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Sharrack N, Das A, Kelly C, Teh I, Stoeck CT, Kozerke S, Swoboda PP, Greenwood JP, Plein S, Schneider JE, Dall'Armellina E. The relationship between myocardial microstructure and strain in chronic infarction using cardiovascular magnetic resonance diffusion tensor imaging and feature tracking. J Cardiovasc Magn Reson 2022; 24:66. [PMID: 36419059 PMCID: PMC9685947 DOI: 10.1186/s12968-022-00892-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiac diffusion tensor imaging (cDTI) using cardiovascular magnetic resonance (CMR) is a novel technique for the non-invasive assessment of myocardial microstructure. Previous studies have shown myocardial infarction to result in loss of sheetlet angularity, derived by reduced secondary eigenvector (E2A) and reduction in subendocardial cardiomyocytes, evidenced by loss of myocytes with right-handed orientation (RHM) on helix angle (HA) maps. Myocardial strain assessed using feature tracking-CMR (FT-CMR) is a sensitive marker of sub-clinical myocardial dysfunction. We sought to explore the relationship between these two techniques (strain and cDTI) in patients at 3 months following ST-elevation MI (STEMI). METHODS 32 patients (F = 28, 60 ± 10 years) underwent 3T CMR three months after STEMI (mean interval 105 ± 17 days) with second order motion compensated (M2), free-breathing spin echo cDTI, cine gradient echo and late gadolinium enhancement (LGE) imaging. HA maps divided into left-handed HA (LHM, - 90 < HA < - 30), circumferential HA (CM, - 30° < HA < 30°), and right-handed HA (RHM, 30° < HA < 90°) were reported as relative proportions. Global and segmental analysis was undertaken. RESULTS Mean left ventricular ejection fraction (LVEF) was 44 ± 10% with a mean infarct size of 18 ± 12 g and a mean infarct segment LGE enhancement of 66 ± 21%. Mean global radial strain was 19 ± 6, mean global circumferential strain was - 13 ± - 3 and mean global longitudinal strain was - 10 ± - 3. Global and segmental radial strain correlated significantly with E2A in infarcted segments (p = 0.002, p = 0.011). Both global and segmental longitudinal strain correlated with RHM of infarcted segments on HA maps (p < 0.001, p = 0.003). Mean Diffusivity (MD) correlated significantly with the global infarct size (p < 0.008). When patients were categorised according to LVEF (reduced, mid-range and preserved), all cDTI parameters differed significantly between the three groups. CONCLUSION Change in sheetlet orientation assessed using E2A from cDTI correlates with impaired radial strain. Segments with fewer subendocardial cardiomyocytes, evidenced by a lower proportion of myocytes with right-handed orientation on HA maps, show impaired longitudinal strain. Infarct segment enhancement correlates significantly with E2A and RHM. Our data has demonstrated a link between myocardial microstructure and contractility following myocardial infarction, suggesting a potential role for CMR cDTI to clinically relevant functional impact.
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Affiliation(s)
- N Sharrack
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - A Das
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - C Kelly
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - I Teh
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - C T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Centre for Surgical Research, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - S Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - P P Swoboda
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J P Greenwood
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - S Plein
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J E Schneider
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - E Dall'Armellina
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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2
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Jex N, Cubbon R, Chowdhary A, Thirunavukarasu S, Kotha S, Procter H, Xue H, Swoboda P, Kellman P, Greenwood JP, Plein S, Levelt E. Clinical outcomes and myocardial recovery in energetics, perfusion and contractile function after valve replacement surgery in severe aortic stenosis patients with diabetes comorbidity. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) and type 2 diabetes mellitus (DM) are increasingly frequent comorbidities in aging populations, and diabetes is associated with increased morbidity and mortality after aortic valve replacement (AVR). Although distinct pathological entities, AS and DM share common features of impaired myocardial energetics and coronary microvascular dysfunction (CMD). The mechanisms for the adverse prognostic association between AS and DM are incompletely understood.
Purpose
Utilising 31phosphorus magnetic resonance spectroscopy (31P-MRS) and CMR, we tested the hypotheses that the collective impact of severe AS and DM on the myocardium aggravates the impairment in energetics, function and perfusion.
Methods
Eighty-eight severe AS patients with (AS-DM) and without DM (Iso-AS) undergoing AVR and 15 healthy volunteers were recruited. Patients with coronary artery disease were excluded. Participants with AS underwent 31P-MRS and comprehensive CMR imaging 1 month prior to and 6 months after AVR.
Results
Demographic, biochemical and CMR/31P-MRS data are shown in Table-1. All groups were matched for age and sex distribution, with AS groups matched for surgical scores and frailty scores. NTproBNP levels were similarly elevated in AS groups. Left ventricular (LV) volumes and ejection fraction (EF) were similar between the groups, with no significant difference in LV mass or wall thickness between the AS groups. The baseline differences in myocardial energetics, stress myocardial blood flow (MBF) and global longitudinal strain (GLS) are shown in the Figure. AS-DM patients showed greater reductions in myocardial energetics (p<0.0001), global stress MBF (p<0.0001) and more significant reductions in GLS (p=0.001) than the Iso-AS patients. At 6 month post AVR both AS groups showed significant improvements in stress MBF and GLS. However, only the Iso-AS patients showed significant improvement in myocardial energetics.
AS patients were followed up for a median of 12 months. Cumulative incidence of the clinical events post AVR (composite of cardiovascular death, stroke, heart failure admission, infective endocarditis) were significantly higher in the AS-DM group than the Iso-AS group (Hazard Ratio: 3.35; 95% CI: 0.97–11.6; p=0.02).
Conclusion
Diabetes was associated with increased morbidity and mortality after AVR. We showed for the first time that the collective impact of T2DM and AS on the myocardium aggravates energetic impairment, CMD and contractile dysfunction. While myocardial recovery following AVR was associated with similar improvements in perfusion and contractile function in severe AS patients with and without T2DM, improvements in energetics were only detected in isolated AS patients. However, despite the significant improvements in contractile function and perfusion following AVR in diabetes patients, these parameters remained lower in the group with diabetes comorbidity compared to isolated AS patients.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome Trust
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Affiliation(s)
- N Jex
- University of Leeds , Leeds , United Kingdom
| | - R Cubbon
- University of Leeds , Leeds , United Kingdom
| | - A Chowdhary
- University of Leeds , Leeds , United Kingdom
| | | | - S Kotha
- University of Leeds , Leeds , United Kingdom
| | - H Procter
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - H Xue
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - P Swoboda
- University of Leeds , Leeds , United Kingdom
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | | | - S Plein
- University of Leeds , Leeds , United Kingdom
| | - E Levelt
- University of Leeds , Leeds , United Kingdom
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3
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Gorecka M, Jex N, Thirunavukarasu S, Chowdhary A, Poenar AM, Sharrack N, Swoboda PP, Xue H, Vassiliou V, Kellman P, Plein S, Simms A, Greenwood JP, Levelt E. Evaluation of cardiac involvement in patients with clinical post-COVID-19 syndrome. Eur Heart J 2022. [PMCID: PMC9619493 DOI: 10.1093/eurheartj/ehac544.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The underlying pathophysiology of Post-COVID-19 syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus magnetic resonance spectroscopy (31P-MRS) allows non-invasive assessment of the myocardial energetic state. Purpose We sought to assess whether Post-COVID-19 syndrome is associated with abnormalities of myocardial structure, function, perfusion and tissue characteristics or energetic derangement. Methods Prospective case-control study. A total of 20 patients with a clinical diagnosis of Post-COVID-19 syndrome (seropositive) and no prior underlying cardiovascular disease (CVD) and ten matching controls underwent 31P-MRS and CMR at 3T at a single time point. (Figure 1) All patients had been symptomatic with acute COVID-19, but none required hospital admission. Results Between the Post-COVID-19 syndrome patients and matched contemporary controls there were no differences in myocardial energetics (phosphocreatine to ATP ratio), in cardiac structure (biventricular volumes, left ventricular mass), function (biventricular ejection fractions, global longitudinal strain), tissue characterization (T1 and extracellular volume [ECV] fraction mapping, late gadolinium enhancement) or perfusion (myocardial rest and stress blood flow, myocardial perfusion reserve). One patient with Post-COVID-19 syndrome showed subepicardial hyperenhancement on the late gadolinium enhancement imaging compatible with prior myocarditis, but no accompanying abnormality in cardiac size, function, perfusion, ECV, T1, T2 mapping or energetics. This patient was excluded from statistical analyses. (Table 1) Conclusion In this study, the overwhelming majority of patients with a clinical Post-COVID-19 syndrome with no prior CVD did not exhibit any abnormalities in myocardial energetics, structure, function, blood flow or tissue characteristics. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Welcome Trust Clinical Career Development Fellowship (221690/Z/20/Z);NIHR-UKRI COVID-19 Rapid Response Rolling Call (COV0254)ESC Training Grant
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Affiliation(s)
- M Gorecka
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - N Jex
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - S Thirunavukarasu
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - A Chowdhary
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - A M Poenar
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - N Sharrack
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - P P Swoboda
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - H Xue
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - V Vassiliou
- University of East Anglia , Norwich , United Kingdom
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - S Plein
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - A Simms
- Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - J P Greenwood
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
| | - E Levelt
- University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department , Leeds , United Kingdom
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Sharrack N, Knott KD, Yeo JL, Kotecha T, Brown LAE, Thirunavukarasu S, Chowdhary A, Levelt E, Moon JC, McCann GP, Fontana M, Kellman P, Munyombwe T, Swoboda P, Plein S. Quantitative myocardial blood flow as a prognostic marker for cardiovascular outcomes in patients with Type 2 Diabetes Mellitus: a multicentre study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.284] [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: Patients with Type 2 Diabetes Mellitus (T2DM) are at increased risk of cardiovascular disease, including epicardial coronary heart disease, silent myocardial infarction (MI), and coronary microvascular dysfunction (CMD) [1]. All of these can be assessed and quantified using cardiac magnetic resonance (CMR), including most recently quantitative myocardial blood flow (MBF). We aimed to determine the prognostic relevance of MBF in patients with T2DM and test the hypothesis that impaired stress MBF and myocardial perfusion reserve (MPR) have independent prognostic value over standard clinical and imaging parameters.
