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Gonzales RA, Ibáñez DH, Hann E, Popescu IA, Burrage MK, Lee YP, Altun İ, Weintraub WS, Kwong RY, Kramer CM, Neubauer S, Ferreira VM, Zhang Q, Piechnik SK. Quality control-driven deep ensemble for accountable automated segmentation of cardiac magnetic resonance LGE and VNE images. Front Cardiovasc Med 2023; 10:1213290. [PMID: 37753166 PMCID: PMC10518404 DOI: 10.3389/fcvm.2023.1213290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/16/2023] [Indexed: 09/28/2023] Open
Abstract
Background Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is the gold standard for non-invasive myocardial tissue characterisation. However, accurate segmentation of the left ventricular (LV) myocardium remains a challenge due to limited training data and lack of quality control. This study addresses these issues by leveraging generative adversarial networks (GAN)-generated virtual native enhancement (VNE) images to expand the training set and incorporating an automated quality control-driven (QCD) framework to improve segmentation reliability. Methods A dataset comprising 4,716 LGE images (from 1,363 patients with hypertrophic cardiomyopathy and myocardial infarction) was used for development. To generate additional clinically validated data, LGE data were augmented with a GAN-based generator to produce VNE images. LV was contoured on these images manually by clinical observers. To create diverse candidate segmentations, the QCD framework involved multiple U-Nets, which were combined using statistical rank filters. The framework predicted the Dice Similarity Coefficient (DSC) for each candidate segmentation, with the highest predicted DSC indicating the most accurate and reliable result. The performance of the QCD ensemble framework was evaluated on both LGE and VNE test datasets (309 LGE/VNE images from 103 patients), assessing segmentation accuracy (DSC) and quality prediction (mean absolute error (MAE) and binary classification accuracy). Results The QCD framework effectively and rapidly segmented the LV myocardium (<1 s per image) on both LGE and VNE images, demonstrating robust performance on both test datasets with similar mean DSC (LGE: 0.845 ± 0.075 ; VNE: 0.845 ± 0.071 ; p = n s ). Incorporating GAN-generated VNE data into the training process consistently led to enhanced performance for both individual models and the overall framework. The quality control mechanism yielded a high performance (MAE = 0.043 , accuracy = 0.951 ) emphasising the accuracy of the quality control-driven strategy in predicting segmentation quality in clinical settings. Overall, no statistical difference (p = n s ) was found when comparing the LGE and VNE test sets across all experiments. Conclusions The QCD ensemble framework, leveraging GAN-generated VNE data and an automated quality control mechanism, significantly improved the accuracy and reliability of LGE segmentation, paving the way for enhanced and accountable diagnostic imaging in routine clinical use.
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Affiliation(s)
- Ricardo A. Gonzales
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Daniel H. Ibáñez
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Artificio, Cambridge, MA, United States
| | - Evan Hann
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Iulia A. Popescu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Matthew K. Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Yung P. Lee
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - İbrahim Altun
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - William S. Weintraub
- MedStar Health Research Institute, Georgetown University, Washington, DC, United States
| | - Raymond Y. Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | | | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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Burrage MK, Ferreira VM. Histopathologic Validation of Stress T1 Mapping in Myocardial Ischemia: Another Step toward Clinical Translation? Radiol Cardiothorac Imaging 2023; 5:e230145. [PMID: 37404785 PMCID: PMC10316296 DOI: 10.1148/ryct.230145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Matthew K. Burrage
- From the University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (M.K.B., V.M.F.); and Faculty of Medicine, University of Queensland, Brisbane, Australia (M.K.B.)
| | - Vanessa M. Ferreira
- From the University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (M.K.B., V.M.F.); and Faculty of Medicine, University of Queensland, Brisbane, Australia (M.K.B.)
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Burrage MK, Lewis AJ, Miller JJJ. Functional and Metabolic Imaging in Heart Failure with Preserved Ejection Fraction: Promises, Challenges, and Clinical Utility. Cardiovasc Drugs Ther 2023; 37:379-399. [PMID: 35881280 PMCID: PMC10014679 DOI: 10.1007/s10557-022-07355-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is recognised as an increasingly prevalent, morbid and burdensome condition with a poor outlook. Recent advances in both the understanding of HFpEF and the technological ability to image cardiac function and metabolism in humans have simultaneously shone a light on the molecular basis of this complex condition of diastolic dysfunction, and the inflammatory and metabolic changes that are associated with it, typically in the context of a complex patient. This review both makes the case for an integrated assessment of the condition, and highlights that metabolic alteration may be a measurable outcome for novel targeted forms of medical therapy. It furthermore highlights how recent technological advancements and advanced medical imaging techniques have enabled the characterisation of the metabolism and function of HFpEF within patients, at rest and during exercise.
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Affiliation(s)
- Matthew K Burrage
- Oxford Centre for Clinical Cardiovascular Magnetic Resonance Research (OCMR); Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Andrew J Lewis
- Oxford Centre for Clinical Cardiovascular Magnetic Resonance Research (OCMR); Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, UK
| | - Jack J J. Miller
- Oxford Centre for Clinical Cardiovascular Magnetic Resonance Research (OCMR); Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, UK
- The PET Research Centre and The MR Research Centre, Aarhus University, Aarhus, Denmark
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, UK
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Savic D, Mózes FE, Green PG, Burrage MK, Kjaer MS, Hodson L, Neubauer S, Pavlides M, Valkovič L. Detection and alterations of acetylcarnitine (AC) in human liver by 1 H MRS at 3T after supplementation with l-carnitine. Magn Reson Med 2023; 89:1314-1322. [PMID: 36573435 DOI: 10.1002/mrm.29544] [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: 08/18/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Acetylcarnitine can be assessed in vivo using proton MRS (1 H-MRS) with long TEs and this has been previously applied successfully in muscle. The aim of this study was to evaluate a 1 H-MRS technique for liver acetylcarnitine quantification in healthy humans before and after l-carnitine supplementation. METHOD Baseline acetylcarnitine levels were quantified using a STEAM sequence with prolonged TE in 15 healthy adults. Using STEAM with four different TEs was evaluated in phantoms. To assess reproducibility of the measurements, five of the participants had repeated 1 H-MRS without receiving l-carnitine supplementation. To determine if liver acetylcarnitine could be changed after l-carnitine supplementation, acetylcarnitine was quantified 2 h after intravenous l-carnitine supplementation (50 mg/kg body weight) in the other 10 participants. Hepatic lipids were also quantified from the 1 H-MRS spectra. RESULTS There was good separation between the acetylcarnitine and fat in the phantoms using TE = 100 ms. Hepatic acetylcarnitine levels were reproducible (coefficient of reproducibility = 0.049%) and there was a significant (p < 0.001) increase in the relative abundance after a single supplementation of l-carnitine. Hepatic allylic, methyl, and methylene peaks were not altered by l-carnitine supplementation in healthy volunteers. CONCLUSION Our results demonstrate that our 1 H-MRS technique could be used to measure acetylcarnitine in the liver and detect changes following intravenous supplementation in healthy adults despite the presence of lipids. Our techniques should be explored further in the study of fatty liver disease, where acetylcarnitine is suggested to be altered due to hepatic inflexibilities.
