva AN, Manisty C, Brown LAE, Wong J, Fontana M, Kellman P, Plein S, Moon JC. Influences on myocardial perfusion in non-obstructive coronary disease: an observational quantitative perfusion mapping study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.297] [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: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by a Clinical Training Research Fellowship (K. Knott) from the British Heart Foundation and directly and indirectly from the Biomedical Research Centre at University College London Hospitals and Barts Heart Centre.
Background
Cardiovascular magnetic resonance (CMR) with automated inline perfusion mapping permits rapid fully automated non-invasive myocardial blood flow (MBF, ml/g/min). Understanding the microvascular component of MBF would help optimize epicardial coronary artery disease detection and potentially serve as an independent diagnostic / therapeutic target.
Purpose
To explore MBF influences at stress and rest in patients with unobstructed epicardial coronary arteries.
Methods
242 participants (mean age 56.9 years) from 5 European centers with unobstructed epicardial coronary arteries and no myocardial scar underwent adenosine vasodilator perfusion mapping at stress and rest. The factors influencing MBF were determined using univariate and multivariate linear regression analyses.
Results
Mean rest perfusion was 0.91+/-0.24ml/g/min. Rest perfusion was higher in females (0.97+/-0.22ml/g/min vs 0.83 +/- 0.24ml/g/min) and lower in patients on beta blockers. Mean stress MBF was 2.53+/-0.82ml/g/min. Factors independently associated with reduced stress MBF were increasing age, diabetes, increasing left ventricular mass (LVMi) and the use of beta blockers. The predicted stress MBF can be obtained from the equation MBF = 2.66–0.015(age-60)–0.013(LVMi-57)-0.405(diabetes)–0.365(beta blocker). This means stress MBF falls 10% over 19 years and that diabetes drops the MBF by the equivalent of being 27 years older. These changes are large: for example, a 70-year-old diabetic would have 30% lower stress MBF than a 35 year-old non-diabetic.
Conclusions
In the absence of obstructive epicardial coronary disease, stress MBF falls with age, diabetes, increased LV mass and beta-blockers. These data may help develop normal reference ranges, input to other modelling (eg CT FFR), and they advance perfusion mapping as a measure of microvascular function.
Abstract Figure. Summary of the determinants of perfusion
Collapse
Affiliation(s)
- K Knott
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Seraphim
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JB Augusto
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Camaioni
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - T Kotecha
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - G Joy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - AN Bhuva
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - LAE Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Wong
- Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
11
|
Bicho Augusto J, Johner N, Shah D, Nordin S, Knott K, Lau C, Alfarih M, Seraphim A, Vijapurapu R, Ramaswami U, Steeds R, Kozor R, Hughes D, Moon J, Namdar M. The myocardial phenotype of Fabry disease pre-hypertrophy and pre-detectable storage. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2132] [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
Cardiac involvement in Fabry Disease (FD) occurs prior to left ventricular hypertrophy (LVH) and is characterized by low myocardial native T1 with storage reflected by cardiovascular magnetic resonance (CMR) and ECG changes.
Objectives
We hypothesize that a pre-storage myocardial phenotype might occur even earlier, prior to T1 lowering.
Methods
FD patients and age, sex and heart rate matched healthy controls underwent same-day ECG with advanced analysis and multiparametric CMR (cines, global longitudinal strain [GLS], T1 and T2 mapping, stress perfusion [myocardial blood flow, MBF] and late gadolinium enhancement [LGE]).
Results
114 Fabry patients (46±13 years, 61% female) and 76 controls (49±15 years, 50% female) were included. In pre-LVH FD (n=72, 63%), a low T1 (n=32/72, 44%) was associated with a constellation of ECG and functional abnormalities compared to normal T1 FD patients and controls. However, pre-LVH FD with normal T1 (n=40/72, 56%) also had abnormalities compared to controls: reduced GLS (−18±2 vs −20±2%, P<0.001), microvascular changes (lower MBF 2.5±0.7 vs 3.0±0.8mL/g/min, P=0.028), subtle T2 elevation (50±4 vs 48±2ms, p=0.027) and limited LGE (%LGE 0.3±1.1 vs 0%, P=0.004). ECG abnormalities included shorter P wave duration (88±12 vs 94±15ms, P=0.010) and T wave peak time (Tonset–Tpeak; 104±28 vs 115±20ms, P=0.015), resulting in a more symmetric T wave with lower T wave time ratio (Tonset–Tpeak)/(Tpeak–Tend) (1.5±0.4 vs 1.8±0.4, P<0.001) compared to controls.