Methods
A 4-centre study of patients with T2DM who underwent quantitative perfusion assessment using CMR. Diagnosis of T2DM was based on Hba1c >48mmol/l or a known diagnosis of T2DM. Image analysis was performed automatically using an artificial intelligence approach deriving global MBF and MPR [2]. Cox proportional hazard models adjusting for comorbidities and CMR parameters sought associations between stress MBF and MPR with death and major adverse cardiovascular events (MACE), including MI, non-fatal stroke, heart failure hospitalisation and death.
Results
A total of 630 patients with T2DM were included with a median follow-up of 722 days (interquartile range 493) days. There were 27 (4.3%) deaths and 76 MACE events in 62 (12.1%) patients. Patient data was represented into groups depending on threshold stress MBF values of 1.94ml/g/min and MPR thresholds of 1.96 using validated data from invasive coronary physiology [3]. Patient demographics and CMR data are seen in table 1. Kaplan-Meier curves are seen in figure 1. Stress MBF was associated with mortality and MACE after adjusting for age, LV ejection fraction and HbA1c. The stress MBF adjusted hazard ratios for all cause death and death and MACE were 0.35 (95% CI, 0.13–0.95, P=0.04) and 0.54 (95% CI, 0.30–0.96, P=0.04), respectively. MPR was not significantly associated with death and MACE after adjusting for age, LV ejection fraction and HbA1c; hazard ratio for all cause death and death and MACE was 0.83 (95% CI, 0.41–1.69, P=0.60) and 0.81 (95% CI, 0.53–1.23, p=0.32) respectively.
Conclusion
In patients with T2DM, reduced stress MBF measured automatically inline using artificial intelligence quantification of cardiovascular magnetic resonance perfusion mapping provides a strong, independent predictor of adverse cardiovascular outcome.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): 1. REC ID 14/EE/0007 (Barts Heart Centre funding). 2. For PREDICT (Leicester data) ethical approval was provided by the UK Health Research Authority Research Ethics Committee (reference 17/WM/0192). 3. MATCH Study, Leeds - British Heart Foundation - 17/YH/0300. 4. LEAN-DM, Leeds - British Heart Foundation - 18/YH/01685. CEED, Leeds: British Heart Foundation - REC reference - 18/YH/0190
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Affiliation(s)
- N Sharrack
- University of Leeds , Leeds , United Kingdom
| | - K D Knott
- Barts Heart Centre , London , United Kingdom
| | - J L Yeo
- NIHR Biomedical Research Unit in Cardiovascular Disease , Leicester , United Kingdom
| | - T Kotecha
- Royal Free London NHS Foundation Trust , London , United Kingdom
| | - L A E Brown
- University of Leeds , Leeds , United Kingdom
| | | | - A Chowdhary
- University of Leeds , Leeds , United Kingdom
| | - E Levelt
- University of Leeds , Leeds , United Kingdom
| | - J C Moon
- Barts Heart Centre , London , United Kingdom
| | - G P McCann
- NIHR Biomedical Research Unit in Cardiovascular Disease , Leicester , United Kingdom
| | - M Fontana
- Royal Free London NHS Foundation Trust , London , United Kingdom
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - T Munyombwe
- University of Leeds , Leeds , United Kingdom
| | - P Swoboda
- University of Leeds , Leeds , United Kingdom
| | - S Plein
- University of Leeds , Leeds , United Kingdom
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5
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Thirunavukarasu S, Jex N, Chowdhary A, Hassan I, Straw S, Broadbent D, Swoboda P, Witte KK, Cubbon R, Xue H, Kellman P, Greenwood JP, Plein S, Levelt E. Mechanistic insights from a multiparametric magnetic resonance imaging study regarding the role of sodium glucose co-transporter 2 inhibitors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Type 2 diabetes (T2D) is associated with an increased risk of heart failure (HF) and cardiovascular (CV) mortality. Sodium–glucose-co transporter-2 (SGLT2) inhibitors reduce the risk of major adverse CV events and hospitalisation for HF in T2D patients with high cardiovascular risk, despite only a modest improvement in glycemic control. Restoring cellular energy homeostasis and reversing adverse cardiac remodelling in diabetes have been speculated as a potential metabolic modulatory effect of SGLT2 inhibitors leading to their beneficial CV outcomes. Myocardial energy deficient states can be detected non-invasively by 31-phosphorus magnetic resonance spectroscopy (31P-MRS).
Objectives
Utilising cardiovascular magnetic resonance imaging (CMR) and 31P-MRS in a single centre longitudinal cohort study, we aimed to investigate the effects of the selective SGLT2 inhibitor empagliflozin on myocardial energetics, function, perfusion, and myocardial cellular volume in patients with T2D.
Methods
Eighteen consecutive T2D patients who were commenced on empagliflozin in cardiometabolic optimisation clinics underwent CMR and 31P-MRS scans before and after twelve-week empagliflozin treatment, and plasma N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) levels were measured. Ten controls with no diabetes underwent an identical 31P-MRS and CMR protocol on a single visit.
Results
When compared to controls, patients with T2D showed: lower myocardial energetics (1.52±0.40 vs 2.20±0.5, p=0.0005), lower stress myocardial blood flow (1.60±0.50 vs 2.10±0.50, p=0.02) and lower left ventricular ejection fraction (52±13% vs 63±4%, p=0.01). Treatment with empagliflozin led to significant improvements in myocardial energetics (PCr/ATP: 1.52 to 1.76, p=0.009). This was accompanied by a relative 13% improvement in left ventricular ejection fraction (p=0.001), 3% improvement in global longitudinal strain (p=0.01), 61% reduction in NTproBNP (p=0.05), and 9% reduction in myocardial cell volume (p=0.04). No significant change in myocardial blood flow or diastolic strain was detected.
Conclusions
For the first time, we demonstrate that empagliflizon improves myocardial energetics and function, reduces myocardial cellular volume, and reduces NT-proBNP levels in patients with T2D.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation PCr/ATPLVEF
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Affiliation(s)
| | - N Jex
- University of Leeds, LICAMM, Leeds, United Kingdom
| | - A Chowdhary
- University of Leeds, LICAMM, Leeds, United Kingdom
| | - I Hassan
- University of Leeds, LICAMM, Leeds, United Kingdom
| | - S Straw
- University of Leeds, LICAMM, Leeds, United Kingdom
| | - D Broadbent
- University of Leeds, LICAMM, Leeds, United Kingdom
| | - P Swoboda
- University of Leeds, LICAMM, Leeds, United Kingdom
| | - K K Witte
- University of Leeds, LICAMM, Leeds, United Kingdom
| | - R Cubbon
- University of Leeds, LICAMM, Leeds, United Kingdom
| | - H Xue
- National Heart Lung and Blood Institute, Bethesda, United States of America
| | - P Kellman
- National Heart Lung and Blood Institute, Bethesda, United States of America
| | | | - S Plein
- University of Leeds, LICAMM, Leeds, United Kingdom
| | - E Levelt
- University of Leeds, LICAMM, Leeds, United Kingdom
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Sharrack N, Das A, Kelly C, Aldred M, Teh I, Stoeck CT, Kozerke S, Chowdhury A, Jex N, Ben-Arzi H, Swoboda PP, Greenwood JP, Plein S, Schneider JE, Dall"armellina E. The relationship between myocardial microstructure and strain in chronic infarcts, assessed using diffusion tensor imaging and feature tracking. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
Background
Cardiac diffusion tensor imaging (cDTI) is a novel technique for the non-invasive assessment of myocardial microstructure. It allows in-vivo characterisation of microstructural changes post myocardial infarction (MI). Previously published evidence shows significant loss of sheetlet orientation as derived by cDTI secondary eigenvector (E2A), and loss of subendocardial cardiomyocytes derived by reductions in the proportions of myocytes with right-handed orientation (RHM) on helix angle (HA) maps. The assessment of myocardial strain by feature tracking (FT) allows the measurement of radial strain (RS), thought to be driven by the dynamic reorientation of laminar sheetlets, and longitudinal strain (LS), which is thought to relate to subendocardial function. We sought to explore the relationship between the strain and cDTI parameters in patients at 3 months following ST-elevation MI (STEMI).
Methods
Twenty five STEMI patients (M:F = 18:7, mean age 58 ± 9) underwent 3T CMR scan (mean interval 106 ± 17 days) with the following protocol: second order motion compensated (M2), free-breathing spin echo DTI (3 slices, 18 diffusion directions at b-values 100s/mm2, 200s/mm2 and 500s/mm2, acquired resolution was 2.20*2.27*8mm3; cine gradient echo and Late Gadolinium Enhancement (LGE) imaging. HA maps were described by dividing values into left-handed HA (LHM, -90< HA < -30), circumferential HA (CM, -30° < HA < 30°), and right-handed HA (RHM, 30° < HA < 90°) and reported as relative proportions. Segmental analysis were undertaken to derive: HA proportions, E2A, longitudinal strain and LGE%. Segments positive for LGE were classed as infarct segments.