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Affiliation(s)
- Dragana Savic
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Ferenc E Mózes
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Peregrine G Green
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew K Burrage
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | | | - Leanne Hodson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Michael Pavlides
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Ladislav Valkovič
- The Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
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Shanmuganathan M, Kotronias RA, Burrage MK, Ng Y, Banerjee A, Xie C, Fletcher A, Manley P, Borlotti A, Emfietzoglou M, Mentzer AJ, Marin F, Raman B, Tunnicliffe EM, Neubauer S, Piechnik SK, Channon KM, Ferreira VM. Acute changes in myocardial tissue characteristics during hospitalization in patients with COVID-19. Front Cardiovasc Med 2023; 10:1097974. [PMID: 36873410 PMCID: PMC9978174 DOI: 10.3389/fcvm.2023.1097974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/10/2023] [Indexed: 02/18/2023] Open
Abstract
Background Patients with a history of COVID-19 infection are reported to have cardiac abnormalities on cardiovascular magnetic resonance (CMR) during convalescence. However, it is unclear whether these abnormalities were present during the acute COVID-19 illness and how they may evolve over time. Methods We prospectively recruited unvaccinated patients hospitalized with acute COVID-19 (n = 23), and compared them with matched outpatient controls without COVID-19 (n = 19) between May 2020 and May 2021. Only those without a past history of cardiac disease were recruited. We performed in-hospital CMR at a median of 3 days (IQR 1-7 days) after admission, and assessed cardiac function, edema and necrosis/fibrosis, using left and right ventricular ejection fraction (LVEF, RVEF), T1-mapping, T2 signal intensity ratio (T2SI), late gadolinium enhancement (LGE) and extracellular volume (ECV). Acute COVID-19 patients were invited for follow-up CMR and blood tests at 6 months. Results The two cohorts were well matched in baseline clinical characteristics. Both had normal LVEF (62 ± 7 vs. 65 ± 6%), RVEF (60 ± 6 vs. 58 ± 6%), ECV (31 ± 3 vs. 31 ± 4%), and similar frequency of LGE abnormalities (16 vs. 14%; all p > 0.05). However, measures of acute myocardial edema (T1 and T2SI) were significantly higher in patients with acute COVID-19 when compared to controls (T1 = 1,217 ± 41 ms vs. 1,183 ± 22 ms; p = 0.002; T2SI = 1.48 ± 0.36 vs. 1.13 ± 0.09; p < 0.001). All COVID-19 patients who returned for follow up (n = 12) at 6 months had normal biventricular function, T1 and T2SI. Conclusion Unvaccinated patients hospitalized for acute COVID-19 demonstrated CMR imaging evidence of acute myocardial edema, which normalized at 6 months, while biventricular function and scar burden were similar when compared to controls. Acute COVID-19 appears to induce acute myocardial edema in some patients, which resolves in convalescence, without significant impact on biventricular structure and function in the acute and short-term. Further studies with larger numbers are needed to confirm these findings.
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Affiliation(s)
- Mayooran Shanmuganathan
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Oxford Center for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rafail A. Kotronias
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Matthew K. Burrage
- Oxford Center for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Yujun Ng
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Abhirup Banerjee
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Cheng Xie
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Oxford Center for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alison Fletcher
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Peter Manley
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alessandra Borlotti
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Maria Emfietzoglou
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alexander J. Mentzer
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Wellcome Center for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Federico Marin
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Betty Raman
- Oxford Center for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Elizabeth M. Tunnicliffe
- Oxford Center for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Center for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Center for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, United Kingdom
| | - Keith M. Channon
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Acute Vascular Imaging Center (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Oxford Center for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
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Shanmuganathan M, Masi A, Burrage MK, Kotronias RA, Borlotti A, Scarsini R, Banerjee A, Terentes-Printzios D, Zhang Q, Hann E, Tunnicliffe E, Lucking A, Langrish J, Kharbanda R, De Maria GL, Banning AP, Choudhury RP, Channon KM, Piechnik SK, Ferreira VM. Acute Response in the Noninfarcted Myocardium Predicts Long-Term Major Adverse Cardiac Events After STEMI. JACC Cardiovasc Imaging 2023; 16:46-59. [PMID: 36599569 PMCID: PMC9834063 DOI: 10.1016/j.jcmg.2022.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute ST-segment elevation myocardial infarction (STEMI) has effects on the myocardium beyond the immediate infarcted territory. However, pathophysiologic changes in the noninfarcted myocardium and their prognostic implications remain unclear. OBJECTIVES The purpose of this study was to evaluate the long-term prognostic value of acute changes in both infarcted and noninfarcted myocardium post-STEMI. METHODS Patients with acute STEMI undergoing primary percutaneous coronary intervention underwent evaluation with blood biomarkers and cardiac magnetic resonance (CMR) at 2 days and 6 months, with long-term follow-up for major adverse cardiac events (MACE). A comprehensive CMR protocol included cine, T2-weighted, T2∗, T1-mapping, and late gadolinium enhancement (LGE) imaging. Areas without LGE were defined as noninfarcted myocardium. MACE was a composite of cardiac death, sustained ventricular arrhythmia, and new-onset heart failure. RESULTS Twenty-two of 219 patients (10%) experienced an MACE at a median of 4 years (IQR: 2.5-6.0 years); 152 patients returned for the 6-month visit. High T1 (>1250 ms) in the noninfarcted myocardium was associated with lower left ventricular ejection fraction (LVEF) (51% ± 8% vs 55% ± 9%; P = 0.002) and higher NT-pro-BNP levels (290 pg/L [IQR: 103-523 pg/L] vs 170 pg/L [IQR: 61-312 pg/L]; P = 0.008) at 6 months and a 2.5-fold (IQR: 1.03-6.20) increased risk of MACE (2.53 [IQR: 1.03-6.22]), compared with patients with normal T1 in the noninfarcted myocardium (P = 0.042). A lower T1 (<1,300 ms) in the infarcted myocardium was associated with increased MACE (3.11 [IQR: 1.19-8.13]; P = 0.020). Both noninfarct and infarct T1 were independent predictors of MACE (both P = 0.001) and significantly improved risk prediction beyond LVEF, infarct size, and microvascular obstruction (C-statistic: 0.67 ± 0.07 vs 0.76 ± 0.06, net-reclassification index: 40% [IQR: 12%-64%]; P = 0.007). CONCLUSIONS The acute responses post-STEMI in both infarcted and noninfarcted myocardium are independent incremental predictors of long-term MACE. These insights may provide new opportunities for treatment and risk stratification in STEMI.
