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Glen C, Morrow A, Roditi G, Hopkins T, Macpherson I, Stewart P, Petrie MC, Berry C, Epstein F, Lang NN, Mangion K. Cardiovascular sequelae of trastuzumab and anthracycline in long-term survivors of breast cancer. Heart 2024; 110:650-656. [PMID: 38103912 DOI: 10.1136/heartjnl-2023-323437] [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: 09/07/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Long-term follow-up of patients treated with trastuzumab largely focuses on those with reduced left ventricular ejection fraction (LVEF) on treatment completion. This study sought to evaluate the prevalence of cardiovascular risk factors, overt cardiovascular disease and cardiac imaging abnormalities using cardiac magnetic resonance (CMR), in participants with normal LVEF on completion of trastuzumab±anthracycline therapy at least 5 years previously. METHODS Participants with human epidermal growth factor receptor 2-positive breast cancer treated with trastuzumab±anthracycline ≥5 years previously were identified from a clinical database. All participants had normal LVEF prior to, and on completion of, treatment. Participants underwent clinical cardiovascular evaluation, ECG, cardiac biomarker evaluation and CMR. Left ventricular systolic dysfunction (LVSD) was defined as LVEF <50%. RESULTS Forty participants were recruited between 15 March 2021 and 19 July 2022. Median time since completion of trastuzumab was 7.8 years (range 5.9-10.8 years) and 90% received prior anthracycline. 25% of participants had LVSD; median LVEF was 55.2% (Q1-Q3, 51.3-61.2). 30% of participants had N-terminal pro-B-type natriuretic peptide >125 pg/mL and 8% had high-sensitivity cardiac troponin T >14 ng/L. 33% of participants had a new finding of hypertension. 58% had total cholesterol >5.0 mmol/L, 43% had triglycerides >1.7 mmol/L and 5% had a new diagnosis of diabetes. CONCLUSIONS The presence of asymptomatic LVSD, abnormal cardiac biomarkers and cardiac risk factors in participants treated with trastuzumab and anthracycline at least 5 years previously is common, even in those with normal LVEF on completion of treatment. Our findings reinforce the relevance of comprehensive evaluation of cardiovascular risk factors following completion of cancer therapy, in addition to LVEF assessment.
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Affiliation(s)
- Claire Glen
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Andrew Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Giles Roditi
- Clinical Research Imaging Facility, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tracey Hopkins
- Clinical Research Imaging Facility, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Iain Macpherson
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Philip Stewart
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - Fred Epstein
- School of Engineering and Applied Science, University of Virginia, Charlottesville, Virginia, USA
| | - Ninian N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
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Garrity K, Docherty C, Mangion K, Woodward R, Shaw M, Roditi G, Shelley B, Quasim T, McCall P, McPeake J. Characterizing Cardiac Function in ICU Survivors of Sepsis: A Pilot Study Protocol. CHEST Crit Care 2024; 2:100050. [PMID: 38524255 PMCID: PMC10958646 DOI: 10.1016/j.chstcc.2024.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Background Sepsis is one of the most common reasons for ICU admission and a leading cause of mortality worldwide. More than one-half of survivors experience significant physical, psychological, or cognitive impairments, often termed post-intensive care syndrome (PICS). Sepsis is recognized increasingly as being associated with a risk of adverse cardiovascular events that is comparable with other major cardiovascular risk factors. It is plausible that sepsis survivors may be at risk of unidentified cardiovascular disease, and this may play a role in functional impairments seen after ICU discharge. Research Question What is the prevalence of myocardial dysfunction after an ICU admission with sepsis and to what extent might it be associated with physical impairments in PICS? Study Design and Methods Characterisation of Cardiovascular Function in ICU Survivors of Sepsis (CONDUCT-ICU) is a prospective, multicenter, pilot study characterizing cardiovascular function and functional impairments in survivors of sepsis taking place in the west of Scotland. Survivors of sepsis will be recruited at ICU discharge and followed up 6 to 10 weeks after hospital discharge. Biomarkers of myocardial injury or dysfunction (high sensitivity troponin and N-terminal pro B-type natriuretic peptide) and systemic inflammation (C-reactive protein, IL-1β, IL-6, IL-10, and tumor necrosis factor alpha) will be measured in 69 patients at recruitment and at follow-up. In addition, a cardiovascular magnetic resonance substudy will be performed at follow-up in 35 patients. We will explore associations between cardiovascular magenetic resonance indexes of cardiac function, biomarkers of cardiac dysfunction and inflammation, and patient-reported outcome measures. Interpretation CONDUCT-ICU will provide data regarding the cause and prevalence of cardiac dysfunction in survivors of sepsis and will explore associations with functional impairment. It will provide feasibility data and operational learning for larger studies investigating mechanisms of functional impairment after ICU admission and the association between sepsis and adverse cardiovascular events. Trial Registry ClinicalTrials.gov; No.: NCT05633290; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Kevin Garrity
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow
| | - Christie Docherty
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- University Hospital Crosshouse; NHS Ayrshire and Arran, Crosshouse
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow
| | - Rosie Woodward
- Imaging Centre of Excellence, Queen Elizabeth University Hospital; NHS Greater Glasgow & Clyde, Glasgow
| | - Martin Shaw
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
| | - Giles Roditi
- Imaging Centre of Excellence, Queen Elizabeth University Hospital; NHS Greater Glasgow & Clyde, Glasgow
| | - Benjamin Shelley
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- Golden Jubilee National Hospital, NHS Scotland, Clydebank, Scotland
| | - Tara Quasim
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow
| | - Philip McCall
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- Golden Jubilee National Hospital, NHS Scotland, Clydebank, Scotland
| | - Joanne McPeake
- THIS Institute, University of Cambridge, Cambridge, England
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Morrow AJ, Sykes R, Saleh M, Zahra B, MacIntosh A, Kamdar A, Bagot C, Bayes HK, Blyth KG, Bulluck H, Carrick D, Church C, Corcoran D, Findlay I, Gibson VB, Gillespie L, Grieve D, Barrientos PH, Ho A, Lang NN, Lowe DJ, Lennie V, Macfarlane PW, Mayne KJ, Mark PB, McConnachie A, McGeoch R, Nordin S, Payne A, Rankin AJ, Robertson K, Ryan N, Roditi G, Sattar N, Stobo D, Allwood-Spiers S, Touyz RM, Veldtman G, Weeden S, Weir R, Watkins S, Welsh P, Mangion K, Berry C. Socioeconomic deprivation and illness trajectory in the Scottish population after COVID-19 hospitalization. Commun Med (Lond) 2024; 4:32. [PMID: 38418616 PMCID: PMC10901805 DOI: 10.1038/s43856-024-00455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain. METHODS A prospective, multicentre cohort study was conducted on post-COVID-19 patients, enrolled either in-hospital or shortly post-discharge. Two evaluations were carried out: an initial assessment and a follow-up at 28-60 days post-discharge. The study encompassed research blood tests, patient-reported outcome measures, and multisystem imaging (including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging). Primary and secondary outcomes were analysed in relation to socioeconomic status, using the Scottish Index of Multiple Deprivation (SIMD). The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. RESULTS Of the 252 enrolled patients (mean age 55.0 ± 12.0 years; 40% female; 23% with diabetes), deprivation status was linked with increased BMI and diabetes prevalence. 186 (74%) returned for the follow-up. Within this group, findings indicated associations between deprivation and lung abnormalities (p = 0.0085), coronary artery disease (p = 0.0128), and renal inflammation (p = 0.0421). Furthermore, patients with higher deprivation exhibited worse scores in health-related quality of life (EQ-5D-5L, p = 0.0084), illness perception (BIPQ, p = 0.0004), anxiety and depression levels (PHQ-4, p = 0.0038), and diminished physical activity (DASI, p = 0.002). At the 3-month mark, those with greater deprivation showed a higher frequency of referrals to secondary care due to ongoing COVID-19 symptoms (p = 0.0438). However, clinical outcomes were not influenced by deprivation. CONCLUSIONS In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.
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Affiliation(s)
- Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Merna Saleh
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Baryab Zahra
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Hannah K Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - David Carrick
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - David Corcoran
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, Glasgow, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Ninian N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Peter W Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kaitlin J Mayne
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Sabrina Nordin
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Department of Cardiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Alastair J Rankin
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith Robertson
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | | | - Rhian M Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Service, NHS Golden Jubilee, Clydebank, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Robin Weir
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Stuart Watkins
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK.
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Sykes R, Doherty D, Morrow A, Mangion K, Rushd A, Berry C. NT-proBNP in patients presenting with myocardial infarction and non-obstructive coronary arteries without left ventricular systolic dysfunction. Am Heart J Plus 2023; 33:100311. [PMID: 38510556 PMCID: PMC10946058 DOI: 10.1016/j.ahjo.2023.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 03/22/2024]
Abstract
Background Myocardial infarction and non-obstructive coronary arteries (MINOCA) affects 1 in 9 patients with acute coronary syndrome and has no evidence-based therapy. NT-proBNP is an established biomarker associated with prognosis in heart failure and ischemic heart disease, although there is a paucity of data in patients with MINOCA. Methods Prospective study of the diagnostic and clinical utility of measuring NT-proBNP in patients with MINOCA without left ventricular dysfunction or heart failure. Data collection was undertaken for patients with an initial diagnosis of MINOCA following urgent coronary angiography in the Golden Jubilee National Hospital (Clydebank, UK), a tertiary center. Demographics were collected in addition to left ventricular function by transthoracic echocardiography. NT-proBNP was measured from a clinically indicated blood sample obtained during routine venepuncture or within the catheter laboratory. Patient outcomes were collected prospectively by the clinical care team using digital follow-up. Results Fifty-five patients with an initial diagnosis of MINOCA and left ventricular ejection fraction >40 % were included. NT-proBNP was available in 87 % of patients with a median value of 312 pg/mL (interquartile range: 107, 725). Post-discharge, 40 % (n = 24) of patients were readmitted to the hospital, including 15 with chest pain. NT-proBNP ≥125 pg/mL was associated with rehospitalization (P = 0.02). Two patients died and bleeding complications with concomitant antiplatelet therapy occurred in eight patients. Conclusion NT-proBNP ≥ 125 pg/mL occurred in 72 % of patients presenting with MINOCA and an ejection fraction > 40% and was associated with rehospitalization.
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Affiliation(s)
- Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
| | - Daniel Doherty
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Ahsan Rushd
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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Mangion K, Morrow AJ, Sykes R, Kamdar A, Bagot C, Bruce G, Connelly P, Delles C, Gibson VB, Gillespie L, Barrientos PH, Lennie V, Roditi G, Sattar N, Stobo D, Allwood-Spiers S, McConnachie A, Berry C. Post-COVID-19 illness and associations with sex and gender. BMC Cardiovasc Disord 2023; 23:389. [PMID: 37553628 PMCID: PMC10408208 DOI: 10.1186/s12872-023-03412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Post-COVID-19 syndromes have associated with female sex, but the pathophysiological basis is uncertain. AIM There are sex differences in myocardial inflammation identified using cardiac magnetic resonance (CMR) in post-COVID-19 patients, and in patient reported health outcomes following COVID-19 infection. DESIGN This prospective study investigated the time-course of multiorgan injury in survivors of COVID-19 during convalescence. METHODS Clinical information, blood biomarkers, and patient reported outcome measures were prospectively acquired at enrolment (visit 1) and 28-60 days post-discharge (visit 2). Chest computed tomography (CT) and CMR were performed at visit 2. Follow-up was carried out for serious adverse events, including death and rehospitalization. RESULTS Sixty-nine (43%) of 159 patients recruited were female. During the index admission, females had a lower peak C-reactive protein (74 mg/l (21,163) versus 123 mg/l (70, 192) p = 0.008) and peak ferritin (229 μg/l (103, 551) versus 514 μg/l (228, 1122) p < 0.001). Using the Modified Lake-Louise criteria, females were more likely to have definite evidence of myocardial inflammation (54% (37/68) versus 33% (30/90) p = 0.003). At enrolment and 28-60 days post-discharge, enhanced illness perception, higher levels of anxiety and depression and lower predicted maximal oxygen utilization occurred more commonly in women. The mean (SD, range) duration of follow-up after hospital discharge was 450 (88) days (range 290, 627 days). Compared to men, women had lower rates of cardiovascular hospitalization (0% versus 8% (7/90); p = 0.018). CONCLUSIONS Women demonstrated worse patient reported outcome measures at index admission and 28-60 days follow-up though cardiovascular hospitalization was lower.
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Affiliation(s)
- Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK.
| | - Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - George Bruce
- Department of Medical Physics, NHS G Reater Glasgow and Clyde Health Board, Glasgow, UK
| | - Paul Connelly
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | | | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Sarah Allwood-Spiers
- Department of Medical Physics, NHS G Reater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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Sykes RA, Neves KB, Alves-Lopes R, Caputo I, Fallon K, Jamieson NB, Kamdar A, Legrini A, Leslie H, McIntosh A, McConnachie A, Morrow A, McFarlane RW, Mangion K, McAbney J, Montezano AC, Touyz RM, Wood C, Berry C. Vascular mechanisms of post-COVID-19 conditions: Rho-kinase is a novel target for therapy. Eur Heart J Cardiovasc Pharmacother 2023; 9:371-386. [PMID: 37019821 PMCID: PMC10236521 DOI: 10.1093/ehjcvp/pvad025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/24/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND In post-coronavirus disease-19 (post-COVID-19) conditions (long COVID), systemic vascular dysfunction is implicated, but the mechanisms are uncertain, and the treatment is imprecise. METHODS AND RESULTS Patients convalescing after hospitalization for COVID-19 and risk factor matched controls underwent multisystem phenotyping using blood biomarkers, cardiorenal and pulmonary imaging, and gluteal subcutaneous biopsy (NCT04403607). Small resistance arteries were isolated and examined using wire myography, histopathology, immunohistochemistry, and spatial transcriptomics. Endothelium-independent (sodium nitroprusside) and -dependent (acetylcholine) vasorelaxation and vasoconstriction to the thromboxane A2 receptor agonist, U46619, and endothelin-1 (ET-1) in the presence or absence of a RhoA/Rho-kinase inhibitor (fasudil), were investigated. Thirty-seven patients, including 27 (mean age 57 years, 48% women, 41% cardiovascular disease) 3 months post-COVID-19 and 10 controls (mean age 57 years, 20% women, 30% cardiovascular disease), were included. Compared with control responses, U46619-induced constriction was increased (P = 0.002) and endothelium-independent vasorelaxation was reduced in arteries from COVID-19 patients (P < 0.001). This difference was abolished by fasudil. Histopathology revealed greater collagen abundance in COVID-19 arteries {Masson's trichrome (MT) 69.7% [95% confidence interval (CI): 67.8-71.7]; picrosirius red 68.6% [95% CI: 64.4-72.8]} vs. controls [MT 64.9% (95% CI: 59.4-70.3) (P = 0.028); picrosirius red 60.1% (95% CI: 55.4-64.8), (P = 0.029)]. Greater phosphorylated myosin light chain antibody-positive staining in vascular smooth muscle cells was observed in COVID-19 arteries (40.1%; 95% CI: 30.9-49.3) vs. controls (10.0%; 95% CI: 4.4-15.6) (P < 0.001). In proof-of-concept studies, gene pathways associated with extracellular matrix alteration, proteoglycan synthesis, and viral mRNA replication appeared to be upregulated. CONCLUSION Patients with post-COVID-19 conditions have enhanced vascular fibrosis and myosin light change phosphorylation. Rho-kinase activation represents a novel therapeutic target for clinical trials.