Results
cDTI acquisition was successful in all patients (acquisition time 13 ± 5mins). Mean ejection fraction was 47 ± 8% with mean LGE in the infarcted segment of 57 ± 27%. Mean radial strain was 21 (95% confidence interval, 15-26). The mean E2A was 44 (95% confidence interval 41-47). There was a significant correlation between segmental radial strain and segmental E2A in infarcted segments (p < 0.001, figure 1). In addition, segmental longitudinal strain correlated with the proportion of RHM on HA maps (p < 0.02, figure 2).
Conclusion
Through the combined use of cDTI and FT in patients with chronic infarcts, our results show that the loss of sheetlet orientation assessed using E2A, correlates with worsening radial strain. Segments with less subendocardial cardiomyocytes, evidenced by a lower proportion of myocytes with right-handed orientation on HA maps, correlated with worse longitudinal strain. While this could potentially elucidate the complex association between myocardial microstructure and regional function, further studies are needed to define the incremental clinical value of cDTI.
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Affiliation(s)
- N Sharrack
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Kelly
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Aldred
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - I Teh
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - CT Stoeck
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
| | - S Kozerke
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
| | - A Chowdhury
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - N Jex
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - H Ben-Arzi
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - PP Swoboda
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - JP Greenwood
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - JE Schneider
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
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7
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Chowdhary A, Jex N, Thirunavukarasu S, Craven T, Das A, Gorecka M, Saunderson C, Greenwood JP, Swoboda PP, Plein S, Levelt E. Prospective longitudinal characterisation of the relationship between diabetes and cardiac remodeling. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship and Wellcome Trust
Background
Cardiovascular disease represents the primary cause of death in patients with type 2 diabetes (T2D). Heart failure (HF) is the commonest initial presentation of cardiovascular disease in T2D. Development of HF in patients with T2D is associated with a 4 to 6-fold increase in mortality, making the prevention of cardiac dysfunction an important goal. The long-term impact of T2D on cardiac function in the absence of cardiovascular disease is unknown. This is the first prospective longitudinal study utilising cardiovascular magnetic resonance (CMR) to evaluate the impact of T2D on cardiac remodeling.
Objectives
To determine longitudinal changes in the phenotypic expression of heart disease in diabetes over 6 years, and examine the association of baseline blood and imaging biomarkers with remodeling over time in patients who remained free of cardiovascular/clinical events, and to report clinical outcomes in the entire cohort.
Methods
100 asymptomatic T2D patients with no history of cardiovascular disease or hypertension were previously studied. Biventricular volumes, function, and myocardial strain were assessed by CMR and blood biomarkers taken. 6-year follow-up CMR was repeated in those without interim cardiovascular events.
Results
Of the 100 patients, 78 could be contacted for follow-up. 29 participants experienced cardiovascular/clinical events over 6 years. 32 patients who were asymptomatic and without events received follow-up CMR. The major adverse cardiovascular event rate (MI, angina, revascularisation, stroke, death) during the 6-year follow-up period, including the patients with a silent MI, amounted to 25% in this study with an overall clinical event rate of 35%.
There were no significant changes in BP, BMI or HBA1c between baseline and follow-up (Table 1). Left ventricular end-diastolic-volume(p = 0.005), mass (p = 0.01), ejection fraction (p = 0.0001), and right ventricular end-diastolic-volume(p = 0.03) and ejection fraction(p = 0.003) reduced over time (Figure 2 and Table 1). Baseline plasma high-sensitivity cardiac-troponin-T (hs-cTnT) (R=-0.44; p = 0.01) was significantly associated with change in left ventricular ejection fraction over time.
Conclusions
Even in the absence of overt clinical CAD, significant valvular disease, uncontrolled hypertension or change in BMI, T2D results in significant reductions in cardiac size and biventricular systolic function over time. The major adverse cardiovascular event rate (MI, angina, revascularisation, stroke, death) during the 6-year follow-up period was high in diabetes patients (25%). Plasma biomarker hs-cTnT measured at baseline was associated with change in LV systolic function over the 6-year follow-up period. hs-cTnT could potentially have a significant utility as a risk-predicting tool for cardiac dysfunction in T2D patients.
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Affiliation(s)
- A Chowdhary
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - N Jex
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Thirunavukarasu
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Gorecka
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - JP Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - PP Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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8
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Craven TP, Jex N, Gorecka M, Higgins DM, Brown LAE, Das A, Chowdhary A, Thirunavukarasu S, Sharrack N, Dall"armellina E, Levelt E, Swoboda PP, Plein S, Greenwood JP. Quantification of mitral regurgitation and biventricular assessment is feasible during continuous supine exercise cardiovascular magnetic resonance in primary mitral regurgitation patients. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Biventricular volume and great vessel flow assessment during continuous supine free-breathing exercise cardiovascular magnetic resonance (Ex-CMR) is feasible in healthy volunteers using Compressed SENSEx3 (CS3) sequences1. Exercise transthoracic echocardiography (TTE) provides prognostic information in primary mitral regurgitation (MR). Resting CMR offers reference standard biventricular assessment and MR quantification with superior reproducibility to TTE. Ex-CMR assessment of biventricular volumes and quantitated MR may offer additional prognostic information.
Purpose
Determine the feasibility of biventricular assessment and MR quantification in primary MR patients during continuous supine Ex-CMR using the recently validated protocol1.
Methods
10 asymptomatic patients with at least moderate primary MR on TTE (8 male, median age 62, 55-67years interquartile range) underwent continuous in-scanner (1.5T Philips Ingenia) supine cycle ergometer (Lode BV) Ex-CMR. Target heart rates (THR) were individually prescribed using heart rate reserve (HRR) and age predicted maximal heart rate model. Participants exercised for 2-minutes at no resistance, then an increase of 25-Watts every 2-minutes until THR achieved at low (30-39% HRR), then moderate (40-59% HRR) stages. CMR imaging: free-breathing CS3 respiratory navigated short axis cine imaging and free-breathing CS3 aortic phase-contrast magnetic-resonance at rest, low and moderate exercise stages. MR was quantified indirectly from left ventricular (LV) and aortic stroke volumes. Intra/inter-observer reproducibility was assessed by coefficient of variance (CV).
Results
All patients completed the Ex-CMR protocol without complication. During exercise, no statistically significant changes occurred in LV volumes, global left ventricular ejection fraction (LVEF), right ventricular end-diastolic or systolic volumes (Table 1). From rest to low and moderate exercise: right ventricular ejection fraction increased (55 ± 5.4% to 60 ± 6.0% and 63 ± 6.6% respectively, p = 0.001) and MR fraction decreased (40 ± 14% to 36 ± 11% and 30 ± 15% respectively, p = 0.006) allowing effective forward LVEF (aortic stroke volume/ left ventricular end-diastolic volume) to increase (38 ± 9.3% to 43 ± 9.3% and 46 ± 11% respectively, p = 0.004). Intra-observer reproducibility (Table 2) was excellent (CV <10%), except right ventricular stroke volumes (RVSV) during low, MR volumes and fraction during moderate and right ventricular end-systolic volumes (RVESV) during both exercise stages, which were good (CV10-20%). Inter-observer reproducibility (Table 2) was excellent (CV < 10%), except RVESV and MR volumes at all stages, LV end-systolic volumes during low and MR fraction during moderate exercise, which were good (CV 10-20%).
Conclusion
Biventricular assessment and MR quantification during continuous supine Ex-CMR is feasible in asymptomatic primary MR patients, further research assessing the techniques prognostic ability is now warranted.
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Affiliation(s)
- TP Craven
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - N Jex
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Gorecka
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - DM Higgins
- Philips, Guildford, United Kingdom of Great Britain & Northern Ireland
| | - LAE Brown
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Chowdhary
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Thirunavukarasu
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - N Sharrack
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - PP Swoboda
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
| | - JP Greenwood
- University of Leeds, Leeds institute of Cardiovascular and Metabolic Medicine (LICAMM), Leeds, United Kingdom of Great Britain & Northern Ireland
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9
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Saunderson C, Paton MF, Brown LAE, Gierula J, Chew PG, Das A, Sengupta A, Craven TP, Chowdhary A, Levelt E, Dall"armellina E, Witte KK, Greenwood JP, Plein S, Swoboda PP. Detrimental immediate and long-term clinical effects of right ventricular pacing in patients with myocardial fibrosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Long-term right ventricular (RV) pacing leads to heart failure or a decline in left ventricular (LV) function in up to a fifth of patients.
Objectives
We aimed to establish whether patients with focal fibrosis detected on late gadolinium enhancement cardiovascular magnetic resonance (CMR) have deterioration in LV function after RV pacing.
Methods
We recruited 110 patients (84 in final analysis) into two observational CMR studies. Patients (n = 34) with a dual chamber device and preserved atrioventricular (AV) conduction underwent CMR in two asynchronous pacing modes (AOO & DOO) to compare intrinsic conduction with RV pacing. Patients (n = 50) with high-grade AV block underwent CMR before and 6 months after pacemaker implantation to investigate the long-term effects of RV pacing.