Conclusions
FD has a measurable myocardial phenotype pre-LVH and pre-detectable myocyte storage with microvascular dysfunction, subtly impaired GLS and altered atrial depolarization and ventricular repolarization intervals.
Proposed stages of cardiac involvement
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
| | - N Johner
- Geneva University Hospitals, Cardiology Division, Geneva, Switzerland
| | - D Shah
- Geneva University Hospitals, Cardiology Division, Geneva, Switzerland
| | - S Nordin
- Barts Health NHS Trust, London, United Kingdom
| | - K Knott
- University College London, London, United Kingdom
| | - C Lau
- Barts Health NHS Trust, London, United Kingdom
| | - M Alfarih
- University College London, London, United Kingdom
| | - A Seraphim
- University College London, London, United Kingdom
| | - R Vijapurapu
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - U Ramaswami
- Royal Free Hospital, lysosomal storage disorders unit, London, United Kingdom
| | - R Steeds
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - R Kozor
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - D Hughes
- Royal Free Hospital, lysosomal storage disorders unit, London, United Kingdom
| | - J Moon
- Barts Health NHS Trust, London, United Kingdom
| | - M Namdar
- Geneva University Hospitals, Cardiology Division, Geneva, Switzerland
| |
Collapse
|
12
|
Bicho Augusto JA, Nordin S, Kozor R, Vijapurapu R, Knott K, Ramaswami U, Geberhiwot TD, Steeds RP, Baig S, Hughes D, Moon JC. P340Inflammatory cardiomyopathy in Fabry disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0174] [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
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in α-galactosidase A. Cardiovascular magnetic resonance (CMR) has helped unveil the pathogenesis of Fabry cardiomyopathy: sphingolipid storage (low T1 mapping values), left ventricular hypertrophy (LVH) and myocardial fibrosis with late gadolinium enhancement (LGE) characteristically present in the basal inferolateral (BIFL) wall. Recent evidence has suggested that the LGE may be inflammation and oedema as part of this pathogenic process.
Purpose
To assess the presence of inflammation in patients with FD using T2 mapping (for oedema/inflammation) supported by blood troponin levels (showing myocyte death and by inference inflammation).
Methods
A multi-centre international study in gene positive FD patients using CMR and blood biomarkers. All participants underwent CMR at 1.5 T. Native T1 and T2 mapping were performed. The T1 mapping sequence was MOLLI with sampling scheme in seconds. LGE used a phase sensitive inversion recovery sequence. Global longitudinal 2D strain (GLS) values were obtained using feature tracking analysis. Blood high-sensitivity troponin T (hsTnT) was measured on the same day.
Results
100 FD patients (age 43.8±1.3 years, 42% male) were included. 45% had LVH, 35% LGE. Low T1 mapping (normal <943ms) was found in 49% and 33% had high hsTnT values (normal <15ng/L). Mean T2 mapping values were 52.6±0.6ms in the BIFL wall and 49.5±0.3ms in the remote myocardium/septum (p<0.001, normal <53ms). T2 values in the BIFL wall were significantly higher among patients with LGE (58.2±6.1ms vs 49.2±3.1ms, p<0.001, Figure 1). In a per-segment analysis of 1600 segments, higher T2 values correlated positively with percentage of LGE per segment (r=0,262, p<0.001), T1 values (r=0,205, p<0.001), maximum wall thickness (r=0,253, p<0.001) and GLS values (r=0,212, p<0.001). HsTnT values were higher among patients with LGE (median of 31 vs 3ng/L in patients without LGE, p<0.001). There was a strong positive correlation between T2 values in the BIFL wall and ln(hsTnT) (r=0.776, p<0.001, Figure 2). The strongest predictor of increased hsTnT in multivariate analysis (age, sex, LVH, septum T1, T2 in the BIFL, GLS, LGE) was T2 in the BIFL wall (β=0.4, p=0.001).