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Affiliation(s)
- Robert A Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Karla B Neves
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Rhéure Alves-Lopes
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
| | - Ilaria Caputo
- Università degli Studi di Padova, 35122 Padova, Italy
| | - Kirsty Fallon
- Clinical Research Facility, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde Health Board, Glasgow, UK
| | - Nigel B Jamieson
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
| | - Assya Legrini
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Holly Leslie
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - John McAbney
- Institute of Biomedical and Life Sciences (FBLS), University of Glasgow, Glasgow G12 8QQ, UK
| | - Augusto C Montezano
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada
| | - Rhian M Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada
| | - Colin Wood
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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Wang Y, Sun C, Ghadimi S, Auger DC, Croisille P, Viallon M, Mangion K, Berry C, Haggerty CM, Jing L, Fornwalt BK, Cao JJ, Cheng J, Scott AD, Ferreira PF, Oshinski JN, Ennis DB, Bilchick KC, Epstein FH. StrainNet: Improved Myocardial Strain Analysis of Cine MRI by Deep Learning from DENSE. Radiol Cardiothorac Imaging 2023; 5:e220196. [PMID: 37404792 PMCID: PMC10316292 DOI: 10.1148/ryct.220196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/16/2023] [Accepted: 03/15/2023] [Indexed: 07/06/2023]
Abstract
Purpose To develop a three-dimensional (two dimensions + time) convolutional neural network trained with displacement encoding with stimulated echoes (DENSE) data for displacement and strain analysis of cine MRI. Materials and Methods In this retrospective multicenter study, a deep learning model (StrainNet) was developed to predict intramyocardial displacement from contour motion. Patients with various heart diseases and healthy controls underwent cardiac MRI examinations with DENSE between August 2008 and January 2022. Network training inputs were a time series of myocardial contours from DENSE magnitude images, and ground truth data were DENSE displacement measurements. Model performance was evaluated using pixelwise end-point error (EPE). For testing, StrainNet was applied to contour motion from cine MRI. Global and segmental circumferential strain (Ecc) derived from commercial feature tracking (FT), StrainNet, and DENSE (reference) were compared using intraclass correlation coefficients (ICCs), Pearson correlations, Bland-Altman analyses, paired t tests, and linear mixed-effects models. Results The study included 161 patients (110 men; mean age, 61 years ± 14 [SD]), 99 healthy adults (44 men; mean age, 35 years ± 15), and 45 healthy children and adolescents (21 males; mean age, 12 years ± 3). StrainNet showed good agreement with DENSE for intramyocardial displacement, with an average EPE of 0.75 mm ± 0.35. The ICCs between StrainNet and DENSE and FT and DENSE were 0.87 and 0.72, respectively, for global Ecc and 0.75 and 0.48, respectively, for segmental Ecc. Bland-Altman analysis showed that StrainNet had better agreement than FT with DENSE for global and segmental Ecc. Conclusion StrainNet outperformed FT for global and segmental Ecc analysis of cine MRI.Keywords: Image Postprocessing, MR Imaging, Cardiac, Heart, Pediatrics, Technical Aspects, Technology Assessment, Strain, Deep Learning, DENSE Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Yu Wang
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Changyu Sun
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Sona Ghadimi
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Daniel C. Auger
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Pierre Croisille
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Magalie Viallon
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Kenneth Mangion
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Colin Berry
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Christopher M. Haggerty
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Linyuan Jing
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Brandon K. Fornwalt
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - J. Jane Cao
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Joshua Cheng
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Andrew D. Scott
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Pedro F. Ferreira
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - John N. Oshinski
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Daniel B. Ennis
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Kenneth C. Bilchick
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Frederick H. Epstein
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
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9
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Everett CC, Berry C, McCann GP, Fernandez C, Reynolds C, Bucciarelli-Ducci C, Dall'Armellina E, Prasad A, Foley JR, Mangion K, Bijsterveld P, Brown J, Stocken D, Walker S, Sculpher M, Plein S, Greenwood JP. Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2. Open Heart 2023; 10:openhrt-2022-002221. [PMID: 37130657 PMCID: PMC10163591 DOI: 10.1136/openhrt-2022-002221] [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: 11/28/2022] [Accepted: 04/11/2023] [Indexed: 05/04/2023] Open
Abstract
AIMS Guidelines for suspected cardiac chest pain have used historical risk stratification tools, advocating invasive coronary angiography (ICA) first-line in those at highest risk. We aimed to determine whether different strategies to manage suspected stable angina affected medium-term cardiovascular event rates and patient-reported quality of life (QoL) measures. METHODS CE-MARC 2, a three-arm parallel group trial, randomised patients with suspected stable cardiac chest pain and a Duke Clinical pretest likelihood of coronary artery disease between 10% and 90%. Patients were randomised to either first-line cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT) or the UK National Institute for Health and Care Excellence (NICE) CG95 (2010) guidelines-directed care. For the three arms, 1-year and 3-year first major adverse cardiovascular event (MACE) rates and QoL assessed by the Seattle Angina Questionnaire, Short Form 12 (V.12) Questionnaire and EuroQol-5 Dimension Questionnaire were recorded. RESULTS 1202 patients were randomised to CMR (n=481), SPECT (n=481) and NICE (n=240). Forty-two patients (18 CMR, 18 SPECT, 6 NICE) experienced one or more MACEs. The percentage rates (95% CIs) of MACE in the CMR, SPECT and NICE groups at 3 years were 3.7% (2.4%, 5.8%), 3.7% (2.4%, 5.8%) and 2.1% (0.9%, 4.8%), respectively. QoL scores did not significantly differ across domains. CONCLUSION Despite a fourfold increase in referrals for ICA, the NICE CG95 (2010) guidelines risk-stratified care strategy did not significantly reduce 3-year MACE or improve QoL, as compared with functional imaging with CMR or SPECT. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT01664858).
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Affiliation(s)
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Erica Dall'Armellina
- School of Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Abhiram Prasad
- Cardiovascular Diseases, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - James R Foley
- School of Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Julia Brown
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Sven Plein
- School of Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John P Greenwood
- School of Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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10
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MacLeod C, Mangion K, Roditi G, Ahmad F. Intra-cardiac tumour and bicuspid aortic valve in a patient with neurofibromatosis type 1-rare associations: a case report. Eur Heart J Case Rep 2023; 7:ytad158. [PMID: 37090757 PMCID: PMC10117367 DOI: 10.1093/ehjcr/ytad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/17/2023] [Accepted: 04/03/2023] [Indexed: 04/25/2023]
Abstract
Background Neurofibromatosis (NF) is an autosomal dominant neurocutaneous disease with multi-system involvement. Three cardiovascular associations are recognized but infrequently reported: congenital heart disease, vasculopathy, and hypertension. Cardiac outflow tract pathology, pulmonary stenosis, and aortic co-arctation have been described in the literature with varying frequency. The incidence of intra-cardiac tumour is exceeding rare. Case summary A 53-year-old man presented to the neurosurgical team with myelopathy secondary to cord compression arising from multiple cervical neurofibromas secondary to NF-1. Further cardiac evaluation with echocardiography and cardiac MRI uncovered the presence of both a bicuspid aortic valve (with mild aortic stenosis and moderate aortic regurgitation) and a concurrent intra-cardiac tumour of the mitral papillary muscle; a combined finding which was not reported previously. Serial evaluation confirmed stable disease with no major progression over time. Discussion Our case highlights the importance of recognizing cardiovascular manifestations of NF-1 and instituting appropriate screening and surveillance strategies. Targeted non-invasive imaging strategies may be more suited for this purpose over routine clinical examination alone.
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Affiliation(s)
- Claire MacLeod
- School of Medicine, Dentistry & Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Kenneth Mangion
- School of Medicine, Dentistry & Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, 84 Castle St, G4 0SF Glasgow, UK
| | - Faheem Ahmad
- Corresponding author. Tel: +44 0141 201 1100, Fax: +44 0141 451 6128,
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11
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Rabbani A, Gao H, Lazarus A, Dalton D, Ge Y, Mangion K, Berry C, Husmeier D. Image-based estimation of the left ventricular cavity volume using deep learning and Gaussian process with cardio-mechanical applications. Comput Med Imaging Graph 2023; 106:102203. [PMID: 36848766 DOI: 10.1016/j.compmedimag.2023.102203] [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: 09/02/2022] [Revised: 11/26/2022] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
In this investigation, an image-based method has been developed to estimate the volume of the left ventricular cavity using cardiac magnetic resonance (CMR) imaging data. Deep learning and Gaussian processes have been applied to bring the estimations closer to the cavity volumes manually extracted. CMR data from 339 patients and healthy volunteers have been used to train a stepwise regression model that can estimate the volume of the left ventricular cavity at the beginning and end of diastole. We have decreased the root mean square error (RMSE) of cavity volume estimation approximately from 13 to 8 ml compared to the common practice in the literature. Considering the RMSE of manual measurements is approximately 4 ml on the same dataset, 8 ml of error is notable for a fully automated estimation method, which needs no supervision or user-hours once it has been trained. Additionally, to demonstrate a clinically relevant application of automatically estimated volumes, we inferred the passive material properties of the myocardium given the volume estimates using a well-validated cardiac model. These material properties can be further used for patient treatment planning and diagnosis.
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Affiliation(s)
- Arash Rabbani
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Computing, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Hao Gao
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Alan Lazarus
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - David Dalton
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Yuzhang Ge
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Kenneth Mangion
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Colin Berry
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Dirk Husmeier
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
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12
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Sykes R, Morrow AJ, McConnachie A, Kamdar A, Bagot C, Bayes H, Blyth KG, Briscoe M, Bulluck H, Carrick D, Church C, Corcoran D, Delles C, Findlay I, Gibson VB, Gillespie L, Grieve D, Barrientos PH, Ho A, Lang NN, Lowe DJ, Lennie V, MacFarlane P, Mayne KJ, Mark P, McIntosh A, McGeoch R, McGinley C, Mckee C, Nordin S, Payne A, Rankin A, Robertson KE, Ryan N, Roditi GH, Sattar N, Stobo DB, Allwood-Spiers S, Touyz R, Veldtman G, Weeden S, Watkins S, Welsh P, Wereski R, Mangion K, Berry C. Adjudicated myocarditis and multisystem illness trajectory in healthcare workers post-COVID-19. Open Heart 2023; 10:openhrt-2022-002192. [PMID: 36822817 PMCID: PMC9950584 DOI: 10.1136/openhrt-2022-002192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND We investigated the associations of healthcare worker status with multisystem illness trajectory in hospitalised post-COVID-19 individuals. METHODS AND RESULTS One hundred and sixty-eight patients were evaluated 28-60 days after the last episode of hospital care. Thirty-six (21%) were healthcare workers. Compared with non-healthcare workers, healthcare workers were of similar age (51.3 (8.7) years vs 55.0 (12.4) years; p=0.09) more often women (26 (72%) vs 48 (38%); p<0.01) and had lower 10-year cardiovascular risk (%) (8.1 (7.9) vs 15.0 (11.5); p<0.01) and Coronavirus Clinical Characterisation Consortium in-hospital mortality risk (7.3 (10.2) vs 12.7 (9.8); p<0.01). Healthcare worker status associated with less acute inflammation (peak C reactive protein 48 mg/L (IQR: 14-165) vs 112 mg/L (52-181)), milder illness reflected by WHO clinical severity score distribution (p=0.04) and shorter duration of admission (4 days (IQR: 2-6) vs 6 days (3-12)).In adjusted multivariate logistic regression analysis, healthcare worker status associated with a binary classification (probable/very likely vs not present/unlikely) of adjudicated myocarditis (OR: 2.99; 95% CI (1.01 to 8.89) by 28-60 days postdischarge).After a mean (SD, range) duration of follow-up after hospital discharge of 450 (88) days (range 290, 627 days), fewer healthcare workers died or were rehospitalised (1 (3%) vs 22 (17%); p=0.038) and secondary care referrals for post-COVID-19 syndrome were common (42%) and similar to non-healthcare workers (38%; p=0.934). CONCLUSION Healthcare worker status was independently associated with the likelihood of adjudicated myocarditis, despite better antecedent health. Two in five healthcare workers had a secondary care referral for post-COVID-19 syndrome. TRIAL REGISTRATION NUMBER NCT04403607.
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Affiliation(s)
- Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - C Bagot
- Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | - Hannah Bayes
- Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Kevin G Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, UK.,Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Michael Briscoe
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Heeraj Bulluck
- Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - David Carrick
- Cardiology, University Hospital Hairmyres, East Kilbride, South Lanarkshire, UK
| | - Colin Church
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Scottish Pulmonary Vascular Unit, Golden Jubilee Hospital, Clydebank, UK
| | - David Corcoran
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - C Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Iain Findlay
- Cardiology, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
| | | | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Glasgow, UK
| | - Douglas Grieve
- Respiratory Medicine, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - N N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Vera Lennie
- Cardiology, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, UK
| | - Peter MacFarlane
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kaithlin J Mayne
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Patrick Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Cardiology, University Hospital Hairmyres, East Kilbride, South Lanarkshire, UK
| | | | - Connor Mckee
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sabrina Nordin
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Cardiology, University Hospital Crosshouse, Kilmarnock, East Ayrshire, UK
| | - Alastair Rankin
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith E Robertson
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Nicola Ryan
- Cardiology, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, UK
| | - Giles H Roditi
- Radiology, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David B Stobo
- Radiology, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, UK
| | | | - Rhian Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Stuart Watkins
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Ryan Wereski
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK .,Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
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13
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Artico J, Shiwani H, Moon JC, Gorecka M, McCann GP, Roditi G, Morrow A, Mangion K, Lukaschuk E, Shanmuganathan M, Miller CA, Chiribiri A, Prasad SK, Adam RD, Singh T, Bucciarelli-Ducci C, Dawson D, Knight D, Fontana M, Manisty C, Treibel TA, Levelt E, Arnold R, Macfarlane PW, Young R, McConnachie A, Neubauer S, Piechnik SK, Davies RH, Ferreira VM, Dweck MR, Berry C, Greenwood JP. Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study. Circulation 2023; 147:364-374. [PMID: 36705028 PMCID: PMC9889203 DOI: 10.1161/circulationaha.122.060632] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/29/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation. METHODS Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin-) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID-/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months. RESULTS Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin-] versus 31% [COVID-/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 (P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12-4.57]; P=0.02). CONCLUSIONS Compared with contemporary controls, patients with COVID-19 and elevated cardiac troponin level have more ventricular impairment and myocardial scar in early convalescence. However, the proportion with myocarditis was low and scar pathogenesis was diverse, including a newly described pattern of microinfarction. REGISTRATION URL: https://www.isrctn.com; Unique identifier: 58667920.