Results: The three key findings were
1) Initiation of RV pacing in patients with fibrosis, compared to those without, was associated with greater immediate changes in both LV end-systolic volume index (LVESVi) (5.3 ± 3.5 vs 2.1 ± 2.4 mL/m2; p < 0.01) and LV ejection fraction (LVEF) (-5.7 ± 3.4% vs -3.2 ± 2.6%; p = 0.02); 2) Long-term RV pacing in patients with fibrosis, compared to those without, was associated with greater changes in LVESVi (8.0 ± 10.4 vs -0.6 ± 7.3 mL/m2; p = 0.008) and LVEF (-12.3 ± 7.9 vs -6.7 ± 6.2%; p = 0.012); 3) Patients with fibrosis did not experience an improvement in quality of life, biomarkers or functional class after pacemaker implantation.
Conclusions
Fibrosis detected on CMR is associated with immediate and long-term deterioration in LV function following RV pacing and could be used to identify those at risk of heart failure prior to pacemaker implantation.
Characteristics before and after pacing Study 1 No fibrosis (n = 16) Fibrosis (n = 18) AOO DOO p-value AOO DOO p-value LVEDVi - mL/m² 66 ± 13 66 ± 12 0.67 78 ± 14 79 ± 13 0.34 LVESVi - mL/m² 30 ± 10 32 ± 9 0.003 38 ± 11 43 ± 12 <0.001 LVEF - % 56 ± 6 53 ± 5 <0.001 52 ± 8 47 ± 9 <0.001 Mechanical Dyssynchrony index - ms 61 ± 17 71 ± 25 0.07 81 ± 18 89 ± 21 0.04 Study 2 No fibrosis (n = 19) Fibrosis (n = 31) Pre-PPM Post-PPM p-value Pre-PPM Post-PPM p-value LVEDVi -mL/m² 88 ± 21 73 ± 14 <0.001 90 ± 18 83 ± 21 0.007 LVESVi -mL/m² 35 ± 9 34 ± 9 0.71 41 ± 14 49 ± 21 0.001 LVEF - % 60 ± 5 54 ± 7 <0.001 56 ± 8 43 ± 12 <0.001 Mechanical Dyssynchrony index - ms 70 ± 29 81 ± 22 0.15 84 ± 30 98 ± 31 0.03 Abstract Figure. Mechanism for heart failure after pacing
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Affiliation(s)
- C Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - MF Paton
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - LAE Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Gierula
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - PG Chew
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Sengupta
- Leeds General Infirmary, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - TP Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Chowdhary
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - KK Witte
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - JP Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - PP Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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10
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Ben-Arzi H, Das A, Kelly C, Van Der Geest RJ, Chowdhary A, Craven T, Jex N, Thirunavukarasu S, Levelt E, Bissell M, Swoboda PP, Greenwood JP, Plein S, Dall"armellina E. Longitudinal change in left ventricular 4D flow kinetic energy after myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation HRUK
Background. Four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) imaging provides quantification of intra-cavity left ventricular (LV) flow kinetic energy (KE) parameters in three dimensions. Myocardial infarction (MI) is known to cause acute alterations in intra-cardiac blood flow but assessments of longitudinal changes are lacking.
Purpose. Assess longitudinal changes in LV flow post ST-elevation myocardial infarction (STEMI).
Method. Twenty acutely reperfused STEMI patients (13 men, 7 women, mean age 54 ± 9 years) underwent 3T CMR acutely (within 5-7 days) and 3 months post-MI. CMR protocol included functional imaging, late gadolinium enhancement and 4D flow. Using Q-MASS, LV KE parameters were derived and indexed to LV end-diastolic volume (LVKEiEDV). Based on acute ejection fraction (EF), patients were grouped as follows: preserved (pEF) EF >50%, reduced (rEF) EF <50% including mild (rEF= 40-49%), moderate to severe (EF <40%) impairment.
Results. Out of 20 patients, 13 had rEF acutely (7 mild rEF, 6 moderate to severe rEF). Acute LVKEiEDV parameters varied significantly between pEF and rEF (Table). At 3 months, pEF and mild rEF patients showed a significant (P < 0.05) reduction in average, systolic and peak-A wave LVKEiEDV. Mild rEF patients also had significant (P < 0.05) reduction in minimal and peak-E wave LVKEiEDV. However in patients with moderate to severe rEF in the acute scan, there were no significant change by 3 months (Figure).
Conclusion. Following MI, 4D flow LVKE derived biomarkers significantly decreased over time in pEF and mild rEF groups but not in moderate to severe rEF group. 4D flow assessment might provide incremental prognostic value beyond EF assessment alone.
Table pEF (n = 7) rEF (n = 13) V1 V2 P-value V1 V2 P-value EF(%) 56 ± 5 55 ± 4 0.40 41 ± 7 47 ± 9 0.01 Infarct Size(%) 31 ± 20 15 ± 9 0.04 18 ± 13† 16 ± 11 0.41 LV KEiEDV parameters Average(µJ/ml) 9 ± 2 7 ± 2 0.02 10 ± 3† 8 ± 3 0.01 Minimal(µJ/ml) 1 ± 0.6 1 ± 0.5 0.46 1.3 ± 0.5 1 ± 0.6 0.03 Systolic(µJ/ml) 10 ± 4 7 ± 2 <0.01 12 ± 4† 7 ± 3 <0.01 Diastolic(µJ/ml) 8 ± 3 7 ± 2 0.13 9 ± 3 8 ± 3 0.09 Peak-E wave(µJ/ml) 22 ± 9 23 ± 8 0.44 20 ± 7 18 ± 10 0.23 Peak-A wave(µJ/ml) 18 ± 10 11 ± 4 0.04 17 ± 9 14 ± 7 0.02 †P < 0.05 V1 comparison between pEF and rEF Abstract Figure
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Affiliation(s)
- H Ben-Arzi
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Kelly
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - RJ Van Der Geest
- Leiden University Medical Center, Department of Radiology, Leiden, Netherlands (The)
| | - A Chowdhary
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - N Jex
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Thirunavukarasu
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Bissell
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - PP Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - JP Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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11
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Koshy A, Gierula J, Paton M, Swoboda P, Toms A, Saunderson C, Shelley D, Broadbent D, Plein S, Kearney M, Witte K. Partial normalisation of cardiac mechanics with active CRT in patients with chronic failure: a novel application of 3.0T CMR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1091] [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
Cardiac resynchronisation therapy (CRT) is a routine treatment for chronic heart failure (CHF) with reduced ejection fraction and conduction delay to improve prognosis. Cardiac mechanics in patients with CHF are believed to be altered from controls based on invasive and echocardiographic based data. Technological advancements in cardiac magnetic resonance (CMR) and devices enable investigation of the cardiac response to CRT over a range of heart rates.
Methods
Patients with a CRT-D device were enrolled from heart failure clinics at Leeds General Infirmary, UK. After a MRI safety assessment, a baseline device check was conducted by a cardiac physiologist. Left ventricular (LV) volumes and systolic BP were measured at baseline and heart rates of 75, 90, 100, 115, 125, and 140 (randomised order) with CRT active and intrinsic conduction. All scans were conducted using a 3.0 T Siemens Prisma MRI scanner. Analysis of the scans used commercially available software. LV contractility was derived as a ratio of the LV end systolic volume and systolic BP. A post scan device interrogation was conducted to assess for scanning safety. Control participants with a 3.0T MR-conditional dual chamber pacemakers completed a similar protocol.
Results
Scanning was conducted in 17 CRT patients and 13 controls with a pre and post device and lead interrogation. No patient experienced symptoms related to scanning or device failure. The mean LV ejection fraction at baseline in the CRT cohort was 33.7±12.9%. Left ventricular ejection fraction fell across both cohorts as paced heart rate increased with reduced deterioration in control patients and those with CRT active. Peak LV cardiac output was significantly higher during active CRT (p<0.05). LV contractility was relatively static with CRT disabled (r2=0.13, p=0.38) and improved with CRT active (r2=0.91, p=0.01) and in controls (r2=0.74, p=0.01). Peak LV strain occurred at 100bpm during active CRT and in control patients whereas CRT disabled resulted in earlier deterioration.
Conclusion
We have demonstrated improvements in cardiac output and contractility consequent to active CRT using 3.0T CMR and subsequently validated via strain analysis. CRT appears to partially normalise cardiac mechanics across the range of heart rates studied. Further work is required to explore this phenomenon on a cellular or metabolic level.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): AK is supported by an unconditional grant provided by Medtronic
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Affiliation(s)
- A Koshy
- University of Leeds, Leeds, United Kingdom
| | - J Gierula
- University of Leeds, Leeds, United Kingdom
| | - M Paton
- Leeds General Infirmary, Leeds, United Kingdom
| | - P Swoboda
- University of Leeds, Leeds, United Kingdom
| | - A.G Toms
- Leeds General Infirmary, Leeds, United Kingdom
| | | | - D Shelley
- Leeds General Infirmary, Leeds, United Kingdom
| | - D Broadbent
- Leeds General Infirmary, Leeds, United Kingdom
| | - S Plein
- University of Leeds, Leeds, United Kingdom
| | | | - K.K Witte
- University of Leeds, Leeds, United Kingdom
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12
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Koshy A, Gierula J, Paton M, Swoboda P, Toms A, Saunderson C, Shelley D, Plein D, Cubbon R, Kearney M, Witte K. P1236Revealing cardiac mechanics with CMR whilst CRT is active: the first step. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cardiac resynchronisation therapy (CRT) is a routine treatment for heart failure with reduced ejection fraction and conduction delay to improve symptoms and prognosis. Technological advancements both in cardiac magnetic resonance (CMR) and devices (MRI-conditional modes) now enable investigation of the haemodynamic response to CRT over a range of heart rates.