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Affiliation(s)
- Mayooran Shanmuganathan
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ambra Masi
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Matthew K. Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rafail A. Kotronias
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alessandra Borlotti
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Roberto Scarsini
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Abhirup Banerjee
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Dimitrios Terentes-Printzios
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Evan Hann
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Elizabeth Tunnicliffe
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Andrew Lucking
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jeremy Langrish
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rajesh Kharbanda
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Giovanni Luigi De Maria
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Adrian P. Banning
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Robin P. Choudhury
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Keith M. Channon
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom,Address for correspondence: Prof Keith Channon, Level 2–Oxford Heart Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
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Burrage MK, Cheshire C, Hey CY, Azam S, Watson WD, Bhagra S, Berman M, D'Errico L, Jenkins DP, Kaul P, Large S, Lewis C, Martinez L, Messer S, Page A, Parameshwar J, Pettit S, Rafiq M, Tsui S, Tweed K, Weir-McCall JR, Kydd A. Comparing Cardiac Mechanics and Myocardial Fibrosis in DBD and DCD Heart Transplant Recipients. J Card Fail 2022; 29:834-840. [PMID: 36521726 DOI: 10.1016/j.cardfail.2022.11.014] [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: 10/01/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart transplantation (HTx) after donation after circulatory death (DCD) is an expanding practice but is associated with increased warm ischemic time. The impact of DCD HTx on cardiac mechanics and myocardial fibrosis has not been reported. We aimed to compare cardiac mechanics and myocardial fibrosis using cardiovascular magnetic resonance (CMR) imaging in donation after brain death (DBD) and DCD HTx recipients and healthy controls. METHODS AND RESULTS Consecutive HTx recipients between March 2015 and March 2021 who underwent routine surveillance CMR imaging were included. Cardiac mechanics were assessed using CMR feature tracking to compute global longitudinal strain, global circumferential strain, and right ventricular free-wall longitudinal myocardial strain. Fibrosis was assessed using late gadolinium enhancement imaging and estimation of extracellular volume. There were 82 (DBD n = 42, DCD n = 40) HTx recipients (aged 53 years, interquartile range 41-59 years, 24% female) who underwent CMR imaging at median of 9 months (interquartile range 6-14 months) after transplantation. HTx recipients had increased extracellular volume (29.7 ± 3.6%) compared with normal ranges (25.9%, interquartile range 25.4-26.5). Myocardial strain was impaired after transplantation compared with controls (global longitudinal strain -12.6 ± 3.1% vs -17.2 ± 1.8%, P < .0001; global circumferential strain -16.9 ± 3.1% vs -19.2 ± 2.0%, P = .002; right ventricular free-wall longitudinal strain -15.7 ± 4.5% vs -21.6 ± 4.7%, P < .0001). There were no differences in fibrosis burden (extracellular volume 30.6 ± 4.4% vs 29.2 ± 3.2%; P = .39) or cardiac mechanics (global longitudinal strain -13.1 ± 3.0% vs -12.1 ± 3.1%, P = .14; global circumferential strain -17.3 ± 2.9% vs -16.6 ± 3.1%, P = .27; right ventricular free-wall longitudinal strain -15.9 ± 4.9% vs -15.5 ± 4.1%, P = .71) between DCD and DBD HTx. CONCLUSIONS HTx recipients have impaired cardiac mechanics compared with controls, with increased myocardial fibrosis. There were no differences in early CMR imaging characteristics between DBD and DCD heart transplants, providing further evidence that DCD and DBD HTx outcomes are comparable.
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Affiliation(s)
- Matthew K Burrage
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | | | - Cong Ying Hey
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Saima Azam
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Sai Bhagra
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Marius Berman
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | | | - Pradeep Kaul
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Stephen Large
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Clive Lewis
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Luis Martinez
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Aravinda Page
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | | | | | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Jonathan R Weir-McCall
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anna Kydd
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK.
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8
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Zhang Q, Burrage MK, Shanmuganathan M, Gonzales RA, Lukaschuk E, Thomas KE, Mills R, Leal Pelado J, Nikolaidou C, Popescu IA, Lee YP, Zhang X, Dharmakumar R, Myerson SG, Rider O, Channon KM, Neubauer S, Piechnik SK, Ferreira VM. Artificial Intelligence for Contrast-Free MRI: Scar Assessment in Myocardial Infarction Using Deep Learning-Based Virtual Native Enhancement. Circulation 2022; 146:1492-1503. [PMID: 36124774 PMCID: PMC9662825 DOI: 10.1161/circulationaha.122.060137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Myocardial scars are assessed noninvasively using cardiovascular magnetic resonance late gadolinium enhancement (LGE) as an imaging gold standard. A contrast-free approach would provide many advantages, including a faster and cheaper scan without contrast-associated problems. METHODS Virtual native enhancement (VNE) is a novel technology that can produce virtual LGE-like images without the need for contrast. VNE combines cine imaging and native T1 maps to produce LGE-like images using artificial intelligence. VNE was developed for patients with previous myocardial infarction from 4271 data sets (912 patients); each data set comprises slice position-matched cine, T1 maps, and LGE images. After quality control, 3002 data sets (775 patients) were used for development and 291 data sets (68 patients) for testing. The VNE generator was trained using generative adversarial networks, using 2 adversarial discriminators to improve the image quality. The left ventricle was contoured semiautomatically. Myocardial scar volume was quantified using the full width at half maximum method. Scar transmurality was measured using the centerline chord method and visualized on bull's-eye plots. Lesion quantification by VNE and LGE was compared using linear regression, Pearson correlation (R), and intraclass correlation coefficients. Proof-of-principle histopathologic comparison of VNE in a porcine model of myocardial infarction also was performed. RESULTS VNE provided significantly better image quality than LGE on blinded analysis by 5 independent operators on 291 data sets (all P<0.001). VNE correlated strongly with LGE in quantifying scar size (R, 0.89; intraclass correlation coefficient, 0.94) and transmurality (R, 0.84; intraclass correlation coefficient, 0.90) in 66 patients (277 test data sets). Two cardiovascular magnetic resonance experts reviewed all test image slices and reported an overall accuracy of 84% for VNE in detecting scars when compared with LGE, with specificity of 100% and sensitivity of 77%. VNE also showed excellent visuospatial agreement with histopathology in 2 cases of a porcine model of myocardial infarction. CONCLUSIONS VNE demonstrated high agreement with LGE cardiovascular magnetic resonance for myocardial scar assessment in patients with previous myocardial infarction in visuospatial distribution and lesion quantification with superior image quality. VNE is a potentially transformative artificial intelligence-based technology with promise in reducing scan times and costs, increasing clinical throughput, and improving the accessibility of cardiovascular magnetic resonance in the near future.