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Affiliation(s)
- Jessica Artico
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Hunain Shiwani
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - James C. Moon
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Miroslawa Gorecka
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, UK (M.G., E. Levelt, J.P.G.)
| | - Gerry P. McCann
- University of Leicester and the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, UK (G.P.M., R.A.)
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Andrew Morrow
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Mayooran Shanmuganathan
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Christopher A. Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK (C.A.M.)
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, BHF Centre of Excellence and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, The Rayne Institute, St Thomas’ Hospital, London, UK (A.C., C.B.-D.)
| | - Sanjay K. Prasad
- National Heart and Lung Institute, Imperial College, London, UK (S.K.P.)
| | - Robert D. Adam
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Trisha Singh
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, UK (T.S., M.R.D.)
| | - Chiara Bucciarelli-Ducci
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, BHF Centre of Excellence and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, The Rayne Institute, St Thomas’ Hospital, London, UK (A.C., C.B.-D.)
- Royal Brompton and Harefield Hospitals and Guys’ and St Thomas NHS Trust, London, UK (C.B.-D.)
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Bristol, UK (C.B.-D.)
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, UK (D.D.)
| | - Daniel Knight
- Division of Medicine, Royal Free Hospital (D.K., M.F.), University College London, UK
| | - Marianna Fontana
- Division of Medicine, Royal Free Hospital (D.K., M.F.), University College London, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Thomas A. Treibel
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Eylem Levelt
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, UK (M.G., E. Levelt, J.P.G.)
| | - Ranjit Arnold
- University of Leicester and the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, UK (G.P.M., R.A.)
| | - Peter W. Macfarlane
- Electrocardiology Core Laboratory (P.W.M.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Robin Young
- Robertson Centre for Biostatistics (R.Y., A. McConnachie), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics (R.Y., A. McConnachie), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Rhodri H. Davies
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Vanessa M. Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Marc R. Dweck
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, UK (T.S., M.R.D.)
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - OxAMI (Oxford Acute Myocardial Infarction Study) Investigators; COVID-HEART Investigators†
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
- Division of Medicine, Royal Free Hospital (D.K., M.F.), University College London, UK
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, UK (M.G., E. Levelt, J.P.G.)
- University of Leicester and the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, UK (G.P.M., R.A.)
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
- Electrocardiology Core Laboratory (P.W.M.), Institute of Health and Wellbeing, University of Glasgow, UK
- Robertson Centre for Biostatistics (R.Y., A. McConnachie), Institute of Health and Wellbeing, University of Glasgow, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK (C.A.M.)
- School of Biomedical Engineering and Imaging Sciences, King’s College London, BHF Centre of Excellence and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, The Rayne Institute, St Thomas’ Hospital, London, UK (A.C., C.B.-D.)
- National Heart and Lung Institute, Imperial College, London, UK (S.K.P.)
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, UK (T.S., M.R.D.)
- Royal Brompton and Harefield Hospitals and Guys’ and St Thomas NHS Trust, London, UK (C.B.-D.)
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Bristol, UK (C.B.-D.)
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, UK (D.D.)
| | - John P. Greenwood
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, UK (M.G., E. Levelt, J.P.G.)
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14
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Glass A, McCall P, Arthur A, Mangion K, Shelley B. Pulmonary artery wave reflection and right ventricular function after lung resection. Br J Anaesth 2023; 130:e128-e136. [PMID: 36115714 PMCID: PMC9875909 DOI: 10.1016/j.bja.2022.07.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/02/2022] [Accepted: 07/26/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Lung resection has been shown to impair right ventricular function. Although conventional measures of afterload do not change, surgical ligation of a pulmonary artery branch, as occurs during lobectomy, can create a unilateral proximal reflection site, increasing wave reflection (pulsatile component of afterload) and diverting blood flow through the contralateral pulmonary artery. We present a cardiovascular magnetic resonance imaging (MRI) observational cohort study of changes in wave reflection and right ventricular function after lung resection. METHODS Twenty-seven patients scheduled for open lobectomy for suspected lung cancer underwent cardiovascular MRI preoperatively, on postoperative Day 2, and at 2 months. Wave reflection was assessed in the left and right pulmonary arteries (operative and non-operative, as appropriate) by wave intensity analysis and calculation of wave reflection index. Pulmonary artery blood flow distribution was calculated as percentage of total blood flow travelling in the non-operative pulmonary artery. Right ventricular function was assessed by ejection fraction and strain analysis. RESULTS Operative pulmonary artery wave reflection increased from 4.3 (2.1-8.8) % preoperatively to 9.5 (4.9-14.9) % on postoperative Day 2 and 8.0 (2.3-11.7) % at 2 months (P<0.001) with an associated redistribution of blood flow towards the nonoperative pulmonary artery (r>0.523; P<0.010). On postoperative Day 2, impaired right ventricular ejection fraction was associated with increased operative pulmonary artery wave reflection (r=-0.480; P=0.028) and pulmonary artery blood flow redistribution (r=-0.545; P=0.011). At 2 months, impaired right ventricular ejection fraction and right ventricular strain were associated with pulmonary artery blood flow redistribution (r=-0.634, P=0.002; r=0.540, P=0.017). CONCLUSIONS Pulsatile afterload increased after lung resection. The unilateral increase in operative pulmonary artery wave reflection resulted in redistribution of blood flow through the nonoperative pulmonary artery and was associated with right ventricular dysfunction. CLINICAL TRIAL REGISTRATION NCT01892800.
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Affiliation(s)
- Adam Glass
- Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK,School of Anaesthesia, Northern Ireland Medical and Dental Training Agency, Belfast, UK,Corresponding author.
| | - Philip McCall
- Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK,Department of Anaesthesia, Golden Jubilee National Hospital, Clydebank, UK
| | - Alex Arthur
- Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Ben Shelley
- Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK,Department of Anaesthesia, Golden Jubilee National Hospital, Clydebank, UK
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15
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Mark PB, Mangion K, Rankin AJ, Rutherford E, Lang NN, Petrie MC, Stoumpos S, Patel RK. Left ventricular dysfunction with preserved ejection fraction: the most common left ventricular disorder in chronic kidney disease patients. Clin Kidney J 2022; 15:2186-2199. [PMID: 36381379 PMCID: PMC9664574 DOI: 10.1093/ckj/sfac146] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 08/25/2023] Open
Abstract
Chronic kidney disease (CKD) is a risk factor for premature cardiovascular disease. As kidney function declines, the presence of left ventricular abnormalities increases such that by the time kidney replacement therapy is required with dialysis or kidney transplantation, more than two-thirds of patients have left ventricular hypertrophy. Historically, much research in nephrology has focussed on the structural and functional aspects of cardiac disease in CKD, particularly using echocardiography to describe these abnormalities. There is a need to translate knowledge around these imaging findings to clinical outcomes such as unplanned hospital admission with heart failure and premature cardiovascular death. Left ventricular hypertrophy and cardiac fibrosis, which are common in CKD, predispose to the clinical syndrome of heart failure with preserved left ventricular ejection fraction (HFpEF). There is a bidirectional relationship between CKD and HFpEF, whereby CKD is a risk factor for HFpEF and CKD impacts outcomes for patients with HFpEF. There have been major improvements in outcomes for patients with heart failure and reduced left ventricular ejection fraction as a result of several large randomized controlled trials. Finding therapy for HFpEF has been more elusive, although recent data suggest that sodium-glucose cotransporter 2 inhibition offers a novel evidence-based class of therapy that improves outcomes in HFpEF. These observations have emerged as this class of drugs has also become the standard of care for many patients with proteinuric CKD, suggesting that there is now hope for addressing the combination of HFpEF and CKD in parallel. In this review we summarize the epidemiology, pathophysiology, diagnostic strategies and treatment of HFpEF with a focus on patients with CKD.
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Affiliation(s)
- Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Alastair J Rankin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Nephrology, NHS Dumfries and Galloway, Dumfries, UK
| | - Ninian N Lang
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sokratis Stoumpos
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rajan K Patel
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
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Morrow A, Gray SR, Bayes HK, Sykes R, McGarry E, Anderson D, Boiskin D, Burke C, Cleland JGF, Goodyear C, Ibbotson T, Lang CC, McConnachie, Mair F, Mangion K, Patel M, Sattar N, Taggart D, Taylor R, Dawkes S, Berry C. Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise-CISCO-21. Trials 2022; 23:660. [PMID: 35971155 PMCID: PMC9376905 DOI: 10.1186/s13063-022-06632-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/04/2022] [Indexed: 11/11/2022] Open
Abstract
Background Coronavirus disease-19 (COVID-19) infection causes persistent health problems such as breathlessness, chest pain and fatigue, and therapies for the prevention and early treatment of post-COVID-19 syndromes are needed. Accordingly, we are investigating the effect of a resistance exercise intervention on exercise capacity and health status following COVID-19 infection. Methods A two-arm randomised, controlled clinical trial including 220 adults with a diagnosis of COVID-19 in the preceding 6 months. Participants will be classified according to clinical presentation: Group A, not hospitalised due to COVID but persisting symptoms for at least 4 weeks leading to medical review; Group B, discharged after an admission for COVID and with persistent symptoms for at least 4 weeks; or Group C, convalescing in hospital after an admission for COVID. Participants will be randomised to usual care or usual care plus a personalised and pragmatic resistance exercise intervention for 12 weeks. The primary outcome is the incremental shuttle walks test (ISWT) 3 months after randomisation with secondary outcomes including spirometry, grip strength, short performance physical battery (SPPB), frailty status, contacts with healthcare professionals, hospitalisation and questionnaires assessing health-related quality of life, physical activity, fatigue and dyspnoea. Discussion Ethical approval has been granted by the National Health Service (NHS) West of Scotland Research Ethics Committee (REC) (reference: GN20CA537) and recruitment is ongoing. Trial findings will be disseminated through patient and public forums, scientific conferences and journals. Trial registration ClinicialTrials.gov NCT04900961. Prospectively registered on 25 May 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06632-y.
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Affiliation(s)
- A Morrow
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - H K Bayes
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R Sykes
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - E McGarry
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - D Anderson
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - D Boiskin
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C Burke
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J G F Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Goodyear
- Institute of Inflammation, Infection and Immunity, University of Glasgow, Glasgow, UK
| | - T Ibbotson
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C C Lang
- School of Medicine, University of Dundee, Dundee, UK
| | - McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - F Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - K Mangion
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - M Patel
- University Hospital Wishaw, NHS Lanarkshire, Wishaw, UK
| | - N Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Taggart
- NHS Project Management Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R Taylor
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S Dawkes
- School for Nursing Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - C Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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Mangion K, Berry C. Multisystem involvement in COVID-19: what have we learnt? Br J Hosp Med (Lond) 2022; 83:1-5. [DOI: 10.12968/hmed.2022.0290] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The COVID-19 illness trajectory involves persistent cardio-renal inflammation, activation of the haemostatic pathway and lung involvement. Results of a study carried out by the authors' team demonstrate a link between post-COVID-19 syndrome (people who have long COVID) and multisystem disease, which partly explains the lingering impairments in patient-reported health-related quality of life, physical function and psychological wellbeing after COVID-19. This article discusses what hospital physicians need to be aware of when considering the likelihood of myocarditis in patients with post-COVID-19 syndrome and the implications in the longer term.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Elizabeth University Hospital, Glasgow, UK
- Department of Cardiology, Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Elizabeth University Hospital, Glasgow, UK
- Department of Cardiology, Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Lee MMY, Gillis KA, Brooksbank KJM, Allwood-Spiers S, Hall Barrientos P, Wetherall K, Roditi G, AlHummiany B, Berry C, Campbell RT, Chong V, Coyle L, Docherty KF, Dreisbach JG, Kuehn B, Labinjoh C, Lang NN, Lennie V, Mangion K, McConnachie A, Murphy CL, Petrie CJ, Petrie JR, Sharma K, Sourbron S, Speirits IA, Thompson J, Welsh P, Woodward R, Wright A, Radjenovic A, McMurray JJV, Jhund PS, Petrie MC, Sattar N, Mark PB. Effect of Empagliflozin on Kidney Biochemical and Imaging Outcomes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure with Reduced Ejection Fraction (SUGAR-DM-HF). Circulation 2022; 146:364-367. [PMID: 35877829 DOI: 10.1161/circulationaha.122.059851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Matthew M Y Lee
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Keith A Gillis
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Katriona J M Brooksbank
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Sarah Allwood-Spiers
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, UK (S.A.-S., P.H.B.)
| | - Pauline Hall Barrientos
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, UK (S.A.-S., P.H.B.)
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics (K.W., A.M.), University of Glasgow, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | | | - Colin Berry
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Ross T Campbell
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Victor Chong
- University Hospital Crosshouse, Kilmarnock, UK (V.C.)
| | | | - Kieran F Docherty
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | | | - Bernd Kuehn
- Siemens Healthcare GmbH, Erlangen, Germany (B.K.)
| | | | - Ninian N Lang
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Vera Lennie
- University Hospital Ayr, UK (V.L.)
- Aberdeen Royal Infirmary, UK (V.L.)
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics (K.W., A.M.), University of Glasgow, UK
| | | | - Colin J Petrie
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- University Hospital Monklands, Airdrie, UK (C.J.P.)
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | | | - Steven Sourbron
- University of Leeds, UK (B.A., S.S.)