Methods
Patients with a CRT-D device were enrolled from heart failure clinics at a single tertiary centre. A complete device system assessment and baseline device check was conducted to ensure MRI compatibility and suitability. Left ventricular (LV) volumes and systolic blood pressure were measured at baseline and heart rates of 75, 90, 100, 115, 125, and 140 bpm (randomised order) with CRT active and intrinsic conduction (AOO). MRI conditional mode parameters were replicated through standard parameter modification to ensure biventricular pacing during CRT active scans. All scans were conducted using a 3.0 T Siemens Prisma MRI scanner with analysis on commercially available software. Contractility was derived from the systolic blood pressure and left ventricular end systolic volume. A post scan device and lead assessment was conducted to assess for scanning safety.
Results
Scanning was conducted in 22 patients (safety cohort). Post scan battery voltage reduced by 2.9±1.0%. Mean change in atrial, right ventricular and left ventricular lead impedance was 0.5±0.06%, 3.0±0.04% and −1.7±0.05% respectively. Mean change in atrial, right ventricular and left ventricular pacing threshold was 0.0±0.3%, 8.3±0.3% and 5.6±0.3%. No patient experienced symptoms related to scanning or device failure.
Preliminary data for patients with CRT on and off have been analysed (paired analysis cohort, n=8, 6 men). Mean age was 71.1±8.2, aetiology was primarily ischaemic (62.5%) with the remainder dilated cardiomyopathy. The mean LV ejection fraction at baseline was 29.4±12.9%. Biventricular pacing led to acute improvements in ejection fraction (p=0.005), left ventricular cardiac output (p<0.0001) and contractility (p=0.05) over the entire range of heart rates studied. We also noted an improvement in the force frequency relationship during biventricular pacing with a higher peak contractility (p=0.05), a higher heart rate at which this occurred (HR=130) and a generally up sloping relationship when compared with intrinsic conduction.
Conclusion
We have demonstrated for the first time, the mechanistic improvements in cardiac contractility consequent to CRT using CMR and also that MRI scans of conditional devices can be safe with CRT active.
Acknowledgement/Funding
Dr A Koshy is conducting a PhD supported by grant from Medtronic. Dr Klaus Witte has received honoraria from Medtronic
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Affiliation(s)
- A Koshy
- University of Leeds, Leeds, United Kingdom
| | - J Gierula
- University of Leeds, Leeds, United Kingdom
| | - M Paton
- University of Leeds, Leeds, United Kingdom
| | - P Swoboda
- University of Leeds, Leeds, United Kingdom
| | - A Toms
- Leeds General Infirmary, Leeds, United Kingdom
| | | | - D Shelley
- Leeds General Infirmary, Leeds, United Kingdom
| | - D Plein
- University of Leeds, Leeds, United Kingdom
| | - R Cubbon
- University of Leeds, Leeds, United Kingdom
| | - M Kearney
- University of Leeds, Leeds, United Kingdom
| | - K Witte
- University of Leeds, Leeds, United Kingdom
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13
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Chew PG, Dobson LE, Garg P, Richards FJL, Foley JR, Fent GJ, Brown LAE, Saunderson CED, Das A, Kidambi A, Levelt E, Swoboda PP, Dall'armellina E, Plein S, Greenwood JP. P589Assessment of cardiac reverse remodelling following mitral valve repair and mitral valve replacement in degenerative mitral regurgitation: a cardiovascular magnetic resonance study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mitral valve (MV) repair is currently recommended over replacement (1). The guidelines suggesting this are however based on historic evidence which compared outdated techniques of MV replacement. Recent data cast doubts on its validity in the current era of chordal-preservation techniques in MV replacement.
Purpose
Using cardiovascular magnetic resonance (CMR) imaging, this study aimed to assess the impact of MV repair and MV replacement on cardiac left ventricular (LV) reverse remodelling.
Methods
65 patients with moderate-severe and severe mitral regurgitation (MR) were prospectively recruited. Of these, 37 patients (59% men, 65±15 years) to date with paired CMR scans at baseline and at 6 months were evaluated. Patients either underwent MV repair (n=9), MV replacement (n=10) or watchful waiting (n=18). The CMR protocol included cines for left ventricle (LV), left atria (LA), and aortic flow assessment. The LA and LV parameters, and MR fraction were analysed.
Results
At 6 months, both the MV repair and replacement groups exhibited a reduction in LV end-diastolic volume (LVEDV) and LA volumes when compared to the control group. The indexed LVEDV decreased significantly from 129±33ml/m2 to 99±37ml/m2, p<0.001 in the repair group, from 118±24ml/m2 to 90±26ml/m2, p<0.001 in the replacement group and remained unchanged in the control group 115±25ml/m2 to 113±25ml/m2, p=0.53. The absolute reduction in indexed LVEDV was not significantly different between the repair and replacement groups (−30±15ml/m2 vs −29±19ml/m2, repair vs replacement, p=1.00). Similarly, both surgical groups also sustained an equal degree of LA size reduction (−42±26ml/m2 vs −36±23ml/m2, repair vs replacement; p=1.00). There was a decline in the global postoperative LV ejection fraction (Table 1). The degree of reduction in LV ejection fraction however did not differ between the repair and replacement group (−9±6% vs −6±8%, repair vs replacement; p=1.00). Those undergoing surgery experienced a significant reduction in their MR severity, although those with replacement had a more effective reduction in MR severity (MR fraction for repair: 47±9% to 15±10%, p<0.001 vs replacement: 41±13% to 5±4%, p<0.001).
Conclusion
MV surgery leads to atrial and left ventricular reverse remodelling, and a decline in global LV ejection fraction. In this small series, MV replacement with chordal preservation showed similar cardiac reverse remodelling benefits to MV repair. Although residual MR is often seen following repair, this did not lead to less favourable cardiac reverse remodelling.
Acknowledgement/Funding
Leeds NIHR infrastructure
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Affiliation(s)
- P G Chew
- University of Leeds, Leeds, United Kingdom
| | - L E Dobson
- University of Leeds, Leeds, United Kingdom
| | - P Garg
- University of Leeds, Leeds, United Kingdom
| | | | - J R Foley
- University of Leeds, Leeds, United Kingdom
| | - G J Fent
- University of Leeds, Leeds, United Kingdom
| | | | | | - A Das
- University of Leeds, Leeds, United Kingdom
| | - A Kidambi
- University of Leeds, Leeds, United Kingdom
| | - E Levelt
- University of Leeds, Leeds, United Kingdom
| | | | | | - S Plein
- University of Leeds, Leeds, United Kingdom
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14
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Price NJ, Saunderson CE, O"neill J, Mcdiarmid AK, Erhayiem B, Miller L, Malhotra A, Sharma S, Plein S, Greenwood JP, Swoboda PP. P143Association of left atrial size and function and aerobic fitness in endurance athletes. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N J Price
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J O"neill
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A K Mcdiarmid
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - B Erhayiem
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - L Miller
- St George"s University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Malhotra
- St George"s University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Sharma
- St George"s University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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15
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Brown L, Saunderson CED, Das A, Craven T, Xue H, Knott K, Levelt E, Dall"armellina E, Swoboda PP, Moon J, Greenwood JP, Kellman P, Plein S. P152Assessing myocardial perfusion in heart failure - are we achieving adequate stress? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - K Knott
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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Saunderson C, Paton MF, Gierula J, Brown LAE, Chew PG, Das A, Craven TP, Jain M, Levelt E, Dall"armellina E, Witte KK, Greenwood JP, Plein S, Swoboda PP. 492Prevalence and distribution of cardiac fibrosis in patients with atrioventricular block undergoing pacemaker implantation. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez123.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M F Paton
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Gierula
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - L A E Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P G Chew
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T P Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Jain
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - K K Witte
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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Brown L, Saunderson CED, Das A, Craven T, Xue H, Knott K, Levelt E, Moon J, Dall"armellina E, Greenwood JP, Kellman P, Plein S, Swoboda PP. P151Defining the phenotype of heart failure with mid-range ejection fraction by cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - K Knott
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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Das A, Kelly C, Teh I, Stoeck CT, Kozerke S, Brown LAE, Saunderson CED, Craven T, Swoboda PP, Levelt E, Greenwood JP, Plein S, Schneider JE, Dallarmellina E. 542Longitudinal changes in diffusion tensor imaging parameters following acute ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Kelly
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - I Teh
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C T Stoeck
- University of Zurich, Institute of Biomedical Engineering, Zurich, Switzerland
| | - S Kozerke
- University of Zurich, Institute of Biomedical Engineering, Zurich, Switzerland
| | - L A E Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J E Schneider