Conclusions
Cardiac involvement in FD goes beyond storage (low T1 values). When LGE is present, this is almost always associated with a high T2 and troponin elevation supporting FD as a chronic inflammatory cardiomyopathy. Initial reports of LGE being fibrosis are too simplistic – LGE in FD appears to have a significant chronic inflammation/oedema component.
Collapse
Affiliation(s)
| | - S Nordin
- Barts Health NHS Trust, London, United Kingdom
| | - R Kozor
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - R Vijapurapu
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - K Knott
- University College London, London, United Kingdom
| | - U Ramaswami
- Royal Free Hospital, Lysosomal Storage Disorder Unit, London, United Kingdom
| | - T D Geberhiwot
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - R P Steeds
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - S Baig
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - D Hughes
- Royal Free Hospital, Lysosomal Storage Disorder Unit, London, United Kingdom
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom
| |
Collapse
|
13
|
Bicho Augusto JA, Nordon S, Kozor R, Vijapurapu R, Knott K, Hughes R, Rosmini S, Ramaswami U, Geberhiwot T, Steeds RP, Baig S, Hughes D, Moon JC. 323Inflammatory cardiomyopathy in Fabry disease. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez102.003] [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: 11/12/2022] Open
Affiliation(s)
- J A Bicho Augusto
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Nordon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - R Kozor
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - R Vijapurapu
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - R Hughes
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Rosmini
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - U Ramaswami
- Royal Free Hospital, Lysosomal Storage Disorder Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - T Geberhiwot
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R P Steeds
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Baig
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - D Hughes
- Royal Free Hospital, Lysosomal Storage Disorder Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
14
|
Bicho Augusto JA, Alfarih M, Knott K, Radenkovic D, Chaturvedi N, Hughes AD, Boubertakh R, Moon JC, Weingartner S, Captur G. P415Dark-Blood T1 SAPPHIRE mapping gives cleaner myocardial signal at both 1.5T and 3T. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.003] [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)
- J A Bicho Augusto
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Alfarih
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - D Radenkovic
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - N Chaturvedi
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A D Hughes
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Boubertakh
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Weingartner
- University of Minnesota, Minneapolis, United States of America
| | - G Captur
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
15
|
Brown L, Saunderson CED, Das A, Craven T, Xue H, Knott K, Levelt E, Dall"armellina E, Swoboda PP, Moon J, Greenwood JP, Kellman P, Plein S. P152Assessing myocardial perfusion in heart failure - are we achieving adequate stress? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - K Knott
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
16
|
Knott K, Alfarih M, Augusto JB, Boubertakh R, Chaturvedi N, Hughes AD, Moon JC, Weingartner S, Captur G. P618Using systolic SAPPHIRE to optimise T1 mapping for thin-walled hearts and arrhythmia. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez116.021] [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)
- K Knott
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Alfarih
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J B Augusto
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Boubertakh
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - N Chaturvedi
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A D Hughes
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | | | - G Captur
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
17
|
Knott K, Augusto JB, Nordin S, Kozor R, Camaioni C, Xue H, Hughes RK, Manisty C, Brown LAE, Ramaswami U, Hughes D, Kellman P, Plein S, Moon JC. 304Quantitative perfusion mapping in Fabry disease. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez119.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Knott
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J B Augusto
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Nordin
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Kozor
- University of Sydney, Sydney, Australia
| | - C Camaioni
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - R K Hughes
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - L A E Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - U Ramaswami
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Hughes
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
18
|
Brown L, Saunderson CED, Das A, Craven T, Xue H, Knott K, Levelt E, Moon J, Dall"armellina E, Greenwood JP, Kellman P, Plein S, Swoboda PP. P151Defining the phenotype of heart failure with mid-range ejection fraction by cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.014] [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)