- University of Sheffield, UK (K.S., S.S.)
| | | | - Joyce Thompson
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
| | - Rosemary Woodward
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Ann Wright
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Aleksandra Radjenovic
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Pardeep S Jhund
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
- University Hospital Crosshouse, Kilmarnock, UK (V.C.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
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20
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Mangion K, Morrow A, Sykes R, MacIntosh A, Bagot C, Bayes HK, Bulluck H, Carrick D, Corcoran D, Findlay I, Hall Barrientos P, Ho A, Lang NN, Lennie V, Mark P, McConnachie A, McGeoch R, Nordin S, Payne A, Ryan N, Roditi G, Allwood-Speirs S, Veldtman G, Watkins S, Welsh P, Berry C. 157 Multi-system investigation of covid-19 illness. IMAGING 2022. [DOI: 10.1136/heartjnl-2022-bcs.157] [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: 11/03/2022] Open
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21
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Morrow AJ, Sykes R, McIntosh A, Kamdar A, Bagot C, Bayes HK, Blyth KG, Briscoe M, Bulluck H, Carrick D, Church C, Corcoran D, Findlay I, Gibson VB, Gillespie L, Grieve D, Hall Barrientos P, Ho A, Lang NN, Lennie V, Lowe DJ, Macfarlane PW, Mark PB, Mayne KJ, McConnachie A, McGeoch R, McGinley C, McKee C, Nordin S, Payne A, Rankin AJ, Robertson KE, Roditi G, Ryan N, Sattar N, Allwood-Spiers S, Stobo D, Touyz RM, Veldtman G, Watkins S, Weeden S, Weir RA, Welsh P, Wereski R, Mangion K, Berry C. A multisystem, cardio-renal investigation of post-COVID-19 illness. Nat Med 2022; 28:1303-1313. [PMID: 35606551 PMCID: PMC9205780 DOI: 10.1038/s41591-022-01837-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/25/2022] [Indexed: 12/27/2022]
Abstract
The pathophysiology and trajectory of post-Coronavirus Disease 2019 (COVID-19) syndrome is uncertain. To clarify multisystem involvement, we undertook a prospective cohort study including patients who had been hospitalized with COVID-19 (ClinicalTrials.gov ID NCT04403607 ). Serial blood biomarkers, digital electrocardiography and patient-reported outcome measures were obtained in-hospital and at 28-60 days post-discharge when multisystem imaging using chest computed tomography with pulmonary and coronary angiography and cardio-renal magnetic resonance imaging was also obtained. Longer-term clinical outcomes were assessed using electronic health records. Compared to controls (n = 29), at 28-60 days post-discharge, people with COVID-19 (n = 159; mean age, 55 years; 43% female) had persisting evidence of cardio-renal involvement and hemostasis pathway activation. The adjudicated likelihood of myocarditis was 'very likely' in 21 (13%) patients, 'probable' in 65 (41%) patients, 'unlikely' in 56 (35%) patients and 'not present' in 17 (11%) patients. At 28-60 days post-discharge, COVID-19 was associated with worse health-related quality of life (EQ-5D-5L score 0.77 (0.23) versus 0.87 (0.20)), anxiety and depression (PHQ-4 total score 3.59 (3.71) versus 1.28 (2.67)) and aerobic exercise capacity reflected by predicted maximal oxygen utilization (20.0 (7.6) versus 29.5 (8.0) ml/kg/min) (all P < 0.01). During follow-up (mean, 450 days), 24 (15%) patients and two (7%) controls died or were rehospitalized, and 108 (68%) patients and seven (26%) controls received outpatient secondary care (P = 0.017). The illness trajectory of patients after hospitalization with COVID-19 includes persisting multisystem abnormalities and health impairments that could lead to substantial demand on healthcare services in the future.
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Affiliation(s)
- Andrew J Morrow
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Anna Kamdar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Hannah K Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Michael Briscoe
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - David Carrick
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, Glasgow, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Ninian N Lang
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Peter W Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Kaitlin J Mayne
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | | | - Connor McKee
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sabrina Nordin
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Department of Cardiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Alastair J Rankin
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Keith E Robertson
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Sarah Allwood-Spiers
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Services, NHS Golden Jubilee, Clydebank, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robin A Weir
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Ryan Wereski
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK.
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK.
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22
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He W, McCarroll CS, Nather K, Ford K, Mangion K, Riddell A, O’Toole D, Zaeri A, Corcoran D, Carrick D, Lee MMY, McEntegart M, Davie A, Good R, Lindsay MM, Eteiba H, Rocchiccioli P, Watkins S, Hood S, Shaukat A, McArthur L, Elliott EB, McClure J, Hawksby C, Martin T, Petrie MC, Oldroyd KG, Smith GL, Channon KM, Berry C, Nicklin SA, Loughrey CM. Inhibition of myocardial cathepsin-L release during reperfusion following myocardial infarction improves cardiac function and reduces infarct size. Cardiovasc Res 2022; 118:1535-1547. [PMID: 34132807 PMCID: PMC9074968 DOI: 10.1093/cvr/cvab204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS Identifying novel mediators of lethal myocardial reperfusion injury that can be targeted during primary percutaneous coronary intervention (PPCI) is key to limiting the progression of patients with ST-elevation myocardial infarction (STEMI) to heart failure. Here, we show through parallel clinical and integrative preclinical studies the significance of the protease cathepsin-L on cardiac function during reperfusion injury. METHODS AND RESULTS We found that direct cardiac release of cathepsin-L in STEMI patients (n = 76) immediately post-PPCI leads to elevated serum cathepsin-L levels and that serum levels of cathepsin-L in the first 24 h post-reperfusion are associated with reduced cardiac contractile function and increased infarct size. Preclinical studies demonstrate that inhibition of cathepsin-L release following reperfusion injury with CAA0225 reduces infarct size and improves cardiac contractile function by limiting abnormal cardiomyocyte calcium handling and apoptosis. CONCLUSION Our findings suggest that cathepsin-L is a novel therapeutic target that could be exploited clinically to counteract the deleterious effects of acute reperfusion injury after an acute STEMI.
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Affiliation(s)
| | | | - Katrin Nather
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Kristopher Ford
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Alexandra Riddell
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Dylan O’Toole
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Ali Zaeri
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - David Corcoran
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - David Carrick
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Mathew M Y Lee
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Mitchell M Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Lisa McArthur
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Elspeth B Elliott
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - John McClure
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Catherine Hawksby
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Tamara Martin
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Godfrey L Smith
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | | | - Keith M Channon
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Stuart A Nicklin
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
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Van Rhijn P, Mark P, Thomson P, Mangion K, Stoumpos S. MO981: DE Novo Heart Failure After Kidney Transplantation: Epidemiology, Risk Factors and Outcomes. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac087.039] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Although the risk for congestive heart failure (CHF) decreases after kidney transplantation (KT) compared with dialysis, it remains a significant clinical concern associated with a higher risk of mortality, cardiovascular events and kidney graft loss. Available epidemiological data on CHF after KT are limited, outdated and have mostly focused on traditional risk factors. We aim to describe the risk, predictors and outcomes associated with de novo CHF after KT.
METHOD
We used electronic patient records from the West of Scotland renal database to retrospectively investigate de novo CHF in adult kidney transplant recipients between 1 January 2010 and 31 March 2020. Heart failure was ascertained using a combination of physician-reported diagnosis, echocardiographic criteria, radiological evidence of heart failure and elevation of NT-proBNP levels. Participants were followed up until 15 April 2021. Multivariable regression analysis was used to identify independent correlates of post-transplantation de novo CHF (odds ratio [OR] and 95% confidence interval [CI]) and examine de novo CHF as a predictor of death and graft loss after transplantation.
RESULTS
One hundred and four (8.9%) of 1172 transplant recipients had de novo CHF [mean age, 50 ± 13 years; 470 (40%) women]. The cumulative incidences of de novo CHF were 3.8% (95% CI: 2.9–5.1), 5.2% (95% CI: 4.1–6.7) and 7.1% (95% CI: 5.6–8.9) at 1, 3 and 5 years, respectively. Risk factors for de novo CHF included older recipient age (OR: 1.04; 95% CI: 1.02–1.06; P < 0.001), pre-transplantation diabetes mellitus (OR: 1.9; 95% CI: 1.1–3.2; P = 0.014), pre-transplantation vascular disease (OR: 2.2; 95% CI: 1.3–3.7; P = 0.003), pre-emptive kidney transplant (OR: 0.4; 95% CI: 0.2–0.9; P = 0.024) and the presence of a functional fistula at time of transplantation (OR: 2.3; 95% CI: 1.1–4.9; P = 0.025). In separate analyses, de novo CHF predicted death (OR: 3.3; 95% CI: 1.5–7; P = 0.002) and death-censored graft failure (OR: 5.1; 95% CI: 2.8–9.3; P < 0.001).
CONCLUSION
Congestive heart failure is a common complication after kidney transplantation associated with markedly increased risk for death and graft loss. Identification and optimization of pretransplantation risk factors for CHF and pre-emptive transplantation, suggests targets for improving outcomes.
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Affiliation(s)
- Peter Van Rhijn
- Queen Elizabeth University Hospital, Renal and Transplant Unit, Glasgow, UK
| | - Patrick Mark
- Queen Elizabeth University Hospital, Renal and Transplant Unit, Glasgow, UK
- University of Glasgow, Institute of Cardiovascular and medical sciences, Glasgow, UK
| | - Peter Thomson
- Queen Elizabeth University Hospital, Renal and Transplant Unit, Glasgow, UK
| | - Kenneth Mangion
- University of Glasgow, Institute of Cardiovascular and medical sciences, Glasgow, UK
| | - Sokratis Stoumpos
- Queen Elizabeth University Hospital, Renal and Transplant Unit, Glasgow, UK
- University of Glasgow, Institute of Cardiovascular and medical sciences, Glasgow, UK
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24
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Kamdar A, Sykes R, Morrow A, Mangion K, Berry C. Cardiovascular outcomes of glucose lowering therapy in chronic kidney disease patients: a systematic review with meta-analysis. Rev Cardiovasc Med 2021; 22:1479-1490. [PMID: 34957787 DOI: 10.31083/j.rcm2204152] [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: 09/05/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022] Open
Abstract
Chronic kidney disease (CKD) and cardiovascular disease share common risk factors such as hypertension, diabetes mellitus and dyslipidemia. Patients with CKD carry a high burden of cardiovascular disease and may be excluded from clinical trials on the basis of safety. There are an increasing number of clinical trials which predefine sub-group analysis for CKD. This systematic review with fixed-effect meta-analysis investigates glucose lowering therapy and cardiovascular outcomes in relation to CKD. We included randomized controlled trials (RCT) of glucose lowering treatments performed in adults (aged ≥18 years), humans, with no restriction on date, and English-language restriction in patients with pre-existing CKD regardless of diabetes status. Embase & Ovid Medline databases were searched up to April 2021. Risk of bias was assessed according to Revised Cochrane risk-of-bias tool. We included 7 trials involving a total of 48,801 participants. There were 4 sodium-glucose cotransporter-2 inhibitors (SGLT2i), 2 glucagon-like peptide-1 receptor (GLP-1R) agonists and 1 Dipeptidyl-peptidase 4 (DPP4) inhibitor identified. SGLT2i (relative risk (RR) = 0.90, 95% confidence interval (CI) [0.79-1.02]) and GLP-1R agonists (RR = 0.83, 95% CI [0.72-0.96]) were associated with a reduction in cardiovascular death. SGLT2i (RR = 0.69, 95% CI [0.63-0.75]) are also associated with a reduction in hospitalization for heart failure. In summary, this meta-analysis of large, RCTs of glucose lowering therapies has demonstrated that treatment with SGLT2i or GLP-1R agonists may improve 3 point-MACE and cardiovascular outcomes in patients with chronic renal failure compared with placebo. This systematic review was registered with the PROSPERO network (registration number: CRD42021268563) and follows the PRISMA guidelines on systematic reviews and metanalysis.
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Affiliation(s)
- Anna Kamdar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, G12 8TA Glasgow, UK
| | - Robert Sykes
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, G12 8TA Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, G81 4DY Glasgow, UK
| | - Andrew Morrow
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, G12 8TA Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, G81 4DY Glasgow, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, G12 8TA Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, G81 4DY Glasgow, UK.,Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, G51 4TF Glasgow, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, G12 8TA Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, G81 4DY Glasgow, UK.,Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, G51 4TF Glasgow, UK
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25
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Rankin AJ, Zhu L, Mangion K, Rutherford E, Gillis KA, Lees JS, Woodward R, Patel RK, Berry C, Roditi G, Mark PB. Global longitudinal strain by feature-tracking cardiovascular magnetic resonance imaging predicts mortality in patients with end-stage kidney disease. Clin Kidney J 2021; 14:2187-2196. [PMID: 34804519 PMCID: PMC8598121 DOI: 10.1093/ckj/sfab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/11/2021] [Indexed: 11/12/2022] Open
Abstract
Background Patients with end-stage kidney disease (ESKD) are at increased risk of premature death, with cardiovascular disease being the predominant cause of death. We hypothesized that left ventricular global longitudinal strain (LV-GLS) measured by feature-tracking cardiovascular magnetic resonance imaging (CMRI) would be associated with all-cause mortality in patients with ESKD. Methods A pooled analysis of CMRI studies in patients with ESKD acquired within a single centre between 2002 and 2016 was carried out. CMR parameters including LV ejection fraction (LVEF), LV mass index, left atrial emptying fraction (LAEF) and LV-GLS were measured. We tested independent associations of CMR parameters with survival using a multivariable Cox model. Results Among 215 patients (mean age 54 years, 62% male), mortality was 53% over a median follow-up of 5 years. The median LVEF was 64.7% [interquartile range (IQR) 58.5-70.0] and the median LV-GLS was -15.3% (IQR -17.24 to -13.6). While 90% of patients had preserved LVEF (>50%), 58% of this group had abnormal LV-GLS (>-16%). On multivariable Cox regression, age {hazard ratio [HR] 1.04 [95% confidence interval (CI) 1.02-1.05]}, future renal transplant [HR 0.29 (95% CI 0.17-0.47)], LAEF [HR 0.98 (95% CI 0.96-1.00)] and LV-GLS [HR 1.08 (95% CI 1.01-1.16)] were independently associated with mortality. Conclusions In this cohort of patients with ESKD, LV-GLS on feature-tracking CMRI and LAEF was associated with all-cause mortality, independent of baseline clinical variables and future renal transplantation. This effect was present even when >90% of the cohort had normal LVEF. Using LV-GLS instead of LVEF to diagnose cardiac dysfunction in patients with ESKD could result in a major advance in our understanding of cardiovascular disease in ESKD.
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Affiliation(s)
- Alastair J Rankin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Luke Zhu
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Keith A Gillis
- Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rosie Woodward
- Clinical Research Imaging, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rajan K Patel
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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26
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Rankin AJ, Mangion K, Lees JS, Rutherford E, Gillis KA, Edy E, Dymock L, Treibel TA, Radjenovic A, Patel RK, Berry C, Roditi G, Mark PB. Myocardial changes on 3T cardiovascular magnetic resonance imaging in response to haemodialysis with fluid removal. J Cardiovasc Magn Reson 2021; 23:125. [PMID: 34758850 PMCID: PMC8580743 DOI: 10.1186/s12968-021-00822-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mapping of left ventricular (LV) native T1 is a promising non-invasive, non-contrast imaging biomarker. Native myocardial T1 times are prolonged in patients requiring dialysis, but there are concerns that the dialysis process and fluctuating fluid status may confound results in this population. We aimed to assess the changes in cardiac parameters on 3T cardiovascular magnetic resonance (CMR) before and after haemodialysis, with a specific focus on native T1 mapping. METHODS This is a single centre, prospective observational study in which maintenance haemodialysis patients underwent CMR before and after dialysis (both scans within 24 h). Weight measurement, bio-impedance body composition monitoring, haemodialysis details and fluid intake were recorded. CMR protocol included cine imaging and mapping native T1 and T2. RESULTS Twenty-six participants (16 male, 65 ± 9 years) were included in the analysis. The median net ultrafiltration volume on dialysis was 2.3 L (IQR 1.8, 2.5), resulting in a median weight reduction at post-dialysis scan of 1.35 kg (IQR 1.0, 1.9), with a median reduction in over-hydration (as measured by bioimpedance) of 0.75 L (IQR 0.5, 1.4). Significant reductions were observed in LV end-diastolic volume (- 25 ml, p = 0.002), LV stroke volume (- 13 ml, p = 0.007), global T1 (21 ms, p = 0.02), global T2 (- 1.2 ms, p = 0.02) following dialysis. There was no change in LV mass (p = 0.35), LV ejection fraction (p = 0.13) or global longitudinal strain (p = 0.22). On linear regression there was no association between baseline over-hydration (as defined by bioimpedance) and global native T1 or global T2, nor was there an association between the change in over-hydration and the change in these parameters. CONCLUSIONS Acute changes in cardiac volumes and myocardial native T1 are detectable on 3T CMR following haemodialysis with fluid removal. The reduction in global T1 suggests that the abnormal native T1 observed in patients on haemodialysis is not entirely due to myocardial fibrosis.