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Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Matthew K. Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Faculty of Medicine, University of Queensland, Brisbane, Australia (M.K.B.)
| | - Mayooran Shanmuganathan
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Ricardo A. Gonzales
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Katharine E. Thomas
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Rebecca Mills
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Joana Leal Pelado
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Chrysovalantou Nikolaidou
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Iulia A. Popescu
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Yung P. Lee
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Xinheng Zhang
- Krannert Cardiovascular Research Center, Indiana School of Medicine/IU Health Cardiovascular Institute, Indianapolis (X.Z., R.D.)
- Department of Bioengineering, University of California in Los Angeles (X.Z.)
| | - Rohan Dharmakumar
- Krannert Cardiovascular Research Center, Indiana School of Medicine/IU Health Cardiovascular Institute, Indianapolis (X.Z., R.D.)
| | - Saul G. Myerson
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Oliver Rider
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Keith M. Channon
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
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9
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Henry JA, Levelt E, Rayner JJ, Hundertmark MJ, Peterzan MA, Green PG, Watson W, Burrage MK, Arvidsson P, Lewis AJM, Chamley R, Neubauer S, Valkovic L, Rider OJ. Investigating myocardial energetic deficit across the spectrum of cardiac disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The phosphocreatine-to-adenosine triphosphate ratio (PCr/ATP) is a sensitive marker of the energetic state of the heart and can be reliably measured non-invasively using 31Phosphorus magnetic resonance spectroscopy (31P-MRS). Derangements in cardiac energetics are a distinctive feature in the pathophysiology of several cardiac diseases, and thus potential therapeutic targets.
Purpose
We sought to compare cardiac PCr/ATP across a range of cardiac pathologies.
Methods
Using a 3D chemical shift 31P spectral acquisition we recorded PCr/ATP in 515 participants: athletes (n=17), healthy controls with normal weight (n=148), overweight (n=67) and with obesity (n=73), diabetes (n=23), heart failure with preserved ejection fraction (HFpEF) (n=33), heart failure with reduced ejection fraction (HFrEF) (n=63), amyloid (n=9), severe aortic stenosis (AS) (n=29), severe mitral regurgitation (MR) (n=18), and hypertrophic cardiomyopathy (HCM) (n=35).
Results
A spectrum of myocardial PCr/ATP exists ranging from normal in athletes (2.23±0.28) and those with normal weight (2.05±0.38) to severely impaired in severe MR (1.56±0.32) and cardiac amyloid (1.34±0.19, Figure 1). Despite normal systolic function (all LVEF >57%) those living with obesity and diabetes have lower PCr/ATP than normal (all p<0.001). In all groups with HF, regardless of aetiology, myocardial energetics were impaired (all p<0.001). Across the whole cohort PCr/ATP was negatively correlated with body mass index (r −0.28, p<0.001), age (r −0.34, p<0.001) and LV mass (r −0.1, p<0.001). PCr/ATP was not related to systolic or diastolic blood pressure in these cohorts.
Conclusions
We demonstrate a spectrum of energetic deficit in cardiac disease and this is affected by not only myocardial pathology but also by obesity and age. Derangements in myocardial energetics are present in myocardial pathologies independent of underlying aetiology.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): We acknowledge support from the British Heart Foundation Oxford Center of Research Excellence.
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Affiliation(s)
- J A Henry
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - E Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - P G Green
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - W Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - M K Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - P Arvidsson
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - A J M Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - R Chamley
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - L Valkovic
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
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10
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Burrage MK, Valkovič L, Rider OJ. Letter regarding the article 'Cardiac energetics in patients with chronic heart failure and iron deficiency: an in-vivo 31 P magnetic resonance spectroscopy study'. Eur J Heart Fail 2022; 24:1992. [PMID: 35703335 DOI: 10.1002/ejhf.2574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/07/2022] [Accepted: 06/02/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Matthew K Burrage
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Ladislav Valkovič
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
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11
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Naing P, Lau K, Wiemers P, Mulligan A, Burrage MK, Scalia GM. Acute Bioprosthetic Mitral Valve Failure Diagnosed Using Point-of-Care Ultrasound Leading to Prompt Treatment and Good Outcome. CASE 2022; 6:281-283. [PMID: 36036049 PMCID: PMC9399625 DOI: 10.1016/j.case.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Acute bioprosthetic mitral valve failure is a medical emergency. POCUS can confirm the diagnosis along with a good history and physical exam. Early diagnosis and prompt multidisciplinary treatment will deliver the best outcome.
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12
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Gibbs T, Tapoulal N, Shanmuganathan M, Burrage MK, Borlotti A, Banning AP, Choudhury RP, Neubauer S, Kharbanda RK, Ferreira VM, Channon KM, Herring N. Neuropeptide-Y Levels in ST-Segment-Elevation Myocardial Infarction: Relationship With Coronary Microvascular Function, Heart Failure, and Mortality. J Am Heart Assoc 2022; 11:e024850. [PMID: 35766271 PMCID: PMC9333365 DOI: 10.1161/jaha.121.024850] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The sympathetic cotransmitter, neuropeptide Y (NPY), is released into the coronary sinus during ST‐segment–elevation myocardial infarction and can constrict the coronary microvasculature. We sought to establish whether peripheral venous (PV) NPY levels, which are easy to obtain and measure, are associated with microvascular obstruction, myocardial recovery, and prognosis. Methods and Results NPY levels were measured immediately after primary percutaneous coronary intervention and compared with angiographic and cardiovascular magnetic resonance indexes of microvascular function. Patients were prospectively followed up for 6.4 (interquartile range, 4.1–8.0) years. PV (n=163) and coronary sinus (n=68) NPY levels were significantly correlated (r=0.92; P<0.001) and associated with multiple coronary and imaging parameters of microvascular function and infarct size (such as coronary flow reserve, acute myocardial edema, left ventricular ejection fraction, and late gadolinium enhancement 6 months later). We therefore assessed the prognostic value of PV NPY during follow‐up, where 34 patients (20.7%) developed heart failure or died. Kaplan‐Meier survival analysis demonstrated that high PV NPY levels (>21.4 pg/mL by binary recursive partitioning) were associated with increased incidence of heart failure and mortality (hazard ratio, 3.49 [95% CI, 1.65–7.4]; P<0.001). This relationship was maintained after adjustment for age, cardiovascular risk factors, and previous myocardial infarction. Conclusions Both PV and coronary sinus NPY levels correlate with microvascular function and infarct size after ST‐segment–elevation myocardial infarction. PV NPY levels are associated with the subsequent development of heart failure or mortality and may therefore be a useful prognostic marker. Further research is required to validate these findings.