- L Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - K Knott
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
19
|
Torlasco C, D'Silva A, Augusto J, Faini A, Knott K, Bhuva A, Benedetti G, Scully P, Jones S, Lobascio I, Parati G, Lloyd G, Manisty C, Moon JC, Sharma S. P3688Age matters: differences in cardiac response to training in young and middle aged first-time marathon runners. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3688] [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: 11/12/2022] Open
Affiliation(s)
- C Torlasco
- S.Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - A D'Silva
- St George's University of London, London, United Kingdom
| | - J Augusto
- Barts Health NHS Trust, London, United Kingdom
| | - A Faini
- S.Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - K Knott
- Barts Health NHS Trust, London, United Kingdom
| | - A Bhuva
- Barts Health NHS Trust, London, United Kingdom
| | - G Benedetti
- Barts Health NHS Trust, London, United Kingdom
| | - P Scully
- Barts Health NHS Trust, London, United Kingdom
| | - S Jones
- University College London, London, United Kingdom
| | - I Lobascio
- Barts Health NHS Trust, London, United Kingdom
| | - G Parati
- University of Milano-Bicocca - Cardiology II, S. Luca Hospital, Milano, Italy
| | - G Lloyd
- Barts Health NHS Trust, London, United Kingdom
| | - C Manisty
- Barts Health NHS Trust, London, United Kingdom
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom
| | - S Sharma
- St George's University of London, London, United Kingdom
| |
Collapse
|
20
|
Masood M, Knott K, Haft J, Hasan R, Romano M, Aaronson K, Pagani F. Assessment of Blood Pressure Measurements in Patients with Continuous Flow Left Ventricular Assist Devices: Arterial Line vs. Doppler Opening Pressure vs. Double-Cuff Oscillatory Sphygmomanometer. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.559] [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: 10/25/2022] Open
|
21
|
Adogwa O, Thompson P, Verla T, Null U, Knott K, Huang KT, Cheng JS, Isaacs RE. 161 Pain and Functional Outcomes After Incidental Durotomy in Lumbar Spine Surgery. Neurosurgery 2013. [DOI: 10.1227/01.neu.0000432752.86182.70] [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: 11/19/2022] Open
|
22
|
Adogwa O, Thompson P, Verla T, Knott K, Null U, Huang KT, Cheng JS, Isaacs RE. 154 Outcomes After ALIF vs TLIF For Treatment of Symtomatic L5-S1 Spondylolisthesis. Neurosurgery 2013. [DOI: 10.1227/01.neu.0000432745.09947.a4] [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: 11/19/2022] Open
|
23
|
|
24
|
Abstract
The Spacelab 1 mission, a joint venture of the European Space Agency and the National Aeronautics and Space Administration took place during the period 28 November through 8 December 1983. An overview of the first flight of the orbiting laboratory is presented here. The payload crew members' view of Spacelab operations and results of the scientific investigations carried out on this mission are presented in the following reports.
Collapse
|
25
|
Esnaola NF, Knott K, Finney C, Gebregziabher M, Ford ME. Urban/rural residence moderates effect of race on receipt of surgery in patients with nonmetastatic breast cancer: a report from the South Carolina central cancer registry. Ann Surg Oncol 2008; 15:1828-36. [PMID: 18398659 DOI: 10.1245/s10434-008-9898-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 02/14/2008] [Accepted: 02/17/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical resection is the cornerstone of therapy in patients with nonmetastatic breast cancer. Previous studies have reported underuse of adjuvant therapy among African Americans (AA). This study explores the independent effect of race on surgical resection in a recent, population-based sample of breast cancer patients. METHODS All cases of nonmetastatic breast cancer reported to the our state Cancer Registry between 1996 and 2002 were identified and linked to the state Inpatient/Outpatient Surgery Files and the 2000 Census. Characteristics between Caucasian and AA patients were compared using Student's t and chi-square tests. Odds ratios (OR) of resection and 95% confidence intervals (CI) were calculated using logistic regression. RESULTS We identified 12,404 Caucasian and 3,411 AA women. AA patients were more likely to be younger, non-married, have greater comorbidity, reside in rural communities, be less educated, live in poverty, and be uninsured or covered by Medicaid (all P < 0.0001). AA patients were slightly less likely to undergo resection compared to Caucasian patients (94.9% versus 96.4%, P < 0.0001). An interaction effect between race and urban/rural patient residence was observed (P = 0.003). After controlling for other factors, the adjusted OR for resection for urban AA patients was 0.58 (95% CI 0.41-0.82). In contrast, race had no effect on resection among rural patients (OR = 1.02; 95% CI 0.70-1.47). CONCLUSIONS AA race is an independent predictor of underuse of surgery among urban patients with breast cancer, while rural residence is associated with underuse of surgery, irrespective of race. Interventions designed to optimize surgical cancer care should target these vulnerable populations.