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Affiliation(s)
- Alastair J Rankin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Keith A Gillis
- Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Elbert Edy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Laura Dymock
- Clinical Research Imaging, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Thomas A Treibel
- Institute for Cardiovascular Sciences and Barts Heart Centre, University College London, London, UK
| | - Aleksandra Radjenovic
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Rajan K Patel
- Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
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McCartney P, Ang D, Mangion K, Maznyczka A, McEntegart M, Eteiba H, Greenwood J, Muir D, Chowdhary S, Appleby C, Cotton J, Wragg A, Curzen N, Oldroyd K, Good R, Robertson K, Ford T, Collison D, Gillespie L, Petrie M, Weir R, Macfarlane P, Ford I, McConnachie A, Berry C. TCT-189 Effect of Low-Dose Intracoronary Alteplase on Global Circumferential Strain: Myocardial Strain Cardiovascular Magnetic Resonance Substudy of the T-TIME Trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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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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29
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McCartney P, Ang D, Mangion K, McEntegart M, Greenwood JP, Muir D, Chowdhary S, Appleby C, Cotton JM, Eteiba H, Oldroyd KG, Maznyczka A, Radjenovic A, McConnachie A, Berry C. Effect of low dose intracoronary alteplase on global circumferential strain (myocardial strain CMR substudy from the T-TIME trial). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1426] [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
Microvascular obstruction affects half of patients with ST-segment elevation myocardial infarction (STEMI) and confers an adverse prognosis. Feature-tracking (FT) cardiac magnetic resonance (CMR) allows myocardial strain assessment from standard cine images without the need for specialist sequences. Myocardial strain reflects both systolic and diastolic function allowing the assessment of both global and regional myocardial deformation. Strain recovery is impaired in patients with microvascular obstruction. There is growing evidence to suggest that global circumferential strain may offer incremental value beyond traditional CMR endpoints.
Purpose
We aimed to determine whether a therapeutic strategy involving low-dose intracoronary alteplase improves global circumferential strain in STEMI.
Methods
Between March 17, 2016, and December 21, 2017, 440 patients presenting at 11 hospitals in the United Kingdom within 6 hours of STEMI were randomised in a 1:1:1 dose-ranging trial design. Participants were randomly assigned to treatment with placebo (n=151), alteplase 10mg (n=144), or alteplase 20mg (n=145). The primary outcome was the amount of microvascular obstruction (%left ventricular mass) quantified by CMR at 2–7 days. Global circumferential strain was a prespecified secondary endpoint measured at 2–7 days and 3 months. Troponin T AUC was measured at 0, 2, and 24 hours post reperfusion. Patients were followed up to 1 year with all events adjudicated by an independent committee.
Results
Among the 440 patients who were randomised (mean age 60.5 years; 85% male), the primary endpoint was achieved in 396 (90%), all patients were followed up to 1 year for clinical events. The amount (mean, standard deviation) of microvascular obstruction was not different between the groups (2.3% vs. 2.6% vs. 3.5% left ventricular mass); p=0.28. Global circumferential strain was worse in patients receiving alteplase. −23.1% (placebo) vs −20.6 (10mg alteplase) vs −22.0% (20mg alteplase); mean difference for both doses combined vs placebo: 1.8% (95% CI 0.5, 3.2), p=0.009. There were no differences between groups in the other CMR endpoints including LV ejection fraction (LVEF). The area-under-the-curve for troponin T measured in 317 (72%) patients was increased in both treatment groups compared to placebo, mean difference 1.53 (95% CI: 1.16, 2.01), p=0.002. There were no differences in MACE at 1 year; placebo n=16 (10.6%), 10mg alteplase n=22 (15.3%), 20mg alteplase group n=15 (10.3%).
Conclusion
In patients presenting within 6 hours of STEMI, low-dose intracoronary alteplase compared with placebo did not reduce microvascular obstruction. There was a reduction in global circumferential strain and an increase in Troponin T AUC supporting an increase in myocardial injury early after reperfusion in patients receiving alteplase. There was no differences in MACE at one year suggesting no long-term clinical sequelae.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): T-TIME was supported by grant 12/170/4 from the Efficacy and Mechanism Evaluation (EME) programme of the National Institute for Health Research (NIHR-EME). Boehringer-Ingelheim U.K. Ltd. provided the study drugs (alteplase 10mg, 20mg), matched placebo, and sterile water for injection. Study recruitment flowchartTable- Study endpoints
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Affiliation(s)
- P McCartney
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - D Ang
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - K Mangion
- University of Glasgow, ICAMS, Glasgow, United Kingdom
| | - M McEntegart
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | | | - D Muir
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - S Chowdhary
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - C Appleby
- Cardiothoracic Centre Trust of Liverpool, Liverpool, United Kingdom
| | - J M Cotton
- New Cross Hospital, Wolverhampton, United Kingdom
| | - H Eteiba
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - K G Oldroyd
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - A Maznyczka
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - A Radjenovic
- University of Glasgow, ICAMS, Glasgow, United Kingdom
| | - A McConnachie
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | - C Berry
- University of Glasgow, ICAMS, Glasgow, United Kingdom
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Lees JS, Rankin AJ, Gillis KA, Zhu LY, Mangion K, Rutherford E, Roditi GH, Witham MD, Chantler D, Panarelli M, Jardine AG, Mark PB. The ViKTORIES trial: A randomized, double-blind, placebo-controlled trial of vitamin K supplementation to improve vascular health in kidney transplant recipients. Am J Transplant 2021; 21:3356-3368. [PMID: 33742520 DOI: 10.1111/ajt.16566] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/24/2021] [Accepted: 03/13/2021] [Indexed: 01/25/2023]
Abstract
Premature cardiovascular disease and death with a functioning graft are leading causes of death and graft loss, respectively, in kidney transplant recipients (KTRs). Vascular stiffness and calcification are markers of cardiovascular disease that are prevalent in KTR and associated with subclinical vitamin K deficiency. We performed a single-center, phase II, parallel-group, randomized, double-blind, placebo-controlled trial (ISRCTN22012044) to test whether vitamin K supplementation reduced vascular stiffness (MRI-based aortic distensibility) or calcification (coronary artery calcium score on computed tomography) in KTR over 1 year of treatment. The primary outcome was between-group difference in vascular stiffness (ascending aortic distensibility). KTRs were recruited between September 2017 and June 2018, and randomized 1:1 to vitamin K (menadiol diphosphate 5 mg; n = 45) or placebo (n = 45) thrice weekly. Baseline demographics, clinical history, and immunosuppression regimens were similar between groups. There was no impact of vitamin K on vascular stiffness (treatment effect -0.23 [95% CI -0.75 to 0.29] × 10-3 mmHg-1 ; p = .377), vascular calcification (treatment effect -141 [95% CI - 320 to 38] units; p = .124), nor any other outcome measure. In this heterogeneous cohort of prevalent KTR, vitamin K supplementation did not reduce vascular stiffness or calcification over 1 year. Improving vascular health in KTR is likely to require a multifaceted approach.
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Affiliation(s)
- Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alastair J Rankin
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Keith A Gillis
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Luke Y Zhu
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Giles H Roditi
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, 3rd Floor Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne, Glasgow, UK
| | - Donna Chantler
- Department of Clinical Biochemistry, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Maurizio Panarelli
- Department of Clinical Biochemistry, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alan G Jardine
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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El Farissi M, Good R, Engstrøm T, Oldroyd KG, Karamasis GV, Vlaar PJ, Lønborg JT, Teeuwen K, Keeble TR, Mangion K, De Bruyne B, Fröbert O, De Vos A, Zwart B, Snijder RJR, Brueren GRG, Palmers PJ, Wijnbergen IF, Berry C, Tonino PAL, Otterspoor LC, Pijls NHJ. Safety of Selective Intracoronary Hypothermia During Primary Percutaneous Coronary Intervention in Patients With Anterior STEMI. JACC Cardiovasc Interv 2021; 14:2047-2055. [PMID: 34454860 DOI: 10.1016/j.jcin.2021.06.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/21/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to determine the safety of selective intracoronary hypothermia during primary percutaneous coronary intervention (PPCI) in patients with anterior ST-segment elevation myocardial infarction (STEMI). BACKGROUND Selective intracoronary hypothermia is a novel treatment designed to reduce myocardial reperfusion injury and is currently being investigated in the ongoing randomized controlled EURO-ICE (European Intracoronary Cooling Evaluation in Patients With ST-Elevation Myocardial Infarction) trial (NCT03447834). Data on the safety of such a procedure during PPCI are still limited. METHODS The first 50 patients with anterior STEMI treated with selective intracoronary hypothermia during PPCI were included in this analysis and compared for safety with the first 50 patients randomized to the control group undergoing standard PPCI. In-hospital mortality, occurrence of rhythm or conduction disturbances, stent thrombosis, onset of heart failure during the procedure, and subsequent hospital admission were assessed. RESULTS In-hospital mortality was 0%. One patient in both groups developed cardiogenic shock. Atrial fibrillation occurred in 0 and 3 patients (P = 0.24), and ventricular fibrillation occurred in 5 and 3 patients (P = 0.72) in the intracoronary hypothermia group and control group, respectively. Stent thrombosis occurred in 2 patients in the intracoronary hypothermia group; 1 instance was intraprocedural, and the other occurred following interruption of dual-antiplatelet therapy consequent to an intracranial hemorrhage 6 days after enrollment. No stent thrombosis was observed in the control group (P = 0.50). CONCLUSIONS Selective intracoronary hypothermia during PPCI in patients with anterior STEMI can be implemented within the routine of PPCI and seems to be safe. The final safety results will be reported at the end of the trial.
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Affiliation(s)
- Mohamed El Farissi
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Richard Good
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Keith G Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Grigoris V Karamasis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmford, Essex, United Kingdom
| | - Pieter J Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jacob T Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmford, Essex, United Kingdom
| | - Kenneth Mangion
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Ole Fröbert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Annemiek De Vos
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Bastiaan Zwart
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Roel J R Snijder
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Guus R G Brueren
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pieter-Jan Palmers
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Inge F Wijnbergen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Colin Berry
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom; British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
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Affiliation(s)
- Robert Sykes
- West of Scotland Heart and Lung Centre, Beardmore Street, Clydebank, G81 4HX, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126, University Place, Glasgow G12 8TA, UK
| | - Andrew Morrow
- West of Scotland Heart and Lung Centre, Beardmore Street, Clydebank, G81 4HX, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126, University Place, Glasgow G12 8TA, UK
| | - Kenneth Mangion
- West of Scotland Heart and Lung Centre, Beardmore Street, Clydebank, G81 4HX, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126, University Place, Glasgow G12 8TA, UK.,Department of Cardiology, Queen Elizabeth University Hospital, 1345 Govan Rd,, Glasgow G51 4TF, UK
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Mangion K, Dewantoro D, Mclennan E, Tynan N, Dymock L, Woodward R, Hopkins T, Berry C, Adams J, Stobo D, Roditi GH, Byrne J. Role of inpatient coronary CT angiography on clinical decision making during COVID- 19 pandemic. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC8344799 DOI: 10.1093/ehjci/jeab111.023] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The COVID-19 pandemic has had a profound effect on healthcare delivery. Here we describe the effect of repurposing of a research Computed Tomography scanner on clinical care of cardiology patients in an urban academic medical centre which did not have routine access to CCTA prior to the pandemic.
Patients requiring invasive coronary angiography require transfer to a regional cardiac centre (no ICA available on site).
Purpose
We investigated the effect of CCTA on i) diagnostic certainty ii) avoidance of clinician defined unnecessary invasive angiography in hospitalised patients.
Methods
This was a prospective, longitudinal cohort study involving hospitalized patients admitted to an urban academic medical centre (catchment population 650 000) between March 29 and September 21, 2020. Routinely collected (usual care) data were gathered by clinicians who were members of the usual care medical team and ethics approval or explicit patient consent was not required. High-sensitivity Troponin-I was measured on admission and 3- and 6– hours after if mandated (Abbott Architect TnI assay).
A 320-detector scanner (Aquilon ONE, Canon) was used. Intravenous metoprolol was used where required to control the heart rate (target 60 b.p.m.) and sublingual glyceryl trinitrate will be given to all patients immediately before the scan acquisition.
Results
Forty-three patients underwent inpatient CCTA, mean age: 61 ± 13 years (range 30-88y), 54% female. The presenting complaint was typical chest pain in 28 (65%), atypical chest pain in 10 (23%), and a variety of symptoms in 5 (12%) including palpitations, syncope, breathlessness.
Thirty-six (84%) of patients had a detectable TnI above the 99% centile. Median(IQR) peak TnI was 127 (33-635)ng/L.
CCTA was carried out on average 1 day post request.
CCTA resulted in an improvement in clinician diagnostic certainty (Initial review: 21% yes, 79% probable, post-CCTA review: 84% yes, 16% probable) in providing a diagnosis.
21 (49%) of invasive coronary angiograms were avoided due to CCTA, whilst an inpatient invasive coronary angiogram (ICA) was performed in 4(9%) due to CCTA demonstrating significant disease, and in 2(%) the ICA was changed from out-patient to in-patient. Three ICA tests were requested as OP due to CCTA findings. CCTA did not overestimate disease severity in this cohort.
We saved 21 inter hospital transfers for ICA during this time period.
Using NHS England cost tariffs, a cost saving of >£36,000 was made for using CCTA instead of ICA in these 21 patients who would have required ICA.
Conclusion
Inpatient CCTA resulted in greater clinician diagnostic confidence, avoidance of unnecessary invasive angiograms and a significant cost saving. This also reduced the duration of patient stay, reducing the potential exposure of patients to COVID-19.