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Affiliation(s)
- Thomas Gibbs
- Department of Physiology, Anatomy and Genetics, Burdon Sanderson Cardiac Science Centre University of Oxford United Kingdom
| | - Nidi Tapoulal
- Department of Physiology, Anatomy and Genetics, Burdon Sanderson Cardiac Science Centre University of Oxford United Kingdom
| | - Mayooran Shanmuganathan
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom
| | - Matthew K Burrage
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom
| | - Alessandra Borlotti
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom
| | - Adrian P Banning
- National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Robin P Choudhury
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Rajesh K Kharbanda
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom.,Oxford Acute Vascular Imaging Centre University of Oxford United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, Burdon Sanderson Cardiac Science Centre University of Oxford United Kingdom.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence University of Oxford United Kingdom
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13
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Gonzales RA, Zhang Q, Papież BW, Werys K, Lukaschuk E, Popescu IA, Burrage MK, Shanmuganathan M, Ferreira VM, Piechnik SK. MOCOnet: Robust Motion Correction of Cardiovascular Magnetic Resonance T1 Mapping Using Convolutional Neural Networks. Front Cardiovasc Med 2021; 8:768245. [PMID: 34888366 PMCID: PMC8649951 DOI: 10.3389/fcvm.2021.768245] [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: 08/31/2021] [Accepted: 10/27/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Quantitative cardiovascular magnetic resonance (CMR) T1 mapping has shown promise for advanced tissue characterisation in routine clinical practise. However, T1 mapping is prone to motion artefacts, which affects its robustness and clinical interpretation. Current methods for motion correction on T1 mapping are model-driven with no guarantee on generalisability, limiting its widespread use. In contrast, emerging data-driven deep learning approaches have shown good performance in general image registration tasks. We propose MOCOnet, a convolutional neural network solution, for generalisable motion artefact correction in T1 maps. Methods: The network architecture employs U-Net for producing distance vector fields and utilises warping layers to apply deformation to the feature maps in a coarse-to-fine manner. Using the UK Biobank imaging dataset scanned at 1.5T, MOCOnet was trained on 1,536 mid-ventricular T1 maps (acquired using the ShMOLLI method) with motion artefacts, generated by a customised deformation procedure, and tested on a different set of 200 samples with a diverse range of motion. MOCOnet was compared to a well-validated baseline multi-modal image registration method. Motion reduction was visually assessed by 3 human experts, with motion scores ranging from 0% (strictly no motion) to 100% (very severe motion). Results: MOCOnet achieved fast image registration (<1 second per T1 map) and successfully suppressed a wide range of motion artefacts. MOCOnet significantly reduced motion scores from 37.1±21.5 to 13.3±10.5 (p < 0.001), whereas the baseline method reduced it to 15.8±15.6 (p < 0.001). MOCOnet was significantly better than the baseline method in suppressing motion artefacts and more consistently (p = 0.007). Conclusion: MOCOnet demonstrated significantly better motion correction performance compared to a traditional image registration approach. Salvaging data affected by motion with robustness and in a time-efficient manner may enable better image quality and reliable images for immediate clinical interpretation.
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Affiliation(s)
- Ricardo A Gonzales
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Bartłomiej W Papież
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Iulia A Popescu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Matthew K Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mayooran Shanmuganathan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Burrage MK, Hundertmark M, Valkovič L, Watson WD, Rayner J, Sabharwal N, Ferreira VM, Neubauer S, Miller JJ, Rider OJ, Lewis AJ. Energetic Basis for Exercise-Induced Pulmonary Congestion in Heart Failure With Preserved Ejection Fraction. Circulation 2021; 144:1664-1678. [PMID: 34743560 PMCID: PMC8601674 DOI: 10.1161/circulationaha.121.054858] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 03/19/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transient pulmonary congestion during exercise is emerging as an important determinant of reduced exercise capacity in heart failure with preserved ejection fraction (HFpEF). We sought to determine whether an abnormal cardiac energetic state underpins this process. METHODS We recruited patients across the spectrum of diastolic dysfunction and HFpEF (controls, n=11; type 2 diabetes, n=9; HFpEF, n=14; and severe diastolic dysfunction attributable to cardiac amyloidosis, n=9). Cardiac energetics were measured using phosphorus spectroscopy to define the myocardial phosphocreatine to ATP ratio. Cardiac function was assessed by cardiovascular magnetic resonance cine imaging and echocardiography and lung water using magnetic resonance proton density mapping. Studies were performed at rest and during submaximal exercise using a magnetic resonance imaging ergometer. RESULTS Paralleling the stepwise decline in diastolic function across the groups (E/e' ratio; P<0.001) was an increase in NT-proBNP (N-terminal pro-brain natriuretic peptide; P<0.001) and a reduction in phosphocreatine/ATP ratio (control, 2.15 [2.09, 2.29]; type 2 diabetes, 1.71 [1.61, 1.91]; HFpEF, 1.66 [1.44, 1.89]; cardiac amyloidosis, 1.30 [1.16, 1.53]; P<0.001). During 20-W exercise, lower left ventricular diastolic filling rates (r=0.58; P<0.001), lower left ventricular diastolic reserve (r=0.55; P<0.001), left atrial dilatation (r=-0.52; P<0.001), lower right ventricular contractile reserve (right ventricular ejection fraction change, r=0.57; P<0.001), and right atrial dilation (r=-0.71; P<0.001) were all linked to lower phosphocreatine/ATP ratio. Along with these changes, pulmonary proton density mapping revealed transient pulmonary congestion in patients with HFpEF (+4.4% [0.5, 6.4]; P=0.002) and cardiac amyloidosis (+6.4% [3.3, 10.0]; P=0.004), which was not seen in healthy controls (-0.1% [-1.9, 2.1]; P=0.89) or type 2 diabetes without HFpEF (+0.8% [-1.7, 1.9]; P=0.82). The development of exercise-induced pulmonary congestion was associated with lower phosphocreatine/ATP ratio (r=-0.43; P=0.004). CONCLUSIONS A gradient of myocardial energetic deficit exists across the spectrum of HFpEF. Even at low workload, this energetic deficit is related to markedly abnormal exercise responses in all 4 cardiac chambers, which is associated with detectable pulmonary congestion. The findings support an energetic basis for transient pulmonary congestion in HFpEF.