Collapse
Affiliation(s)
- N F Esnaola
- Department of Surgery, Medical University of South Carolina (MUSC), 25 Courtenay Drive - Suite 7018 (MSC 295), Charleston, SC 29425, USA.
| | | | | | | | | |
Collapse
|
26
|
|
27
|
Curyto KJ, Johnson J, TenHave T, Mossey J, Knott K, Katz IR. Survival of hospitalized elderly patients with delirium: a prospective study. Am J Geriatr Psychiatry 2001; 9:141-7. [PMID: 11316618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The authors tested the relationship between clinically diagnosed delirium during hospitalization and increased mortality after accounting for pre-hospital measures of global cognition, physical functioning, and medical comorbidity. Patients (N=102), 53 of which were hospitalized during the course of a year, received the Mini-Mental State Exam, Physical Self-Maintenance Scale, Cumulative Illness Rating Scale, and 15-item Geriatric Depression Scale. Mortality rates were determined at discharge and after 3 years. Patients who developed delirium did not differ on pre-hospitalization levels of depression, global cognitive performance, physical functioning, or medical comorbidity. Three-year mortality in the hospitalized subjects was 75% for delirium patients vs. 51% for control patients (risk ratio=2.24). Delirium occurring during hospitalization places elderly subjects at long-term risk of mortality. This effect is not accounted for by earlier measures of cognitive, functional, or health status.
Collapse
Affiliation(s)
- K J Curyto
- Section on Geriatric Psychiatry, University of Pennsylvania, Philadephia, USA
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
One hundred ninety-six older. White females were followed for 12 months after hip fracture. We examined the effects of persistently elevated depressive symptoms, measured by the Center for Epidemiological Studies Depression (CES-D) scale during a postsurgery interview and 2, 6, and 12 months later, on ambulation, overall physical function, and return to prefracture physical function 12 months after fracture. Age, prefracture physical function, and cognitive status were predictors of recovery. Controlling for these factors, persons consistently reporting few depressive symptoms were three times more likely than those with persistently elevated CES-D scores to achieve independence in walking, nine times more likely to return to prefracture levels in at least five of seven physical function measures, and nine times more likely to be in the highest quartile of overall physical function. These findings emphasize the importance of persistently elevated depressive symptoms for recovery. Routine screening, evaluation, and treatment of depression or depressed mood may be beneficial to the recovering hip fracture patient.