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dallarmellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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Craven T, Levelt E, Jex N, Jain M, Brown LAE, Saunderson CED, Das A, Dall" Armellina E, Bijsterveld P, Greenwood JP, Plein S, Swoboda PP. P153Modulation of renin-angiotensin-aldosterone system reverses adverse left atrial remodelling in type 2 diabetes. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - N Jex
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Jain
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - L A E Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall" Armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P Bijsterveld
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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Swoboda PP, Garg P, Foley JR, Fent GJ, Brown LA, Chew PG, Saunderson CE, Dall'armellina E, Greenwood JP, Plein S. P5646Cardiac effects of complete enforced detraining assessed by cardiovascular magnetic resonance. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P P Swoboda
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - P Garg
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - J R Foley
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - G J Fent
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - L A Brown
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - P G Chew
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - C E Saunderson
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - E Dall'armellina
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - J P Greenwood
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - S Plein
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
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Fent G, Garg P, Dobson L, Musa TA, Foley J, Greenwood J, Plein S, Swoboda P. 9 Global longitudinal strain using feature tracking identifies the presence of chronic myocardial infarction in patients with normal LV ejection fraction. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Foley JRJ, Garg P, Musa TA, Dobson LE, Swoboda PP, Fent GJ, Haaf P, Plein S, Greenwood JP. 11 Left ventricular end diastolic filling pressure predicted by left atrial strain measured by feature tracking. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fent G, Garg P, Dobson L, Musa TA, Foley J, Swoboda P, Greenwood J, Plein S. 10 Quantitative myocardial perfusion and longitudinal strain by feature tracking in newly diagnosed, treatment naïve rheumatoid arthritis. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Greulich S, Meloni A, Nazir SA, Stefan Biesbroek P, Arenja N, Kammerlander AA, Sayeed A, Ricci F, Bernhardt P, Meierhofer C, Devos DG, Ruecker B, Burkhardt B, Kamphuis VP, De Lazzari M, Nederend I, Dux-Santoy L, Cavalcante JL, Rosmini S, Liu B, Fent G, Claessen G, Behar J, Oebel S, Baritussio A, Ranjit Arnold J, Kitterer D, Latus J, Henes J, Kurmann R, Gloekler S, Wahl A, Buss S, Katus H, Bobbo M, Lombardi M, Braun N, Alscher M, Sechtem U, Mahrholdt H, Neri M, Preziosi P, Grassedonio E, Schicchi N, Keilberg P, Pulini S, Facchini E, Positano V, Pepe A, Shetye A, Khan JN, Singh A, Kanagala P, Swarbrick D, Gulsin G, Graham-Brown M, Squire I, Gershlick A, McCann GP, Amier RP, Teunissen PF, Robbers LF, Beek AM, van Rossum AC, Hofman MB, van Royen N, Nijveldt R, Riffel JH, Djiokou CN, Andre F, Fritz T, Halder M, Thomas Z, Korosoglou G, Katus HA, Buss SJ, Schwaiger ML, Duca F, Aschauer S, Marzluf BA, Zotter-Tufaro C, Dalos D, Pfaffenberger S, Bonderman D, Mascherbauer J, Fridman Y, Hackman B, Kadakkal A, Maanja M, Daya HA, Wong TC, Schelbert EB, Barison A, Todiere G, Gaeta R, Galllina S, Emdin M, De Caterina R, Aquaro G, Buckert D, Dyckmanns N, Rottbauer W, Kühn A, Shehu N, Müller J, Stern H, Ewert P, Fratz S, Vogt M, De Groote K, Babin D, Demulier L, Taeymans Y, Westenberg JJ, Van Bortel L, Segers P, Achten E, De Schepper J, Rietzschel E, Geiger J, Makki M, Burkhardt B, Kellenberger CJ, Buechel ERV, Kellenberger C, Geiger J, Ruecker B, Buechel EV, Elbaz MS, Kroft LJ, van der Geest RJ, de Roos A, Blom NA, Westenberg JJ, Roest AA, Cipriani A, Susana A, Rizzo S, Giorgi B, Carmelo L, Bertaglia E, Bauce B, Corrado D, Thiene G, Marra MP, Basso C, Iliceto S, Roest A, van den Boogaard P, ten Harkel A, de Geus J, Kroft L, de Roos A, Westenberg J, Kale R, Teixido-Tura G, Maldonado G, Huguet M, Garcia-Dorado D, Evangelista A, Rodriguez-Palomares J, Rijal S, Schindler JT, Gleason TG, Lee JS, Schelbert EB, Bulluck H, Treibel TA, Bhuva A, Abdel-Gadir A, Culotta V, Merghani A, Maestrini V, Herrey AS, Kellman P, Manisty C, Moon JC, Hayer M, Baig S, Shah T, Rooney S, Edwards N, Steeds R, Garg P, Swoboda P, Dobson L, Musa T, Foley J, Haaf P, Greenwood J, Plein S, Schnell F, Bogaert J, Dymarkowski S, Pattyn N, Claus P, Van Cleemput J, Gerche AL, Heidbuchel H, Toth D, Reiml S, Panayiotou M, Claridge S, Jackson T, Sohal M, Webb J, O'Neill M, Brost A, Mountney P, Razavi R, Rhode K, Rinaldi CA, Arya A, Hilbert S, Bollmann A, Hindricks G, Jahnke C, Paetsch I, Dinov B, Perazzolo Marra M, Ghosh Dastidar A, Rodrigues J, Zorzi A, Susana A, Scatteia A, De Garate E, Mattesi G, Strange J, Corrado D, Bucciarelli-Ducci C, Jerosch-Herold M, Karamitsos TD, Francis JM, Bhamra-Ariza P, Sarwar R, Choudhury R, Selvanayagam JB, Neubauer S. ORAL AB AGORA1362Cardiac Involvement in Patients With Different Rheumatic Disorders1366Gender differences in the development of cardiac complications: a multicentric prospective study in a large cohort of thalassemia major patients1646Comparison of T1-mapping, T2-weighted and contrast-enhanced cine imaging at 3.0T CMR for diagnostic oedema assessment in ST-segment elevation myocardial infarction1375Evaluation of Tissue Changes in Remote Noninfarcted Myocardium after Acute Myocardial Infarction using T1-mapping1377Right ventricular long axis strain – The prognostic value of a novel parameter in non-ischemic dilated cardiomyopathy using standard cardiac magnetic resonance imaging1389The role of the right ventricular insertion point in heart failure patients with preserved ejection fraction: Insights from a cardiovascular magnetic resonance study1398Myocardial fibrosis associates with B-type natriuretic peptide levels and outcomes more than wall stress1478Prognostic Value of Pulmonary Blood Volume by Contrast-Enhanced Magnetic Resonance Imaging in Heart Failure Outpatients – The PROVE-HF Study1370Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary1509Influence of non-invasive hemodynamic CMR parameters on maximal exercise capacity in surgically untreated patients with Ebstein's anomaly1356Proximal aortic stiffening in Turner patients is more pronounced in the presence of a bicuspid valve. A segmental functional MRI study1503Flow pattern and vascular distensibility of the pulmonary arteries in patients after repair of tetralogy of Fallot. Insights from 4D flow CMR1516Myocardial deformation characteristics of the systemic right ventricle after atrial switch operation for transposition of the great arteries1633Three-dimensional vortex formation in patients with a Fontan circulation: evaluation with 4D flow CMR1483Mitral valve prolapse: arrhythmogenic substrates by cardiac magnetic imaging1596Increased local wall shear stress after coarctation repair is associated with descending aorta pulse wave velocity: evaluation with CMR and 4D flow1636Three-dimensional wall shear stress assessed by 4Dflow CMR in bicuspid aortic valve disease1464Cardiac Amyloidosis and Aortic Stenosis – The Convergence of Two Aging Processes1630Blood T1 variability explained in healthy volunteers: an analysis on MOLLI, ShMOLLI and SASHA1408Myocardial deformation on CMR predicts adverse outcomes in carcinoid heart disease - a new marker of risk1492Myocardial Perfusion Reserve and Global Longitudinal Strain in Early Rheumatoid Arthritis1500Exercise CMR to differentiate athlete's heart from patients with early dilated cardiomyopathy1559Real-Time, x-mri guidance to optimise left ventricular lead placement for delivery of cardiac resynchronisation therapy1560The role of Cardiac magnetic resonance imaging in patients undergoing ablation for ventricular tachycardia- Defining the substrate and visualizing the outcome1590Impact of cardiovascular magnetic resonance on clinical management and decision-making of out of hospital cardiac arrest survivors with inconclusive coronary angiogram1561Detection of coronary stenosis at rest using Oxygenation-Sensitive Magnetic Resonance Imaging. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Piasecki B, Sasani T, O'Flaherety B, Swords T, Henriksson J, Stasio ED, Swoboda P. Comparative genomics reveals novel genes associated with sensory cilia. Cilia 2015. [PMCID: PMC4518670 DOI: 10.1186/2046-2530-4-s1-p16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Erhayiem B, McDiarmid A, Swoboda P, Kidambi A, Ripley D, Musa T, Dobson L, Garg P, Horton S, Dumitru R, Andrews J, Greenwood J, Emery P, Plein S, Buch M. OP0163 Treatment-Naïve, Early Rheumatoid Arthritis Patients Demonstrate Vascular and Myocardial Abnormalities on Cardiac MRI. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Garg P, Foley JRJ, Kidambi A, Ripley DP, Dobson LE, Swoboda PP, Musa TA, McDiarmid AK, Erhayiem B, Greenwood JP, Plein S. 14 Feature tracking versus manual methods of assessment of left atrial mechanics in acute myocardial infarction: a pilot study: Abstract 14 Table 1. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Musa TA, Uddin A, Fairbairn TA, Dobson LE, Steadman C, Kidambi A, Motwani M, Ripley DP, McDiarmid AK, Swoboda P, Erhayiem B, Garg P, Sourbron S, Plein S, McCann G, Greenwood JP. 21 Left atrial remodelling following treatment of symptomatic severe aortic stenosis. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Garg P, Kidambi A, Ripley DP, Dobson LE, Swoboda PP, Musa TA, McDiarmid AK, Erhayiem B, Haaf P, Greenwood JP, Plein S. 15 Predictors of right ventricular remodelling in reperfused inferior myocardial infarctions: cmr voxel feature tracking based feasibility study. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Garg P, Kidambi A, Ripley DP, Dobson LE, Swoboda PP, Musa TA, McDiarmid AK, Erhayiem B, Greenwood JP, Plein S. 16 Relationship of mitral annular plane systolic excursion and intra-myocardial haemorrhage in reperfused st-elevation myocardial infarction. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Garg P, Kidambi A, Ripley DP, Dobson LE, Swoboda PP, Musa TA, McDiarmid AK, Erhayiem B, Greenwood JP, Plein S. 13 Correlation of interventricular systolic relationship and infarct size in acute myocardial infarction. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Musa TA, Uddin A, Fairbairn TA, Dobson LE, Steadman C, Kidambi A, Motwani M, Ripley DP, McDiarmid AK, Swoboda P, Erhayiem B, Garg P, Sourbron S, Plein S, McCann G, Greenwood JP. 22 Surgical aortic valve replacement (SAVR) upon right ventricular function: a cardiac mri study: Abstract 22 Table 1. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kidambi A, Motwani M, Uddin A, Ripley DP, McDiarmid AK, Swoboda PP, Broadbent DA, Musa TA, Erhayiem B, Greenwood JP, Plein S. 20 Myocardial extracellular volume predicts functional recovery in acute myocardial infarction more accurately than threshold-based measures of late gadolinium enhancement transmural extent. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kidambi A, Mather AN, Motwani M, Swoboda P, Uddin A, Greenwood JP, Plein S. Contractile recovery of infarct zone in reperfused acute myocardial infarction is influenced by microvascular obstruction and intramyocardial hemorrhage. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Miłoszewska J, Przybyszewska M, Gos M, Swoboda P, Trembacz H. TrkB expression level correlates with metastatic properties of L1 mouse sarcoma cells cultured in non-adhesive conditions. Cell Prolif 2013; 46:146-52. [PMID: 23510469 DOI: 10.1111/cpr.12015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 10/19/2012] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Ability of a cell to survive without adhesion, and to overcome anoikis, is indispensable for malignant cell invasion and metastasis formation. It has previously been shown that TrkB -neutrophin growth factor receptor might be involved in suppression of apoptosis, induced by the lack of adhesion. The aim of our study was to analyse changes in expression of genes and proteins as well as in biological properties of cancer cells cultured without adhesion. A mouse sarcoma, stable, adherent L1 cell line, derived from a spontaneously arisen Balb/c mouse lung tumour, was established in vitro. MATERIALS AND METHODS L1 cells resistant to anoikis were established by culture of L1 cells without adhesion, followed by selection of clones with elevated expression levels of TrkB protein. Biological characteristics of the cells were studied by migration/invasion tests and colony forming assay. Gene expression analysis was performed by with the aid of cDNA Gene Expression Array and Real-Time PCR. In vivo experiments were conducted in syngeneic Balb/c mice. RESULTS Significant changes in gene expression, including higher expression level of TrkB, were found in cells that were able to survive without adhesion. Selected TrkB-expressing clones were found to have higher clonogenicity and invasive potential, formed more colonies in mouse lungs, and induced larger tumours, when injected subcutaneously into Balb/c mice. CONCLUSION Lack of adhesion induced significant changes in the cancer cells' behaviour, which may result from alterations in gene and protein expression levels, including changes in anoikis-connected protein - TrkB.
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Affiliation(s)
- J Miłoszewska
- Department of Cell Biology, Cancer Centre and Institute of Oncology, Warsaw, Poland.
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Kidambi A, Mather AN, Motwani M, Swoboda P, Uddin A, Greenwood JP, Plein S. 092 MICROVASCULAR OBSTRUCTION AND INTRAMYOCARDIAL HAEMORRHAGE INFLUENCES INFARCT ZONE CONTRACTILE RECOVERY IN REPERFUSED ACUTE MYOCARDIAL INFARCTION. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fally MA, Redlberger-Fritz M, Starzengruber P, Swoboda P, Fuehrer HP, Yunus EB, Khan WA, Noedl H. Characterization and epidemiology of influenza viruses in patients seeking treatment for influenza-like illnesses in rural Bangladesh. J Postgrad Med 2013; 58:242-5. [PMID: 23298917 DOI: 10.4103/0022-3859.105441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Infections caused by influenza viruses are a major health burden, both in developed and developing countries worldwide. Nevertheless, the overwhelming majority of influenza reports originate from industrialized countries in northern and southern temperate zones. AIMS The aim of this study was to determine the epidemiology of influenza viruses in patients seeking treatment for acute febrile illnesses in rural Bangladesh. SETTINGS AND DESIGN As part of our research on the causes of febrile illnesses in rural Bangladesh, nasopharyngeal swabs from patients with signs and symptoms consistent with influenza were collected from 2008 onwards. MATERIALS AND METHODS Viral infection was established using two independent rapid diagnostic tests (RDTs) and later confirmed by RT-PCR. RESULTS A total of 314 fever cases were enrolled in a survey of febrile illnesses carried out in Bandarban District in southeastern Bangladesh, out of whom 38 (12.1%) tested positive by RDT. Molecular subtyping showed that seasonal H3 strains (N=22; 7.0%) as well as the new H1N1v pandemic influenza subtype (N=13; 4.1%) had been circulating at the time of our investigations resulting in a PCR-adjusted positivity rate of 11.1% (95% CI 8.0 - 15.3). The positive predictive values for the RDTs used were 90.9% and 94.4%, respectively. CONCLUSIONS This study provides a first insight into influenza epidemics in one of the most remote parts of Asia. Our findings suggest that respiratory illnesses due to influenza viruses are underreported in areas with limited access to health care and show a distinct seasonality also in rural areas of tropical countries.
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Affiliation(s)
- M A Fally
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
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Stremitzer S, Riss S, Swoboda P, Dauser B, Dubsky P, Bîrsan T, Herbst F, Stift A. Repeat endorectal advancement flap after flap breakdown and recurrence of fistula-in-ano--is it an option? Colorectal Dis 2012; 14:1389-93. [PMID: 22340667 DOI: 10.1111/j.1463-1318.2012.02990.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 02/08/2023]
Abstract
AIM Endorectal advancement flaps are an established treatment for high transsphincteric and suprasphincteric fistulae. The outcome of a repeat procedure in the case of flap breakdown and fistula recurrence remains unclear. The aim of the study was to analyse the outcome of repeat endorectal advancement flaps. METHODS We retrospectively analysed patients with a repeat endorectal advancement flap procedure after flap breakdown and recurrence of fistula-in-ano of cryptoglandular origin who had been treated in our unit between 1994 and 2010. RESULTS In all, 97 patients underwent an endorectal advancement flap procedure for fistula-in-ano and, of these, nine patients (five men, four women, 9.3%) subsequently underwent a repeat procedure due to flap breakdown. Median age was 40 years (range 25-60). Median follow-up time was 85 months (range 26-136). Seven full-thickness and two mucosal flap repeat procedures were performed because of eight transsphincteric and one suprasphincteric fistulae. The repeat procedure was successful in seven (78%) patients. In one of the two patients with repeat flap failure, a third flap procedure failed again. Disturbances of postoperative faecal incontinence were observed in five (55%) patients. Overall, the median postoperative Vaizey faecal incontinence score was 1 (range 0-4). CONCLUSION Repeat endorectal advancement flap procedures are feasible and associated with a low recurrence rate and mild postoperative faecal incontinence. Therefore, a repeat procedure is a viable option in the case of a flap breakdown and fistula recurrence.
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Affiliation(s)
- S Stremitzer
- Department of General Surgery, Medical University Vienna, Austria Department of Surgery, St John of God's Hospital Vienna, Austria.
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Kidambi A, Mather AN, Swoboda P, Motwani M, Greenwood JP, Plein S. 089 Regression of myocardial oedema is related to improvement in myocardial contractility following reperfused acute myocardial infarction. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sinha S, Chiu D, Peebles G, Swoboda P, Kolakkat S, Lamerton E, Fenwick S, Bhandari S, Kalra PA. Accelerated total dose infusion of low molecular weight iron dextran is safe and efficacious in chronic kidney disease patients. QJM 2011; 104:221-30. [PMID: 20956457 DOI: 10.1093/qjmed/hcq180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Low molecular weight iron dextran (LMWID) is licensed for use as a total dose infusion (TDI) over 4-6 h. In order to improve patient convenience and cost-effectiveness of therapy, we investigated the safety and efficacy of adopting accelerated dosing regimens and compared this with a standard rate LMWID infusion. METHODS A retrospective study of patients undergoing accelerated and standard rate TDI of LMWID was conducted across three centres. A total of 1904 doses of LMWID were administered at an accelerated rate of 1 g over 1 h 40 min. This was compared with 395 patients who had standard rate infusion of 1 g LMWID over 3-4 h. RESULTS There were eight minor adverse events in patients receiving accelerated dose LMWID (8/1904, 0.42%) in comparison to one adverse event in patients receiving a standard regimen (1/395, 0.25%). No serious adverse events occurred. Serum haemoglobin and ferritin significantly improved in both groups. CONCLUSION TDI LMWID is a safe and efficacious method of iron replacement. Accelerated infusion regimen is safe and compares well with standard rate infusion regimen. Furthermore, accelerated TDI of LMWID enables greater numbers of patients to be treated and consequently there appear to be advantages for both patient and health resources.