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Affiliation(s)
- Matthew K. Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
| | - Moritz Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
| | - Ladislav Valkovič
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia (L.V.)
| | - William D. Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
| | - Jennifer Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
| | - Nikant Sabharwal
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
| | - Vanessa M. Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
| | - Jack J. Miller
- Department of Physics, Clarendon Laboratory (J.J.M.), University of Oxford, UK
- The MR Research Centre and The PET Research Centre, Aarhus University, Denmark (J.J.M.)
| | - Oliver J. Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
| | - Andrew J.M. Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
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15
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Zhang Q, Burrage MK, Lukaschuk E, Shanmuganathan M, Popescu IA, Nikolaidou C, Mills R, Werys K, Hann E, Barutcu A, Polat SD, Salerno M, Jerosch-Herold M, Kwong RY, Watkins HC, Kramer CM, Neubauer S, Ferreira VM, Piechnik SK. Toward Replacing Late Gadolinium Enhancement With Artificial Intelligence Virtual Native Enhancement for Gadolinium-Free Cardiovascular Magnetic Resonance Tissue Characterization in Hypertrophic Cardiomyopathy. Circulation 2021; 144:589-599. [PMID: 34229451 PMCID: PMC8378544 DOI: 10.1161/circulationaha.121.054432] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 03/02/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is the gold standard for noninvasive myocardial tissue characterization but requires intravenous contrast agent administration. It is highly desired to develop a contrast agent-free technology to replace LGE for faster and cheaper CMR scans. METHODS A CMR virtual native enhancement (VNE) imaging technology was developed using artificial intelligence. The deep learning model for generating VNE uses multiple streams of convolutional neural networks to exploit and enhance the existing signals in native T1 maps (pixel-wise maps of tissue T1 relaxation times) and cine imaging of cardiac structure and function, presenting them as LGE-equivalent images. The VNE generator was trained using generative adversarial networks. This technology was first developed on CMR datasets from the multicenter Hypertrophic Cardiomyopathy Registry, using hypertrophic cardiomyopathy as an exemplar. The datasets were randomized into 2 independent groups for deep learning training and testing. The test data of VNE and LGE were scored and contoured by experienced human operators to assess image quality, visuospatial agreement, and myocardial lesion burden quantification. Image quality was compared using a nonparametric Wilcoxon test. Intra- and interobserver agreement was analyzed using intraclass correlation coefficients (ICC). Lesion quantification by VNE and LGE were compared using linear regression and ICC. RESULTS A total of 1348 hypertrophic cardiomyopathy patients provided 4093 triplets of matched T1 maps, cines, and LGE datasets. After randomization and data quality control, 2695 datasets were used for VNE method development and 345 were used for independent testing. VNE had significantly better image quality than LGE, as assessed by 4 operators (n=345 datasets; P<0.001 [Wilcoxon test]). VNE revealed lesions characteristic of hypertrophic cardiomyopathy in high visuospatial agreement with LGE. In 121 patients (n=326 datasets), VNE correlated with LGE in detecting and quantifying both hyperintensity myocardial lesions (r=0.77-0.79; ICC=0.77-0.87; P<0.001) and intermediate-intensity lesions (r=0.70-0.76; ICC=0.82-0.85; P<0.001). The native CMR images (cine plus T1 map) required for VNE can be acquired within 15 minutes and producing a VNE image takes less than 1 second. CONCLUSIONS VNE is a new CMR technology that resembles conventional LGE but without the need for contrast administration. VNE achieved high agreement with LGE in the distribution and quantification of lesions, with significantly better image quality.
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Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Matthew K. Burrage
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Mayooran Shanmuganathan
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Iulia A. Popescu
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Chrysovalantou Nikolaidou
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Rebecca Mills
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Evan Hann
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Ahmet Barutcu
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
| | - Suleyman D. Polat
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
| | | | - Michael Salerno
- Department of Medicine, University of Virginia Health System, Charlottesville, VA (M.Salerno, C.M.K.)
| | - Michael Jerosch-Herold
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.J-H., R.Y.K.)
| | - Raymond Y. Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.J-H., R.Y.K.)
| | - Hugh C. Watkins
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, VA (M.Salerno, C.M.K.)
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford Biomedical Research Centre National Institute for Health Research, Division of Cardiovascular (Q.Z., M.J.B., E.L., M.Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., A.B., S.D.P., H.C.W., S.N., V.M.F., S.K.P.)
- Radcliffe Department of Medicine (Q.Z., M.J.B., E.L., M. Shanmuganathan, I.A.P., C.N., R.M., K.W., E.H., H.C.W., S.N., V.M.F., S.K.P.), University of Oxford, UK
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16
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Burrage MK, Shanmuganathan M, Zhang Q, Hann E, Popescu IA, Soundarajan R, Chow K, Neubauer S, Ferreira VM, Piechnik SK. Cardiac stress T1-mapping response and extracellular volume stability of MOLLI-based T1-mapping methods. Sci Rep 2021; 11:13568. [PMID: 34193894 PMCID: PMC8245629 DOI: 10.1038/s41598-021-92923-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023] Open
Abstract
Stress and rest T1-mapping may assess for myocardial ischemia and extracellular volume (ECV). However, the stress T1 response is method-dependent, and underestimation may lead to misdiagnosis. Further, ECV quantification may be affected by time, as well as the number and dosage of gadolinium (Gd) contrast administered. We compared two commonly available T1-mapping approaches in their stress T1 response and ECV measurement stability. Healthy subjects (n = 10, 50% female, 35 ± 8 years) underwent regadenoson stress CMR (1.5 T) on two separate days. Prototype ShMOLLI 5(1)1(1)1 sequence was used to acquire consecutive mid-ventricular T1-maps at rest, stress and post-Gd contrast to track the T1 time evolution. For comparison, standard MOLLI sequences were used: MOLLI 5(3)3 Low (256 matrix) & High (192 matrix) Heart Rate (HR) to acquire rest and stress T1-maps, and MOLLI 4(1)3(1)2 Low & High HR for post-contrast T1-maps. Stress and rest myocardial blood flow (MBF) maps were acquired after IV Gd contrast (0.05 mmol/kg each). Stress T1 reactivity (delta T1) was defined as the relative percentage increase in native T1 between rest and stress. Myocardial T1 values for delta T1 (dT1) and ECV were calculated. Residuals from the identified time dependencies were used to assess intra-method variability. ShMOLLI achieved a greater stress T1 response compared to MOLLI Low and High HR (peak dT1 = 6.4 ± 1.7% vs. 4.8 ± 1.3% vs. 3.8 ± 1.0%, respectively; both p < 0.0001). ShMOLLI dT1 correlated strongly with stress MBF (r = 0.77, p < 0.001), compared to MOLLI Low HR (r = 0.65, p < 0.01) and MOLLI High HR (r = 0.43, p = 0.07). ShMOLLI ECV was more stable to gadolinium dose with less time drift (0.006-0.04% per minute) than MOLLI variants. Overall, ShMOLLI demonstrated less intra-individual variability than MOLLI variants for stress T1 and ECV quantification. Power calculations indicate up to a fourfold (stress T1) and 7.5-fold (ECV) advantage in sample-size reduction using ShMOLLI. Our results indicate that ShMOLLI correlates strongly with increased MBF during regadenoson stress and achieves a significantly higher stress T1 response, greater effect size, and greater ECV measurement stability compared with the MOLLI variants tested.