Collapse
Affiliation(s)
- J M Mossey
- Medical College of Pennsylvania, Philadelphia
| | | | | |
Collapse
|
29
|
Tempero MA, Nishioka K, Knott K, Zetterman RK. Chemoprevention of mouse colon tumors with difluoromethylornithine during and after carcinogen treatment. Cancer Res 1989; 49:5793-7. [PMID: 2507137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
alpha-Difluoromethylornithine (DFMO) treatment has been shown to modify carcinogenesis in many experimental tumor models, including skin, breast, and colon. This study was designed to determine whether DFMO treatment can inhibit experimental mouse colon tumors after carcinogen treatment and whether an associated effect of DFMO on cell proliferation in colon mucosa occurs. Male CD1 mice (40 per group) received dimethylhydrazine (30 mg/kg/week x 6 weeks, s.c.) and various schedules of DFMO, 1% in drinking water: Group A, none; Group B, following dimethylhydrazine treatment; Group C, during dimethylhydrazine treatment; and Group D, continuously throughout the study. Measurements of RBC polyamine levels showed that DFMO treatment ablated putrescine levels and confirmed that a systemic biological effect was achieved. Analysis of tumor data showed a significant inhibitory effect of DFMO treatment on colon tumor (adenomas and adenocarcinomas) incidence in Groups B (24%) and D (20%) compared to control Group A (52%, P less than 0.05 A versus B, P less than 0.02 A versus D) and on squamous cell carcinomas of the anus in all groups (P less than 0.001 A versus B, P less than 0.05 A versus C, A versus D). No consistent effect of DFMO treatment on cell proliferation in colon mucosa was identified. This study supports the hypothesis that DFMO treatment alters events in the postinitiation phases of mouse colon tumorigenesis.
Collapse
Affiliation(s)
- M A Tempero
- Omaha Veterans Administration Medical Center, Nebraska 68105
| | | | | | | |
Collapse
|
30
|
Abstract
The independent contributions to recovery from hip fracture of psychosocial factors including depression, personality, social connectedness, and self-rated health were studied in 219 women age 59 and older (mean age 78.5) who were community dwelling prior to fracture. Initial assessments were conducted shortly after surgery and follow up assessments 2, 6, and 12 months later. By 12 months, 15 patients had died and 15 had entered a nursing home. Substantial declines in physical functioning though not psychosocial status were observed. Only 21 per cent (compared to 81 per cent prefracture) reported walking independently; fewer than 30 per cent had regained reported prefracture levels of physical function. The proportion with elevated depression scores at 12 months was 20 per cent, down from 51 per cent following surgery; 64 per cent rated their health excellent or good at 12 months, up from 43 per cent after surgery. Poor cognitive status and post-surgical self-rated health were predictive of mortality. Among survivors, age, prefracture physical functioning, and cognitive status were associated with recovery in physical function but not psychosocial status. High post-surgery depression scores, but not the other psychosocial factors, were associated with poorer recovery in both functional and psychosocial status. These findings demonstrate the importance of depressive symptoms as one determinant of recovery from hip fracture and support the need to attend to the affective status of hip fracture patients following surgery.
Collapse
Affiliation(s)
- J M Mossey
- Medical College of Pennsylvania, EPPI Division, Philadelphia 19129
| | | | | | | |
Collapse
|
31
|
|
32
|
Knott K, Feuerbacher B, Chappell CR. Spacelab-1: an early space station for science and technology. Acta Astronaut 1982; 9:347-352. [PMID: 11541690 DOI: 10.1016/0094-5765(82)90061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The first flight of Spacelab is primarily a system verification and test flight, but it will also carry a payload of scientific and technological experiments to demonstrate the capability of performing multidisciplinary research in space. The payload covers the disciplines atmospheric physics, plasma physics, solar observations, astronomy, Earth observations, and material and life sciences. In this paper we will give for all represented disciplines short discription of their scientific objectives and experimental techniques. Particular emphasis is placed on how different disciplines utilize features characteristic for manned space stations, such as weight and power capabilities the availability of a human operator, the microgravity environment, the possibility to return samples or recordings and the recoverability of hardware together with a reflight capability. These advantages will be reviewed against the background of the relatively short mission duration, safety requirements and environmental influences caused by the presence of men in space. We will identify a research scenario for which Spacelab offers distinct advantages compared to conventional free-flying satellites, one which might also be pursued from larger space stations in the future.
Collapse
Affiliation(s)
- K Knott
- Space Science Department of ESA, Noordwijk, The Netherlands
| | | | | |
Collapse
|
33
|
Knott K, Fairfield D, Korth A, Young DT. Observations near the magnetopause at the onset of the July 29, 1977, sudden storm commencement. ACTA ACUST UNITED AC 1982. [DOI: 10.1029/ja087ia08p05888] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|