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Affiliation(s)
- K Mangion
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - D Dewantoro
- Queen Elizabeth University Hospital, Cardiology, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - E Mclennan
- Queen Elizabeth University Hospital, Clinical Research Imaging Department, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - N Tynan
- Queen Elizabeth University Hospital, Clinical Research Imaging Department, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - L Dymock
- Queen Elizabeth University Hospital, Clinical Research Imaging Department, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - R Woodward
- Queen Elizabeth University Hospital, Clinical Research Imaging Department, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - T Hopkins
- Queen Elizabeth University Hospital, Clinical Research Imaging Department, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - C Berry
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - J Adams
- Queen Elizabeth University Hospital, Cardiology, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - D Stobo
- NHS Greater Glasgow and Clyde, Radiology, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - GH Roditi
- NHS Greater Glasgow and Clyde, Radiology, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - J Byrne
- Queen Elizabeth University Hospital, Cardiology, Glasgow, United Kingdom of Great Britain & Northern Ireland
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Sykes R, Briscoe M, Krysztofiak T, Peck O, Mangion K, Berry C. Type 2 myocardial infarction and myocardial injury: eligibility for novel medical therapy to derisk clinical trials. Open Heart 2021; 8:openhrt-2021-001633. [PMID: 34083388 PMCID: PMC8174491 DOI: 10.1136/openhrt-2021-001633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/16/2021] [Indexed: 11/05/2022] Open
Abstract
Background Patients with type 2 myocardial infarction (T2MI) and other mechanisms of nonthrombotic myocardial injury have an unmet therapeutic need. Eligibility for novel medical therapy is generally uncertain. Methods We predefined colchicine, eplerenone and ticagrelor as candidates for repurposing towards novel therapy for T2MI or myocardial injury. Considering eligibility for randomisation in a clinical trial, each drug was classified according to indications and contraindications for therapy and survival for at least 24 hours following admission. Eligibility criteria for prescription were evaluated against the Summary of Medical Product Characteristics. Consecutive hospital admissions were screened to identify patients with ≥1 high-sensitivity troponin-I value >99th percentile. Endotypes of myocardial injury were adjudicated according to the Fourth Universal Definition of MI. Patients’ characteristics and medication were prospectively evaluated. Results During 1 March to 15 April 2020, 390 patients had a troponin I>URL. Reasons for exclusion: type 1 MI n=115, indeterminate diagnosis n=42, lack of capacity n=14, death <24 hours n=7, duplicates n=2. Therefore, 210 patients with T2MI/myocardial injury and 174 (82.8%) who survived to discharge were adjudicated for treatment eligibility. Patients who fulfilled eligibility criteria initially on admission and then at discharge were colchicine 25/210 (11.9%) and 23/174 (13.2%); eplerenone 57/210 (27.1%) and 45/174 (25.9%); ticagrelor 122/210 (58.1%) and 98/174 (56.3%). Forty-six (21.9%) and 38 (21.8%) patients were potentially eligible for all three drugs on admission and discharge, respectively. Conclusion A reasonably high proportion of patients may be considered eligible for repurposing novel medical therapy in secondary prevention trials of type 2 MI/myocardial injury.
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Affiliation(s)
- Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Glasgow, UK.,West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Michael Briscoe
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Thomas Krysztofiak
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Oliver Peck
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.,Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Glasgow, UK.,Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Glasgow, UK .,West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.,Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
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Al-Hussaini A, Abdelaty AMSEK, Gulsin GS, Arnold JR, Garcia-Guimaraes M, Premawardhana D, Budgeon C, Wood A, Natarajan N, Mangion K, Rakhit R, Hoole SP, Johnson TW, Berry C, Hudson I, Gershlick AH, Ladwiniec A, Kovac J, Squire I, Samani NJ, Plein S, McCann GP, Adlam D. Chronic infarct size after spontaneous coronary artery dissection: implications for pathophysiology and clinical management. Eur Heart J 2021; 41:2197-2205. [PMID: 31898721 PMCID: PMC7299635 DOI: 10.1093/eurheartj/ehz895] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/29/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS To report the extent and distribution of myocardial injury and its impact on left ventricular systolic function with cardiac magnetic resonance imaging (CMR) following spontaneous coronary artery dissection (SCAD) and to investigate predictors of myocardial injury. METHODS AND RESULTS One hundred and fifty-eight angiographically confirmed SCAD-survivors (98% female) were phenotyped by CMR and compared in a case-control study with 59 (97% female) healthy controls (44.5 ± 8.4 vs. 45.0 ± 9.1 years). Spontaneous coronary artery dissection presentation was with non-ST-elevation myocardial infarction in 95 (60.3%), ST-elevation myocardial infarction (STEMI) in 52 (32.7%), and cardiac arrest in 11 (6.9%). Left ventricular function in SCAD-survivors was generally well preserved with small reductions in ejection fraction (57 ± 7.2% vs. 60 ± 4.9%, P < 0.01) and increases in left ventricular dimensions (end-diastolic volume: 85 ± 14 mL/m2 vs. 80 ± 11 mL/m2, P < 0.05; end-systolic volume: 37 ± 11 mL/m2 vs. 32 ± 7 mL/m2, P <0.01) compared to healthy controls. Infarcts were small with few large infarcts (median 4.06%; range 0-30.9%) and 39% having no detectable late gadolinium enhancement (LGE). Female SCAD patients presenting with STEMI had similar sized infarcts to female Type-1 STEMI patients age <75 years. Multivariate modelling demonstrated STEMI at presentation, initial TIMI 0/1 flow, multivessel SCAD, and a Beighton score >4 were associated with larger infarcts [>10% left ventricular (LV) mass]. CONCLUSION The majority of patients presenting with SCAD have no or small infarctions and preserved ejection fraction. Patients presenting with STEMI, TIMI 0/1 flow, multivessel SCAD and those with features of connective tissue disorders are more likely to have larger infarcts.
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Affiliation(s)
- Abtehale Al-Hussaini
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Ahmed M S E K Abdelaty
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.,Department of Cardiovascular Sciences, Faculty of Medicine, Suez Canal University, km 4.5 Ring road, 41522, Ismailia, Egypt
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Marcos Garcia-Guimaraes
- Department of Cardiology, Hospital Universitario de La Princesa Madrid, Calle Diego de León 62, Madrid, Spain
| | - Diluka Premawardhana
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Charley Budgeon
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Alice Wood
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Nalin Natarajan
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.,Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| | - Roby Rakhit
- Royal Free Hospital, Pond St, Hampstead, London NW3 2QG, UK.,Institute of Cardiovascular Science University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK
| | - Stephen P Hoole
- Royal Papworth Hospital, Papworth Rd, Cambridge CB2 0AY, UK.,NIHR Cambridge Biomedical Research Centre, Box 277 Hills Road Cambridge CB2 0QQ, UK
| | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol BS2 8HW, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.,Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| | - Ian Hudson
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Andrew Ladwiniec
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Jan Kovac
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Iain Squire
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - David Adlam
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
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Berry C, Mangion K. Cardiovascular Complications Are Uncommon in Healthcare Workers With Mild or Asymptomatic COVID-19 Infection. JACC Cardiovasc Imaging 2021; 14:2167-2169. [PMID: 34119431 PMCID: PMC8105427 DOI: 10.1016/j.jcmg.2021.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland.
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland
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Sykes R, Doherty D, Mangion K, Morrow A, Berry C. What an Interventionalist Needs to Know About MI with Non-obstructive Coronary Arteries. Interv Cardiol 2021; 16:e10. [PMID: 34188694 PMCID: PMC8218171 DOI: 10.15420/icr.2021.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
MI with non-obstructive coronary arteries (MINOCA) is caused by a heterogeneous group of vascular or myocardial disorders. MINOCA occurs in 5.15% of patients presenting with acute ST-segment elevation MI or non-ST segment elevation MI and prognosis is impaired. The diagnosis of MINOCA is made during coronary angiography following acute MI, where there is no stenosis ≥50% present in an infarct-related epicardial artery and no overt systemic aetiology for the presentation. Accurate diagnosis and subsequent management require the appropriate utilisation of intravascular imaging, coronary function testing and subsequent imaging to assess for myocardial disorders without coronary involvement. Although plaque-related MINOCA is currently managed with empirical secondary prevention strategies, there remains an unmet therapeutic need for targeted and evidence-based therapy for MINOCA patients and increased awareness of the recommended diagnostic pathway.
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Affiliation(s)
- Robert Sykes
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalGlasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of GlasgowGlasgow, UK
| | - Daniel Doherty
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalGlasgow, UK
| | - Kenneth Mangion
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalGlasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of GlasgowGlasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Andrew Morrow
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalGlasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of GlasgowGlasgow, UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalGlasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of GlasgowGlasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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Pellicori P, Doolub G, Wong CM, Lee KS, Mangion K, Ahmad M, Berry C, Squire I, Lambiase PD, Lyon A, McConnachie A, Taylor RS, Cleland JG. COVID-19 and its cardiovascular effects: a systematic review of prevalence studies. Cochrane Database Syst Rev 2021; 3:CD013879. [PMID: 33704775 PMCID: PMC8078349 DOI: 10.1002/14651858.cd013879] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A small minority of people with coronavirus disease 2019 (COVID-19) develop a severe illness, characterised by inflammation, microvascular damage and coagulopathy, potentially leading to myocardial injury, venous thromboembolism (VTE) and arterial occlusive events. People with risk factors for or pre-existing cardiovascular disease may be at greater risk. OBJECTIVES To assess the prevalence of pre-existing cardiovascular comorbidities associated with suspected or confirmed cases of COVID-19 in a variety of settings, including the community, care homes and hospitals. We also assessed the nature and rate of subsequent cardiovascular complications and clinical events in people with suspected or confirmed COVID-19. SEARCH METHODS We conducted an electronic search from December 2019 to 24 July 2020 in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, covid-19.cochrane.org, ClinicalTrials.gov and EU Clinical Trial Register. SELECTION CRITERIA We included prospective and retrospective cohort studies, controlled before-and-after, case-control and cross-sectional studies, and randomised controlled trials (RCTs). We analysed controlled trials as cohorts, disregarding treatment allocation. We only included peer-reviewed studies with 100 or more participants, and excluded articles not written in English or only published in pre-print servers. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results and extracted data. Given substantial variation in study designs, reported outcomes and outcome metrics, we undertook a narrative synthesis of data, without conducting a meta-analysis. We critically appraised all included studies using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the JBI checklist for case series. MAIN RESULTS We included 220 studies. Most of the studies originated from China (47.7%) or the USA (20.9%); 9.5% were from Italy. A large proportion of the studies were retrospective (89.5%), but three (1.4%) were RCTs and 20 (9.1%) were prospective. Using JBI's critical appraisal checklist tool for prevalence studies, 75 studies attained a full score of 9, 57 studies a score of 8, 31 studies a score of 7, 5 studies a score of 6, three studies a score of 5 and one a score of 3; using JBI's checklist tool for case series, 30 studies received a full score of 10, six studies a score of 9, 11 studies a score of 8, and one study a score of 5 We found that hypertension (189 studies, n = 174,414, weighted mean prevalence (WMP): 36.1%), diabetes (197 studies, n = 569,188, WMP: 22.1%) and ischaemic heart disease (94 studies, n = 100,765, WMP: 10.5%) are highly prevalent in people hospitalised with COVID-19, and are associated with an increased risk of death. In those admitted to hospital, biomarkers of cardiac stress or injury are often abnormal, and the incidence of a wide range of cardiovascular complications is substantial, particularly arrhythmias (22 studies, n = 13,115, weighted mean incidence (WMI) 9.3%), heart failure (20 studies, n = 29,317, WMI: 6.8%) and thrombotic complications (VTE: 16 studies, n = 7700, WMI: 7.4%). AUTHORS' CONCLUSIONS This systematic literature review indicates that cardiometabolic comorbidities are common in people who are hospitalised with a COVID-19 infection, and cardiovascular complications are frequent. We plan to update this review and to conduct a formal meta-analysis of outcomes based on a more homogeneous selected subsample of high-certainty studies.
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Affiliation(s)
- Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Gemina Doolub
- Department of Cardiology, Bristol Heart Institute, Bristol, UK
| | - Chih Mun Wong
- Department of Cardiology, Southmead Hospital, Bristol, UK
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Kenneth Mangion
- British Heart Foundation Centre of Research Excellence, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Colin Berry
- British Heart Foundation Centre of Research Excellence, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Iain Squire
- NIHR Cardiovascular Research Institute, Glenfield Hospital, Leicester, UK
| | - Pier D Lambiase
- Centre for Cardiology in the Young, The Heart Hospital, University College London Hospitals, London, UK
| | - Alexander Lyon
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Alex McConnachie
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - John Gf Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
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Briscoe M, Sykes R, Krystofiak T, Peck O, Mangion K, Berry C. Clinical significance of coronavirus disease 2019 in hospitalized patients with myocardial injury. Clin Cardiol 2021; 44:332-339. [PMID: 33501708 PMCID: PMC7943910 DOI: 10.1002/clc.23530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 12/15/2022] Open
Abstract
Background The clinical significance of Coronavirus disease 2019 (COVID‐19) as an associate of myocardial injury is controversial. Hypothesis Type 2 MI/Myocardial Injury are associated with worse outcomes if complicated by COVID‐19. Methods This longitudinal cohort study involved consecutive patients admitted to a large urban hospital. Myocardial injury was determined using laboratory records as ≥1 hs‐TnI result >99th percentile (male: >34 ng/L; female: >16 ng/L). Endotypes were defined according to the Fourth Universal Definition of Myocardial Infarction (MI) and COVID‐19 determined using PCR. Outcomes of patients with myocardial injury with and without COVID‐19 were assessed. Results Of 346 hospitalized patients with elevated hs‐TnI, 35 (10.1%) had laboratory‐confirmed COVID‐19 (median age [IQR]; 65 [59–74]; 64.8% male vs. COVID‐19 negative: 74 [63–83] years; 43.7% male). Cardiac endotypes by COVID‐19 status (yes vs. no) were: Type 1 MI (0 [0%] vs. 115 [100%]; p < .0005), Type 2 MI (13 [16.5%] vs. 66 [83.5%]; p = .045), and non‐ischemic myocardial injury (cardiac: 4 [5.8%] vs. 65 [94.2%]; p = .191, non‐cardiac:19 [22.9%] vs. 64 [77.%]; p < .0005). COVID‐19 patients had less comorbidity (median [IQR] Charlson Comorbidity Index: 3.0 [3.0] vs. 5.0 [4.0]; p = .001), similar hs‐TnI concentrations (median [IQR] initial: 46 [113] vs. 62 [138]; p = .199, peak: 122 [474] vs. 79 [220] ng/L; p = .564), longer admission (days) (median [IQR]: 14[19] vs. 6[12]; p = .001) and higher in‐hospital mortality (63.9% vs. 11.3%; OR = 13.2; 95%CI: 5.90, 29.7). Conclusions Cardiac sequelae of COVID‐19 typically manifest as Non‐cardiac myocardial injury/Type 2MI in younger patients with less co‐morbidity. Paradoxically, the admission duration and in‐hospital mortality are increased.