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Affiliation(s)
- Matthew K Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Level 0, Oxford, OX3 9DU, UK
| | - Mayooran Shanmuganathan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Level 0, Oxford, OX3 9DU, UK
| | - Qiang Zhang
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Level 0, Oxford, OX3 9DU, UK
| | - Evan Hann
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Level 0, Oxford, OX3 9DU, UK
| | - Iulia A Popescu
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Level 0, Oxford, OX3 9DU, UK
| | - Rajkumar Soundarajan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Level 0, Oxford, OX3 9DU, UK
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Level 0, Oxford, OX3 9DU, UK
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Level 0, Oxford, OX3 9DU, UK
| | - Stefan K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Level 0, Oxford, OX3 9DU, UK.
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Scarsini R, Shanmuganathan M, De Maria GL, Borlotti A, Kotronias RA, Burrage MK, Terentes-Printzios D, Langrish J, Lucking A, Fahrni G, Cuculi F, Ribichini F, Choudhury R, Kharbanda R, Ferreira VM, Channon KM, Banning AP. Coronary Microvascular Dysfunction Assessed by Pressure Wire and CMR After STEMI Predicts Long-Term Outcomes. JACC Cardiovasc Imaging 2021; 14:1948-1959. [PMID: 33865789 DOI: 10.1016/j.jcmg.2021.02.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study sought to evaluate the long-term prognostic implications of coronary microvascular dysfunction (CMD) when assessed with both cardiovascular magnetic resonance (CMR) and index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND Post-ischemic CMD can be assessed using the pressure-wire based IMR and/or by the presence of microvascular obstruction (MVO) on CMR. METHODS A total of 198 patients with STEMI underwent IMR and MVO assessment. Patients were classified as follows: Group 1, no significant CMD (low IMR [≤40 U] and no MVO); Group 2, CMD with either high IMR (>40 U) or MVO; Group 3, CMD with both IMR >40 U and MVO. The primary endpoint was the composite of all-cause mortality, diagnosis of new heart failure, cardiac arrest, sustained ventricular tachycardia/fibrillation, and cardioverter defibrillator implantation. RESULTS CMD with both high IMR and MVO was present in 23.7% of the cases (Group 3) and CMD with either high IMR or MVO was observed in 40.9% of cases (Group 2). At a median follow-up of 40.1 months, the primary endpoint occurred in 34 (17%) cases. At 1 year of follow-up, Group 3 (hazard ratio [HR]: 12.6; 95% confidence interval [CI]: 1.6 to 100.6; p = 0.017) but not Group 2 (HR: 7.2; 95% CI: 0.9 to 57.9; p = 0.062) had worse clinical outcomes compared with those with no significant CMD in Group 1. However, in the long-term, patients in Group 2 (HR: 4.2; 95% CI: 1.4 to 12.5; p = 0.009) and those in Group 3 (HR: 5.2; 95% CI: 1.7 to 16.2; p = 0.004) showed similar adverse outcomes, mainly driven by the occurrence of heart failure. CONCLUSIONS Post-ischemic CMD predicts a more than 4-fold increase in long-term risk of adverse outcomes, mainly driven by the occurrence of heart failure. Defining CMD by either invasive IMR >40 U or by CMR-assessed MVO showed similar risk of adverse outcomes.
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Affiliation(s)
- Roberto Scarsini
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Division of Cardiology, Department of Medicine, University of Verona, Verona Italy
| | - Mayooran Shanmuganathan
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford United Kingdom
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Alessandra Borlotti
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rafail A Kotronias
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Matthew K Burrage
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford United Kingdom
| | - Dimitrios Terentes-Printzios
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Jeremy Langrish
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrew Lucking
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Gregor Fahrni
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Florim Cuculi
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona Italy
| | - Robin Choudhury
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rajesh Kharbanda
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford United Kingdom
| | - Keith M Channon
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Adrian P Banning
- Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom.
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18
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Burrage MK, Shanmuganathan M, Masi A, Hann E, Zhang Q, Popescu IA, Soundarajan R, Leal Pelado J, Chow K, Neubauer S, Piechnik SK, Ferreira VM. Cardiovascular magnetic resonance stress and rest T1-mapping using regadenoson for detection of ischemic heart disease compared to healthy controls. Int J Cardiol 2021; 333:239-245. [PMID: 33705843 PMCID: PMC8117972 DOI: 10.1016/j.ijcard.2021.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/15/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Background Adenosine stress T1-mapping on cardiovascular magnetic resonance (CMR) can differentiate between normal, ischemic, infarcted, and remote myocardial tissue classes without the need for contrast agents. Regadenoson, a selective coronary vasodilator, is often used in stress perfusion imaging when adenosine is contra-indicated, and has advantages in ease of administration, safety profile, and clinical workflow. We aimed to characterize the regadenoson stress T1-mapping response in healthy individuals, and to investigate its ability to differentiate between myocardial tissue classes in patients with coronary artery disease (CAD). Methods Eleven healthy controls and 25 patients with CAD underwent regadenoson stress perfusion CMR, as well as rest and stress ShMOLLI T1-mapping. Native T1 values and stress T1 reactivity were derived for normal myocardium in healthy controls and for different myocardial tissue classes in patients with CAD. Results Healthy controls had normal myocardial native T1 values at rest (931 ± 22 ms) with significant global regadenoson stress T1 reactivity (δT1 = 8.2 ± 0.8% relative to baseline; p < 0.0001). Infarcted myocardium had significantly higher resting T1 (1215 ± 115 ms) than ischemic, remote, and normal myocardium (all p < 0.0001) with an abolished stress T1 response (δT1 = −0.8% [IQR: −1.9–0.5]). Ischemic myocardium had elevated resting T1 compared to normal (964 ± 57 ms; p < 0.01) with an abolished stress T1 response (δT1 = 0.5 ± 1.6%). Remote myocardium in patients had comparable resting T1 to normal (949 ms [IQR: 915–973]; p = 0.06) with blunted stress reactivity (δT1 = 4.3% [IQR: 3.1–6.3]; p < 0.0001). Conclusions Healthy controls demonstrate significant stress T1 reactivity during regadenoson stress. Regadenoson stress and rest T1-mapping is a viable alternative to adenosine and exercise for the assessment of CAD and can distinguish between normal, ischemic, infarcted, and remote myocardium. Regadenoson has advantages over adenosine in terms of administration, safety profile, and clinical workflow. There are distinct tissue characteristics for normal, ischemic, infarcted, and remote myocardium. Healthy controls demonstrate significant stress T1 reactivity during vasodilator stress. Regadenoson stress T1-mapping can distinguish between different myocardial tissue classes. Regadenoson stress T1-mapping is a viable alternative to adenosine and exercise for the assessment of coronary artery disease.