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Affiliation(s)
- S Sinha
- Department of Renal Medicine, Hope Hospital, Stott Lane, Salford, M6 8HD, UK
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41
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Miłoszewska J, Szaniawska B, Trembacz H, Gos M, Przybyszewska M, Swoboda P, Małecki M, Janik P. Effect of transfection with a gene coding for the fibronectin FNIII/10 fragment upon contact inhibition of C3H10T1/2 fibroblasts. Cell Prolif 2006; 39:195-203. [PMID: 16671997 PMCID: PMC6496633 DOI: 10.1111/j.1365-2184.2006.00382.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The density-dependent growth inhibition of non-transformed cells may be associated with inefficient transduction of the proliferative signal from cell adhesion molecules. To verify this concept, the C3H10T1/2 fibroblasts were stably transfected with the gene coding for the fibronectin fragment III/10 (FNIII/10). This resulted in differences in gene's expression between original C3H10T1/2 cells and their FNIII/10 transfectants. No significant differences in growth properties were observed in the original or in the transfected cells. C3H10T1/2 cells and their transfectants, when co-cultured, displayed more cells at confluence than the cells cultured alone. Moreover, co-cultured C3H10T1/2 cells and their transfectants showed elevated levels of phospho-ERK1/2 compared to homogenous cultures. Results obtained indicate that cellular homogeneity is responsible for density-dependent growth inhibition.
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Affiliation(s)
- J Miłoszewska
- Cell Biology Department, Cancer Center, W.K. Roentgen 5, 02-781 Warsaw, Poland
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42
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Gos M, Miloszewska J, Swoboda P, Trembacz H, Skierski J, Janik P. Cellular quiescence induced by contact inhibition or serum withdrawal in C3H10T1/2 cells. Cell Prolif 2005; 38:107-16. [PMID: 15842254 PMCID: PMC6496145 DOI: 10.1111/j.1365-2184.2005.00334.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Either confluence or serum withdrawal may cause growth arrest of cultured non-transformed cells. Here, we compared sparsely populated and confluent C3H10T1/2 cells with and without serum-containing medium. The following proliferation-relevant end points were examined: cell-cycle distribution, Ki-67 antigen presence, the level of the von Hippel-Lindau (VHL) protein, and gene expression, determined using a microarray approach. In sparse/logarithmic cultures, the fraction of cells in G(0)/G(1) phase increased from 55 to 85% following serum withdrawal. Moreover, the fraction of Ki-67 positive cells dropped from 89 to 47%. In confluent cultures, the majority of cells (80%) were in G(0)/G(1) phase and only 25-30% were Ki-67 positive, regardless of serum presence. In both serum-deprived and contact-inhibited cultures, significant and distinct changes in gene expression were observed. Serum deprivation of sparsely cultured cells resulted in significant over-expression of several transcription factors, while confluent cells showed elevated expression of genes coding for Wnt6, uPar, Tdag51, Egr1, Ini1a and Mor1. These results indicate that contact inhibition and serum withdrawal lead to cellular quiescence through distinct genetic and molecular mechanisms.
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Affiliation(s)
- M Gos
- Cell Biology Department, Cancer Center, Warsaw, Poland
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Haycraft CJ, Swoboda P, Taulman PD, Thomas JH, Yoder BK. The C. elegans homolog of the murine cystic kidney disease gene Tg737 functions in a ciliogenic pathway and is disrupted in osm-5 mutant worms. Development 2001; 128:1493-505. [PMID: 11290289 DOI: 10.1242/dev.128.9.1493] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cilia and flagella are important organelles involved in diverse functions such as fluid and cell movement, sensory perception and embryonic patterning. They are devoid of protein synthesis, thus their formation and maintenance requires the movement of protein complexes from the cytoplasm into the cilium and flagellum axoneme by intraflagellar transport (IFT), a conserved process common to all ciliated or flagellated eukaryotic cells. We report that mutations in the Caenorhabditis elegans gene Y41g9a.1 are responsible for the ciliary defects in osm-5 mutant worms. This was confirmed by transgenic rescue of osm-5(p813) mutants using the wild-type Y41g9a.1 gene. osm-5 encodes a tetratricopeptide repeat (TPR)-containing protein that is the homolog of murine polaris (Tg737), a protein associated with cystic kidney disease and left-right axis patterning defects in the mouse. osm-5 is expressed in ciliated sensory neurons in C. elegans and its expression is regulated by DAF-19, an RFX-type transcription factor that governs the expression of other genes involved in cilia formation in the worm. Similar to murine polaris, the OSM-5 protein was found to concentrate at the cilium base and within the cilium axoneme as shown by an OSM-5::GFP translational fusion and immunofluorescence. Furthermore, time-lapse imaging of OSM-5::GFP fusion protein shows fluorescent particle migration within the cilia. Overall, the data support a crucial role for osm-5 in a conserved ciliogenic pathway, most likely as a component of the IFT process. http://www.biologists.com/Development/movies/dev3342.html
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Affiliation(s)
- C J Haycraft
- Department of Cell Biology, University of Alabama at Birmingham Medical Center, Birmingham, AL 35294, USA
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Abstract
Many types of sensory neurons contain modified cilia where sensory signal transduction occurs. We report that the C. elegans gene daf-19 encodes an RFX-type transcription factor that is expressed specifically in all ciliated sensory neurons. Loss of daf-19 function causes the absence of cilia, resulting in severe sensory defects. Several genes that function in all ciliated sensory neurons have an RFX target site in their promoters and require daf-19 function. Several other genes that function in subsets of ciliated sensory neurons do not have an RFX target site and are not daf-19 dependent. These results suggest that expression of the shared components of sensory cilia is activated by daf-19, whereas cell-type-specific expression occurs independently of daf-19.
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Affiliation(s)
- P Swoboda
- Department of Genetics, University of Washington, Seattle 98195, USA.
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Puchta H, Swoboda P, Gal S, Blot M, Hohn B. Somatic intrachromosomal homologous recombination events in populations of plant siblings. Plant Mol Biol 1995; 28:281-92. [PMID: 7599313 DOI: 10.1007/bf00020247] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Intrachromosomal homologous recombination in whole tobacco plants was analyzed using beta-glucuronidase as non-selectable marker. We found that recombination frequencies were additive for transgenes in allelic positions and could be enhanced by treatment of plants with DNA-damaging agents. We compared the patterns of distribution of recombination events of different transgenic lines of tobacco and Arabidopsis with the respective Poisson distributions. Some lines showed Poisson-like distributions, indicating that recombination at the transgene locus was occurring in a random fashion in the plant population. In other cases, however, the distributions deviated significantly from Poisson distributions indicating that for specific transgene loci and/or configurations recombination events are not randomly distributed in the population. This was due to overrepresentation of plants with especially many as well as especially few recombination events. Analysis of one tobacco line indicated furthermore that the distribution of recombination events could be influenced by treating the seedlings with external factors. Our results suggest that different plant individuals, or parts of them, might exhibit different transient 'states' of recombination competence. A possible model relating 'recombination silencing' and transcription silencing to heterochromatization of the transgene locus is discussed.
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Affiliation(s)
- H Puchta
- Friedrich Miescher-Institut, Basel, Switzerland
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Abstract
A system to assay intrachromosomal homologous recombination during the complete life-cycle of a whole higher eukaryote was set up. Arabidopsis thaliana plants were transformed with a recombination substrate carrying a non-selectable and quantitatively detectable marker gene. The recombination substrates contain two overlapping, non-functional deletion mutants of a chimeric beta-glucuronidase (uidA) gene. Upon recombination, as proven by Southern blot analysis, a functional gene is restored and its product can be detected by histochemical staining. Therefore, cells in which recombination events occurred, and their progeny, can be precisely localized in the whole plant. Recombination was observed in all plant organs examined, from the seed stage until the flowering stage of somatic plant development. Meristematic recombination events revealed cell lineage patterns. Overall recombination frequencies typically were in the range 10(-6)-10(-7) events/genome. Recombination frequencies were found to differ in different organs of particular transgenic lines.
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Affiliation(s)
- P Swoboda
- Friedrich Miescher-Institut, Basel, Switzerland
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Swoboda P, Hohn B, Gal S. Somatic homologous recombination in planta: the recombination frequency is dependent on the allelic state of recombining sequences and may be influenced by genomic position effects. Mol Gen Genet 1993; 237:33-40. [PMID: 8455565 DOI: 10.1007/bf00282781] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We have previously described a non-selective method for scoring somatic recombination in the genome of whole plants. The recombination substrate consists of a defective partial dimer of Cauliflower Mosaic Virus (CaMV) sequences, which can code for production of viable virus only upon homologous recombination; this leads to disease symptoms on leaves. Brassica napus plants (rapeseed) harbouring the recombination substrate as a transgene were used to examine the time in plant development at which recombination takes place. The analysis of three transgene loci revealed recombination frequencies specific for each locus. Recombination frequencies were increased if more than one transgene locus was present per genome, either in allelic (homozygosity of the transgene locus) or in non-allelic positions. In both cases, the overall recombination frequency was found to be elevated to approximately the sum of the frequencies for the individual transgene loci or slightly higher, suggesting that the respective transgene loci behave largely independently of each other. For all plants tested (single locus, two or multiple loci) maximal recombination frequencies were of the order of 10(-6) events per cell division.
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Affiliation(s)
- P Swoboda
- Friedrich Miescher-Institut, Basel, Switzerland
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Marberger H, Huber W, Bartsch G, Schulte T, Swoboda P. Orgotein: a new antiinflammatory metalloprotein drug evaluation of clinical efficacy and safety in inflammatory conditions of the urinary tract. Int Urol Nephrol 1974; 6:61-74. [PMID: 4615073 DOI: 10.1007/bf02081999] [Citation(s) in RCA: 47] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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