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Affiliation(s)
- Michael Briscoe
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Robert Sykes
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Thomas Krystofiak
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Oliver Peck
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Kenneth Mangion
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Colin Berry
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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40
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Li W, Gao H, Mangion K, Berry C, Luo X. Apparent growth tensor of left ventricular post myocardial infarction - In human first natural history study. Comput Biol Med 2020; 129:104168. [PMID: 33341555 DOI: 10.1016/j.compbiomed.2020.104168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/24/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022]
Abstract
An outstanding challenge in modelling biomechanics after myocardial infarction (MI) is to estimate the so-called growth tensor. Since it is impossible to track pure growth induced geometry change from in vivo magnetic resonance images alone, in this work, we propose a way of estimating a surrogate or apparent growth tensor of the human left ventricle using cine magnetic resonance (CMR) and late gadolinium enhanced (LGE) images of 16 patients following acute MI. The apparent growth tensor is evaluated at four time-points following myocardial reperfusion: 4-12 h (baseline), 3 days, 10 days and 7 months. We have identified three different growth patterns classified as the Dilation, No-Change and Shrinkage groups defined by the left ventricle end-diastole cavity volume change from baseline. We study the- trends in both the infarct and remote regions. Importantly, although the No-Change group has little change in the ventricular cavity volume, significant remodelling changes are seen within the myocardial wall, both in the infarct and remote regions. Through statistical analysis, we show that the growth tensor invariants can be used as effective biomarkers for adverse and favourable remodelling of the heart from 10 days onwards post-MI with statistically significant changes over time, in contrast to most of the routine clinical indices. We believe this is the first time that the apparent growth tensor has been estimated from in vivo CMR images post-MI. Our study not only provides much-needed information for understanding growth and remodelling in the human heart following acute MI, but also identifies novel biomarker for assessing heart disease progression.
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Affiliation(s)
- Wenguang Li
- School of Engineering, University of Glasgow, UK.
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow, UK.
| | - Kenneth Mangion
- College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
| | - Colin Berry
- College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, UK.
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41
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Rutherford E, Ireland S, Mangion K, Stewart GA, MacGregor MS, Roditi G, Woodward R, Gandy SJ, Houston JG, Jardine AG, Rauchhaus P, Witham MD, Mark PB, Struthers AD. A Randomized, Controlled Trial of the Effect of Allopurinol on Left Ventricular Mass Index in Hemodialysis Patients. Kidney Int Rep 2020; 6:146-155. [PMID: 33426394 PMCID: PMC7783562 DOI: 10.1016/j.ekir.2020.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Increased left ventricular mass index (LVMI) is associated with mortality in end-stage renal disease. LVMI regression may improve outcomes. Allopurinol has reduced LVMI in randomized controlled trials in chronic kidney disease, diabetes, and ischemic heart disease. This study investigated whether allopurinol would regress LVMI in hemodialysis patients. Methods This was a randomized placebo-controlled double-blind multicenter trial funded by the British Heart Foundation (PG/12/72/29743). A total of 80 patients undergoing regular maintenance hemodialysis were recruited from NHS Tayside, NHS Greater Glasgow and Clyde and NHS Ayrshire and Arran in Scotland, UK. Participants were randomly assigned on a 1:1 ratio to 12 months of therapy with allopurinol 300 mg or placebo after each dialysis session. The primary outcome was change in LVMI, as assessed by cardiac magnetic resonance imaging (CMRI) at baseline and 12 months. Secondary outcomes were change in BP, flow-mediated dilation (FMD), augmentation indices (AIx), and pulse wave velocity (PWV). Results A total of 53 patients, with a mean age of 58 years, completed the study and had CMRI follow-up data for analysis. Allopurinol did not regress LVMI (change in LVMI: placebo +3.6 ± 10.4 g/m2; allopurinol: +1.6 ± 11 g/m2; P = 0.49). Allopurinol had no demonstrable effect on BP, FMD, AIx, or PWV. Conclusion Compared with placebo, treatment with allopurinol did not regress LVMI in this trial.
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Affiliation(s)
- Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK.,Renal & Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Sheila Ireland
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK
| | | | - Mark S MacGregor
- Renal Unit, Crosshouse Hospital, NHS Ayrshire & Arran, Kilmarnock, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK.,Department of Radiology, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Rosemary Woodward
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK
| | - Stephen J Gandy
- Department of Radiology, Ninewells Hospital, NHS Tayside, Dundee, UK.,Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | | | - Alan G Jardine
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK.,Renal & Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Miles D Witham
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals Trust, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK.,Renal & Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Allan D Struthers
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
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42
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Mangion K, Morrow A, Bagot C, Bayes H, Blyth KG, Church C, Corcoran D, Delles C, Gillespie L, Grieve D, Ho A, Kean S, Lang NN, Lennie V, Lowe DJ, Kellman P, Macfarlane PW, McConnachie A, Roditi G, Sykes R, Touyz RM, Sattar N, Wereski R, Wright S, Berry C. The Chief Scientist Office Cardiovascular and Pulmonary Imaging in SARS Coronavirus disease-19 (CISCO-19) study. Cardiovasc Res 2020; 116:2185-2196. [PMID: 32702087 PMCID: PMC7454350 DOI: 10.1093/cvr/cvaa209] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 is typically a primary respiratory illness with multisystem involvement. The prevalence and clinical significance of cardiovascular and multisystem involvement in COVID-19 remain unclear. METHODS This is a prospective, observational, multicentre, longitudinal, cohort study with minimal selection criteria and a near-consecutive approach to screening. Patients who have received hospital care for COVID-19 will be enrolled within 28 days of discharge. Myocardial injury will be diagnosed according to the peak troponin I in relation to the upper reference limit (URL, 99th centile) (Abbott Architect troponin I assay; sex-specific URL, male: >34 ng/L; female: >16 ng/L). Multisystem, multimodality imaging will be undertaken during the convalescent phase at 28 days post-discharge (Visit 2). Imaging of the heart, lung, and kidneys will include multiparametric, stress perfusion, cardiovascular magnetic resonance imaging, and computed tomography coronary angiography. Health and well-being will be assessed in the longer term. The primary outcome is the proportion of patients with a diagnosis of myocardial inflammation. CONCLUSION CISCO-19 will provide detailed insights into cardiovascular and multisystem involvement of COVID-19. Our study will inform the rationale and design of novel therapeutic and management strategies for affected patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04403607.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Andrew Morrow
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Hannah Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Christian Delles
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Sharon Kean
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ninian N Lang
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, University Hospital Ayr, Ayrshire and Arran Health Board, Ayr, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Peter W Macfarlane
- Electrocardiography Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Alex McConnachie
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Giles Roditi
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ryan Wereski
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- Department of Cardiology, University Hospital Ayr, Ayrshire and Arran Health Board, Ayr, UK
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sylvia Wright
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Respiratory Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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43
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Lee MMY, Brooksbank KJM, Wetherall K, Mangion K, Roditi G, Campbell RT, Berry C, Chong V, Coyle L, Docherty KF, Dreisbach JG, Labinjoh C, Lang NN, Lennie V, McConnachie A, Murphy CL, Petrie CJ, Petrie JR, Speirits IA, Sourbron S, Welsh P, Woodward R, Radjenovic A, Mark PB, McMurray JJV, Jhund PS, Petrie MC, Sattar N. Effect of Empagliflozin on Left Ventricular Volumes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure With Reduced Ejection Fraction (SUGAR-DM-HF). Circulation 2020; 143:516-525. [PMID: 33186500 PMCID: PMC7864599 DOI: 10.1161/circulationaha.120.052186] [Citation(s) in RCA: 205] [Impact Index Per Article: 51.3] [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: 01/08/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors reduce the risk of heart failure hospitalization and cardiovascular death in patients with heart failure and reduced ejection fraction (HFrEF). However, their effects on cardiac structure and function in HFrEF are uncertain. METHODS We designed a multicenter, randomized, double-blind, placebo-controlled trial (the SUGAR-DM-HF trial [Studies of Empagliflozin and Its Cardiovascular, Renal and Metabolic Effects in Patients With Diabetes Mellitus, or Prediabetes, and Heart Failure]) to investigate the cardiac effects of empagliflozin in patients in New York Heart Association functional class II to IV with a left ventricular (LV) ejection fraction ≤40% and type 2 diabetes or prediabetes. Patients were randomly assigned 1:1 to empagliflozin 10 mg once daily or placebo, stratified by age (<65 and ≥65 years) and glycemic status (diabetes or prediabetes). The coprimary outcomes were change from baseline to 36 weeks in LV end-systolic volume indexed to body surface area and LV global longitudinal strain both measured using cardiovascular magnetic resonance. Secondary efficacy outcomes included other cardiovascular magnetic resonance measures (LV end-diastolic volume index, LV ejection fraction), diuretic intensification, symptoms (Kansas City Cardiomyopathy Questionnaire Total Symptom Score, 6-minute walk distance, B-lines on lung ultrasound, and biomarkers (including N-terminal pro-B-type natriuretic peptide). RESULTS From April 2018 to August 2019, 105 patients were randomly assigned: mean age 68.7 (SD, 11.1) years, 77 (73.3%) male, 82 (78.1%) diabetes and 23 (21.9%) prediabetes, mean LV ejection fraction 32.5% (9.8%), and 81 (77.1%) New York Heart Association II and 24 (22.9%) New York Heart Association III. Patients received standard treatment for HFrEF. In comparison with placebo, empagliflozin reduced LV end-systolic volume index by 6.0 (95% CI, -10.8 to -1.2) mL/m2 (P=0.015). There was no difference in LV global longitudinal strain. Empagliflozin reduced LV end-diastolic volume index by 8.2 (95% CI, -13.7 to -2.6) mL/m2 (P=0.0042) and reduced N-terminal pro-B-type natriuretic peptide by 28% (2%-47%), P=0.038. There were no between-group differences in other cardiovascular magnetic resonance measures, diuretic intensification, Kansas City Cardiomyopathy Questionnaire Total Symptom Score, 6-minute walk distance, or B-lines. CONCLUSIONS The sodium-glucose cotransporter 2 inhibitor empagliflozin reduced LV volumes in patients with HFrEF and type 2 diabetes or prediabetes. Favorable reverse LV remodeling may be a mechanism by which sodium-glucose cotransporter 2 inhibitors reduce heart failure hospitalization and mortality in HFrEF. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03485092.
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Affiliation(s)
- Matthew M Y Lee
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.).,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Katriona J M Brooksbank
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics (K.W., A.M.), University of Glasgow, United Kingdom
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.).,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Ross T Campbell
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.).,Golden Jubilee National Hospital, Glasgow, United Kingdom (R.T.C., C.B., J.G.D., M.C.P.)
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.).,Golden Jubilee National Hospital, Glasgow, United Kingdom (R.T.C., C.B., J.G.D., M.C.P.)
| | - Victor Chong
- University Hospital Crosshouse, Kilmarnock, United Kingdom (V.C.)
| | - Liz Coyle
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom
| | - Kieran F Docherty
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - John G Dreisbach
- Golden Jubilee National Hospital, Glasgow, United Kingdom (R.T.C., C.B., J.G.D., M.C.P.)
| | | | - Ninian N Lang
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Vera Lennie
- University Hospital Ayr, United Kingdom (V.L.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics (K.W., A.M.), University of Glasgow, United Kingdom
| | - Clare L Murphy
- Royal Alexandra Hospital, Paisley, United Kingdom (C.L.M.)
| | - Colin J Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,University Hospital Monklands, Airdrie, United Kingdom (C.J.P.)
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Iain A Speirits
- West Glasgow Ambulatory Care Hospital, United Kingdom (I.A.S.)
| | | | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom
| | - Rosemary Woodward
- Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Aleksandra Radjenovic
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Pardeep S Jhund
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Queen Elizabeth University Hospital, Glasgow, United Kingdom (M.M.Y.L., K.M., G.R., R.T.C., C.B., K.F.D., N.N.L., R.W., P.B.M., J.J.V.M., P.S.J.)
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.).,Golden Jubilee National Hospital, Glasgow, United Kingdom (R.T.C., C.B., J.G.D., M.C.P.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (M.M.Y.L., K.J.M.B., K.M., G.R., R.T.C., C.B., L.C., K.F.D., N.N.L., C.J.P., J.R.P., P.W., A.R., P.B.M., J.J.V.M., P.S.J., M.C.P., N.S.), University of Glasgow, United Kingdom.,Glasgow Royal Infirmary, United Kingdom (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
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44
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Morrow AJ, Ford TJ, Mangion K, Kotecha T, Rakhit R, Galasko G, Hoole S, Davenport A, Kharbanda R, Ferreira VM, Shanmuganathan M, Chiribiri A, Perera D, Rahman H, Arnold JR, Greenwood JP, Fisher M, Husmeier D, Hill NA, Luo X, Williams N, Miller L, Dempster J, Macfarlane PW, Welsh P, Sattar N, Whittaker A, Connachie AM, Padmanabhan S, Berry C. Rationale and design of the Medical Research Council's Precision Medicine with Zibotentan in Microvascular Angina (PRIZE) trial. Am Heart J 2020; 229:70-80. [PMID: 32942043 PMCID: PMC7674581 DOI: 10.1016/j.ahj.2020.07.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 03/12/2020] [Accepted: 07/08/2020] [Indexed: 01/09/2023]
Abstract
Microvascular angina is caused by cardiac small vessel disease, and dysregulation of the endothelin system is implicated. The minor G allele of the non-coding single nucleotide polymorphism (SNP) rs9349379 enhances expression of the endothelin 1 gene in human vascular cells, increasing circulating concentrations of ET-1. The prevalence of this allele is higher in patients with ischemic heart disease. Zibotentan is a potent, selective inhibitor of the ETA receptor. We have identified zibotentan as a potential disease-modifying therapy for patients with microvascular angina. METHODS: We will assess the efficacy and safety of adjunctive treatment with oral zibotentan (10 mg daily) in patients with microvascular angina and assess whether rs9349379 (minor G allele; population prevalence ~36%) acts as a theragnostic biomarker of the response to treatment with zibotentan. The PRIZE trial is a prospective, randomized, double-blind, placebo-controlled, sequential cross-over trial. The study population will be enriched to ensure a G-allele frequency of 50% for the rs9349379 SNP. The participants will receive a single-blind placebo run-in followed by treatment with either 10 mg of zibotentan daily for 12 weeks then placebo for 12 weeks, or vice versa, in random order. The primary outcome is treadmill exercise duration using the Bruce protocol. The primary analysis will assess the within-subject difference in exercise duration following treatment with zibotentan versus placebo. CONCLUSION: PRIZE invokes precision medicine in microvascular angina. Should our hypotheses be confirmed, this developmental trial will inform the rationale and design for undertaking a larger multicenter trial.