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Affiliation(s)
- Matthew K Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Mayooran Shanmuganathan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Ambra Masi
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Evan Hann
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Qiang Zhang
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Iulia A Popescu
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Rajkumar Soundarajan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Joana Leal Pelado
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Stefan K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
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Abstract
PURPOSE OF REVIEW Left ventricular hypertrophy (LVH) is a common presentation encountered in clinical practice with a diverse range of potential aetiologies. Differentiation of pathological from physiological hypertrophy can be challenging but is crucial for further management and prognostication. Cardiovascular magnetic resonance (CMR) with advanced myocardial tissue characterisation is a powerful tool that may help to differentiate these aetiologies in the assessment of LVH. RECENT FINDINGS The use of CMR for detailed morphological assessment of LVH is well described. More recently, advanced CMR techniques (late gadolinium enhancement, parametric mapping, diffusion tensor imaging, and myocardial strain) have been used. These techniques are highly promising in helping to differentiate key aetiologies of LVH and provide valuable prognostic information. Recent advancements in CMR tissue characterisation, such as parametric mapping, in combination with detailed morphological assessment and late gadolinium enhancement, provide a powerful resource that may help assess and differentiate important causes of LVH.
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Affiliation(s)
- Matthew K Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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20
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Lewis AJM, Burrage MK, Ferreira VM. Cardiovascular magnetic resonance imaging for inflammatory heart diseases. Cardiovasc Diagn Ther 2020; 10:598-609. [PMID: 32695640 PMCID: PMC7369270 DOI: 10.21037/cdt.2019.12.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/20/2019] [Accepted: 12/10/2019] [Indexed: 12/28/2022]
Abstract
Inflammatory myocardial diseases represent a diverse group of conditions in which abnormal inflammation within the myocardium is the primary driver of cardiac dysfunction. Broad causes of myocarditis include infection by cardiotropic viruses or other infectious agents, to systemic autoimmune disease, or to toxins. Myocarditis due to viral aetiologies is a relatively common cause of acute chest pain syndromes in younger and middle-aged patients and often has a benign prognosis, though this and other forms of myocarditis also cause serious sequelae, including heart failure, arrhythmia and death. Endomyocardial biopsy remains the gold standard tool for tissue diagnosis of myocarditis in living individuals, although new imaging technologies have a crucial and complementary role. This review outlines the current state-of-the-art and future experimental cardiovascular magnetic resonance (CMR) imaging approaches for the detection of inflammation and immune cell activity in the heart. Multiparametric CMR, particularly with novel quantitative T1- and T2-mapping, is a valuable and widely-available tool for the non-invasive assessment of inflammatory heart diseases. Novel CMR molecular contrast agents will enable a more targeted assessment of immune cell activity and may be useful in guiding the development of novel therapeutics for myocarditis.
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Affiliation(s)
- Andrew J M Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew K Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Burrage MK, Baker C, Nikolaidou C, Myerson S, Ferreira VM. Rare unicuspid pulmonary valve and pulmonary artery aneurysm in an elderly asymptomatic patient. Eur Heart J Cardiovasc Imaging 2020; 21:708. [PMID: 32031610 DOI: 10.1093/ehjci/jeaa008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew K Burrage
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Level 0 John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Cassandra Baker
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Level 0 John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Chrysovalantou Nikolaidou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Level 0 John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Level 0 John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Level 0 John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
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22
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Burrage MK, Ferreira VM. The use of cardiovascular magnetic resonance as an early non-invasive biomarker for cardiotoxicity in cardio-oncology. Cardiovasc Diagn Ther 2020; 10:610-624. [PMID: 32695641 DOI: 10.21037/cdt-20-165] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Contemporary cancer therapy has resulted in significant survival gains for patients. However, many current and emerging cancer therapies have an associated risk of cardiotoxicity, either acutely or later in life. Regular cardiac screening and surveillance is recommended for patients undergoing treatment for cancer, with emphasis on the early detection of cardiotoxicity before irreversible complications develop. Cardiovascular magnetic resonance imaging is able to accurately assess cardiac structure, function, and perform advanced myocardial tissue characterisation, including perfusion, features which may facilitate the diagnosis and management of cardiotoxicity in cancer survivors. This review outlines the current standards for the diagnosis and screening of cardiotoxicity, with particular focus on current and future applications of cardiovascular magnetic resonance imaging.
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Affiliation(s)
- Matthew K Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Moore PT, Burrage MK, Mackenzie E, Law WP, Korczyk D, Mollee P. The Utility of 99mTc-DPD Scintigraphy in the Diagnosis of Cardiac Amyloidosis: An Australian Experience. Heart Lung Circ 2017; 26:1183-1190. [PMID: 28256403 DOI: 10.1016/j.hlc.2016.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/19/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The uptake of bone-seeking radiotracers in the amyloid heart is well recognised. 99mTc-DPD has been shown to be highly sensitive for cardiac transthyretin (ATTR) amyloid in an overseas population, but is not registered for use in Australia. We explored its utility as a diagnostic tool within our population. METHODS Patients diagnosed with AL and ATTR (wild-type and inherited) cardiac amyloidosis were prospectively recruited from the Princess Alexandra Hospital Amyloidosis Centre. Patients underwent injection with 99mTc-DPD then planar whole body imaging was performed at 5 minutes post-injection (soft tissue phase) and 3 hours (bone phase). A myocardial SPECT and low amperage CT were acquired after the late whole-body scan. Scans were analysed by two nuclear imaging specialists. Intensity of cardiac 99mTc-DPD uptake was graded as 0 to 3 in accordance with previous criteria, and semiquantitative analysis was performed using a heart to whole body ratio (H:WB) on the 3-hour scan. Patients also underwent electrocardiography and transthoracic echocardiography, and blood samples were taken for troponin I and brain natriuretic peptide levels, to assess for any correlation with DPD uptake. RESULTS Twenty-one patients (8 AL and 13 ATTR) completed the study. Median age was 58 and 70 years for AL and ATTR patients respectively, and 19 (90.5%) were male. 99mTc-DPD scintigraphy was positive in 2 (25%) of AL, and 13 (100%) of ATTR patients. Grade of cardiac uptake, and mean H:WB (0.1249 v. 0.0794) was greater in the ATTR cohort (p-value<0.001 and 0.001 respectively). No statistically significant correlation was identified between H:WB and echocardiographic parameters. There was a significant positive correlation between H:WB and the PR interval on ECG (p=0.026). CONCLUSIONS 99mTc-DPD scintigraphy is highly sensitive for the diagnosis of cardiac ATTR amyloid, but less so for AL amyloid.
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Affiliation(s)
- Peter T Moore
- Amyloidosis Centre, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia.
| | - Matthew K Burrage
- Amyloidosis Centre, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Emily Mackenzie
- Amyloidosis Centre, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - W Philip Law
- Amyloidosis Centre, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Dariusz Korczyk
- Amyloidosis Centre, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Peter Mollee
- Amyloidosis Centre, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia
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