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Affiliation(s)
- Andrew J Morrow
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Thomas J Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; University of New South Wales, Sydney, Australia
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Tushar Kotecha
- Royal Free Hospital, Royal Free London NHS Foundation Trust London, United Kingdom
| | - Roby Rakhit
- Royal Free Hospital, Royal Free London NHS Foundation Trust London, United Kingdom
| | - Gavin Galasko
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Stephen Hoole
- Department of Interventional Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Anthony Davenport
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Rajesh Kharbanda
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, NIHR Oxford Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, NIHR Oxford Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Mayooran Shanmuganathan
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, NIHR Oxford Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Amedeo Chiribiri
- Division of Imaging Sciences, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Haseeb Rahman
- School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Michael Fisher
- Liverpool University and Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Dirk Husmeier
- School of Mathematics & Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Nicholas A Hill
- School of Mathematics & Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Xiaoyu Luo
- School of Mathematics & Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Nicola Williams
- Department of Clinical Genetics, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Laura Miller
- Department of Clinical Genetics, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jill Dempster
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Peter W Macfarlane
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Whittaker
- Emerging Innovations Unit, Discovery Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Alex Mc Connachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sandosh Padmanabhan
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
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45
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Walker S, Cox E, Rothwell B, Berry C, McCann GP, Bucciarelli-Ducci C, Dall'Armellina E, Prasad A, Foley JRJ, Mangion K, Bijsterveld P, Everett C, Stocken D, Plein S, Greenwood JP, Sculpher M. Cost-effectiveness of cardiovascular imaging for stable coronary heart disease. Heart 2020; 107:381-388. [PMID: 32817271 PMCID: PMC7892375 DOI: 10.1136/heartjnl-2020-316990] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): (1) cardiovascular magnetic resonance (CMR); (2) myocardial perfusion scintigraphy (MPS); and (3) UK National Institute for Health and Care Excellence (NICE) guideline-guided care. METHODS Using UK data for 1202 patients from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial, we conducted an economic evaluation to assess the cost-effectiveness of CMR, MPS and NICE guidelines. Health outcomes were expressed as quality-adjusted life-years (QALYs), and costs reflected UK pound sterling in 2016-2017. Cost-effectiveness results were presented as incremental cost-effectiveness ratios and incremental net health benefits overall and for low, medium and high pretest likelihood of CHD subgroups. RESULTS CMR had the highest estimated QALY gain overall (2.21 (95% credible interval 2.15, 2.26) compared with 2.07 (1.92, 2.20) for NICE and 2.11 (2.01, 2.22) for MPS) and incurred comparable costs (overall £1625 (£1431, £1824) compared with £1753 (£1473, £2032) for NICE and £1768 (£1572, £1989) for MPS). Overall, CMR was the cost-effective strategy, being the dominant strategy (more effective, less costly) with incremental net health benefits per patient of 0.146 QALYs (-0.18, 0.406) compared with NICE guidelines at a cost-effectiveness threshold of £15 000 per QALY (93% probability of cost-effectiveness). Results were similar in the pretest likelihood subgroups. CONCLUSIONS CMR-guided care is cost-effective overall and across all pretest likelihood subgroups, compared with MPS and NICE guidelines.
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Affiliation(s)
- Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | | | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, NIHR Bristol Cardiovascular Biomedical Research Centre and Clinical Research and Imaging Centre (CRIC), University of Bristol and University Hospitals Bristol NHD Trust, Bristol, UK
| | - Erica Dall'Armellina
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK.,Oxford Centre of Cardiovascular Magnetic Resonance, Oxford University, Oxford, UK
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Cardiovascular Sciences Research Centre, St George's, University of London, London, UK
| | - James Robert John Foley
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Petra Bijsterveld
- CTRU - Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Colin Everett
- CTRU - Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Deborah Stocken
- CTRU - Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - John P Greenwood
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
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46
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Mangion K, Loughrey CM, Auger DA, McComb C, Lee MM, Corcoran D, McEntegart M, Davie A, Good R, Lindsay M, Eteiba H, Rocchiccioli P, Watkins S, Hood S, Shaukat A, Haig C, Epstein FH, Berry C. Displacement Encoding With Stimulated Echoes Enables the Identification of Infarct Transmurality Early Postmyocardial Infarction. J Magn Reson Imaging 2020; 52:1722-1731. [PMID: 32720405 DOI: 10.1002/jmri.27295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/06/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Segmental extent of infarction assessed by late gadolinium enhancement (LGE) imaging early post-ST-segment elevation myocardial infarction (STEMI) has utility in predicting left ventricular functional recovery. HYPOTHESIS We hypothesized that segmental circumferential strain with displacement encoding with stimulated echoes (DENSE) would be a stronger predictor of infarct transmurality than feature-tracking strain, and noninferior to extracellular volume fraction (ECV). STUDY TYPE Prospective. POPULATION Fifty participants (mean ± SD, 59 ± 9 years, 40 [80%] male) underwent cardiac MRI on day 1 post-STEMI. FIELD-STRENGTH/SEQUENCES 1.5T/cine, DENSE, T1 mapping, ECV, LGE. ASSESSMENT Two observers assessed segmental percentage LGE extent, presence of microvascular obstruction (MVO), circumferential and radial strain with DENSE and feature-tracking, T1 relaxation times, and ECV. STATISTICAL TESTS Normality was tested using the Shapiro-Wilk test. Skewed distributions were analyzed utilizing Mann-Whitney or Kruskal-Wallis tests and normal distributed data using independent t-tests. Diagnostic cutoff values were identified using the Youden index. The difference in area under the curve was compared using the z-statistic. RESULTS Segmental circumferential strain with DENSE was associated with the extent of infarction ≥50% (AUC [95% CI], cutoff value = 0.9 [0.8, 0.9], -10%) similar to ECV (AUC = 0.8 [0.8, 0.9], 37%) (P = 0.117) and superior to feature-tracking circumferential strain (AUC = 0.7[0.7, 0.8], -19%) (P < 0.05). For the detection of segmental infarction ≥75%, circumferential strain with DENSE (AUC = 0.9 [0.8, 0.9], -10%) was noninferior to ECV (AUC = 0.8 [0.7, 0.9], 42%) (P = 0.132) and superior to feature-tracking (AUC = 0.7 [0.7, 0.8], -13%) (P < 0.05). For MVO detection, circumferential strain with DENSE (AUC = 0.8 [0.8, 0.9], -12%) was superior to ECV (AUC = 0.8 [0.7, 0.8] 34%) (P < 0.05) and feature-tracking (AUC = 0.7 [0.6, 0.7] -21%) (P < 0.05). DATA CONCLUSION Circumferential strain with DENSE is a functional measure of infarct severity and may remove the need for gadolinium contrast agents in some circumstances. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 5 J. MAGN. RESON. IMAGING 2020;52:1722-1731.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Christopher M Loughrey
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Christie McComb
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Matthew M Lee
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Paul Rocchiccioli
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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47
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Lees JS, Mangion K, Rutherford E, Witham MD, Woodward R, Roditi G, Hopkins T, Brooksbank K, Jardine AG, Mark PB. Vitamin K for kidney transplant organ recipients: investigating vessel stiffness (ViKTORIES): study rationale and protocol of a randomised controlled trial. Open Heart 2020; 7:e001070. [PMID: 32675297 PMCID: PMC7368482 DOI: 10.1136/openhrt-2019-001070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 03/09/2020] [Accepted: 05/28/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Renal transplant recipients (RTRs) exhibit increased vascular stiffness and calcification; these parameters are associated with increased cardiovascular risk. Activity of endogenous calcification inhibitors such as matrix gla protein (MGP) is dependent on vitamin K. RTRs commonly have subclinical vitamin K deficiency. The Vitamin K in kidney Transplant Organ Recipients: Investigating vEssel Stiffness (ViKTORIES) study assesses whether vitamin K supplementation reduces vascular stiffness and calcification in a diverse population of RTR. METHODS AND ANALYSIS ViKTORIES (ISRCTN22012044) is a single-centre, phase II, parallel-group, randomised, double-blind, placebo-controlled trial of the effect of vitamin K supplementation in 90 prevalent RTR. Participants are eligible if they have a functioning renal transplant for >1 year. Those on warfarin, with atrial fibrillation, estimated glomerular filtration rate <15 mL/min/1.73 m2 or contraindications to MRI are excluded. Treatment is with vitamin K (menadiol diphosphate) 5 mg three times per week for 1 year or matching placebo. All participants have primary and secondary endpoint measures at 0 and 12 months. The primary endpoint is ascending aortic distensibility on cardiac MR imaging. Secondary endpoints include vascular calcification (coronary artery calcium score by CT), cardiac structure and function on MR, carotid-femoral pulse wave velocity, serum uncarboxylated MGP, transplant function, proteinuria and quality of life. The study is powered to detect 1.0×10-3 mm Hg-1 improvement in ascending aortic distensibility in the vitamin K group relative to placebo at 12 months. Analyses will be conducted as between-group differences at 12 months by intention to treat. DISCUSSION This trial may identify a novel, inexpensive and low-risk treatment to improve surrogate markers of cardiovascular risk in RTR.
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Affiliation(s)
- Jennifer Susan Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Renal Medicine, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Rosemary Woodward
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tracey Hopkins
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Katriona Brooksbank
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Alan G Jardine
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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48
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Dobbin SJH, Mangion K, Berry C, Roditi G, Basak S, Sourbron S, White J, Venugopal B, Touyz RM, Jones RJ, Petrie MC, Lang NN. Cardiotoxicity and myocardial hypoperfusion associated with anti-vascular endothelial growth factor therapies: prospective cardiac magnetic resonance imaging in patients with cancer. Eur J Heart Fail 2020; 22:1276-1277. [PMID: 32379945 DOI: 10.1002/ejhf.1847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/11/2020] [Accepted: 04/06/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Stephen J H Dobbin
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Susmita Basak
- Division of Medical Physics, University of Leeds, Leeds, UK
| | - Steven Sourbron
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jeff White
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Balaji Venugopal
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Rhian M Touyz
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Robert J Jones
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Mark C Petrie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ninian N Lang
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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49
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Jackson AM, Zhang R, Findlay I, Robertson K, Lindsay M, Morris T, Forbes B, Papworth R, McConnachie A, Mangion K, Jhund PS, McCowan C, Berry C. Healthcare disparities for women hospitalized with myocardial infarction and angina. Eur Heart J Qual Care Clin Outcomes 2020; 6:156-165. [PMID: 31346604 PMCID: PMC7132925 DOI: 10.1093/ehjqcco/qcz040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023]
Abstract
AIMS Ischaemic heart disease persists as the leading cause of death in both men and women in most countries and sex disparities, defined as differences in health outcomes and their determinants, may be relevant. We examined sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina. METHODS AND RESULTS We conducted a cohort study of all patients admitted with MI or angina (01 October 2013 to 30 June 2016) from a secondary care acute coronary syndrome e-Registry in NHS Scotland linked with national registers of community drug dispensation and mortality data. A total of 7878 patients hospitalized for MI or angina were prospectively included; 3161 (40%) were women. Women were older, more deprived, had a greater burden of comorbidity, were more often treated with guideline-recommended therapy preadmission and less frequently received immediate invasive management. Men were more likely to receive coronary angiography [adjusted odds ratio (OR) 1.52, confidence interval (CI) 1.37-1.68] and percutaneous coronary intervention (adjusted OR 1.68, CI 1.52-1.86). Women were less comprehensively treated with evidence-based therapies post-MI. Women had worse crude survival, primarily those with ST-elevation myocardial infarction (14.3% vs. 8.0% at 1 year, P < 0.001), but this finding was explained by differences in baseline factors. Men with non-ST-elevation myocardial infarction had a higher risk of all-cause death at 30 days [adjusted hazard ratio (HR) 1.72, CI 1.16-2.56] and 1 year (adjusted HR 1.38, CI 1.12-1.69). CONCLUSION After taking account of baseline risk factors, sex differences in treatment pathway, use of invasive management, and secondary prevention therapies indicate disparities in guideline-directed management of women hospitalized with MI or angina.
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Affiliation(s)
- Alice M Jackson
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Ruiqi Zhang
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Iain Findlay
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK
| | - Keith Robertson
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| | - Mitchell Lindsay
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
| | | | - Brian Forbes
- AstraZeneca UK, Capability Green, Luton LU1 3LU, UK
| | - Richard Papworth
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Pardeep S Jhund
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Colin McCowan
- School of Medicine, Medical and Biological Sciences Building, University of St Andrews, North Haugh, St Andrews KY16 9TF, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
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50
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Mangion K, Adamson PD, Williams MC, Hunter A, Pawade T, Shah ASV, Lewis S, Boon NA, Flather M, Forbes J, McLean S, Roditi G, van Beek EJR, Timmis AD, Newby DE, McAllister DA, Berry C. Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain. Eur Heart J 2020; 41:1337-1345. [PMID: 31883330 PMCID: PMC7109601 DOI: 10.1093/eurheartj/ehz903] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/20/2019] [Accepted: 12/09/2019] [Indexed: 12/26/2022] Open
Abstract
AIMS The relative benefits of computed tomography coronary angiography (CTCA)-guided management in women and men with suspected angina due to coronary heart disease (CHD) are uncertain. METHODS AND RESULTS In this post hoc analysis of an open-label parallel-group multicentre trial, we recruited 4146 patients referred for assessment of suspected angina from 12 cardiology clinics across the UK. We randomly assigned (1:1) participants to standard care alone or standard care plus CTCA. Fewer women had typical chest pain symptoms (n = 582, 32.0%) when compared with men (n = 880, 37.9%; P < 0.001). Amongst the CTCA-guided group, more women had normal coronary arteries [386 (49.6%) vs. 263 (26.2%)] and less obstructive CHD [105 (11.5%) vs. 347 (29.8%)]. A CTCA-guided strategy resulted in more women than men being reclassified as not having CHD {19.2% vs. 13.1%; absolute risk difference, 5.7 [95% confidence interval (CI): 2.7-8.7, P < 0.001]} or having angina due to CHD [15.0% vs. 9.0%; absolute risk difference, 5.6 (2.3-8.9, P = 0.001)]. After a median of 4.8 years follow-up, CTCA-guided management was associated with similar reductions in the risk of CHD death or non-fatal myocardial infarction in women [hazard ratio (HR) 0.50, 95% CI 0.24-1.04], and men (HR 0.63, 95% CI 0.42-0.95; Pinteraction = 0.572). CONCLUSION Following the addition of CTCA, women were more likely to be found to have normal coronary arteries than men. This led to more women being reclassified as not having CHD, resulting in more downstream tests and treatments being cancelled. There were similar prognostic benefits of CTCA for women and men.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
- Christchurch Heart Institute, University of Otago, 2 Riccarton Avenue, Christchurch Central City, Christchurch 8011, New Zealand
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Amanda Hunter
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Tania Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Stephanie Lewis
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Nicholas A Boon
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - John Forbes
- Graduate Entry School, University of Limerick, Limerick, St Nessan's Rd, Dooradoyle, Co. Limerick, V94 F858, Ireland
| | - Scott McLean
- National Health Service, Hayfield House, Hayfield Rd, Kirkcaldy KY2 5AH, Fife, UK
| | - Giles Roditi
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Adam D Timmis
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK
| | - David A McAllister
- Institute of Health and Wellbeing, University of Glasgow, University Ave, Glasgow G12 8QQ, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow G12 8TA, UK
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