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Hammersley DJ, Mukhopadhyay S, Chen X, Cheng L, Jones RE, Mach L, Curran L, Yazdani M, Iacob A, Lota AS, Khalique Z, De Marvao A, Baruah R, Guha K, Ware JS, Gregson J, Zhao S, Pennell DJ, Tayal U, Prasad SK, Halliday BP. Comparative prognostic importance of measures of left atrial structure and function in non-ischaemic dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2024:jeae080. [PMID: 38492215 DOI: 10.1093/ehjci/jeae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/18/2024] Open
Abstract
AIMS To compare the association between measures of left atrial (LA) structure and function, derived from cardiovascular magnetic resonance (CMR), with cardiovascular (CV) death or non-fatal heart failure (HF) events in patients with non-ischaemic dilated cardiomyopathy (DCM). METHODS AND RESULTS CMR studies of 580 prospectively recruited patients with DCM in sinus rhythm (median age 54 [interquartile range 44-64] years, 61% men, median LVEF 42% [30-51%]) were analysed for measures of LA structure (left atrial maximum volume index [LAVImax], left atrial minimum volume index [LAVImin]) and function (left atrial emptying fraction [LAEF], left atrial reservoir strain [LARS], left atrial conduit strain [LACS] and left atrial booster strain [LABS]). Over median follow-up of 7.4 years, 103 patients (18%) met the primary endpoint. Apart from LACS, each measure of LA structure and function was associated with the primary endpoint after adjusting for other important prognostic variables. The addition of each LA metric to a baseline model containing the same important prognostic covariates improved model discrimination, with LAVImin providing the greatest improvement (C-statistic improvement: 0.702 to 0.738; χ2 test comparing likelihood ratio p < 0.0001; categorical net reclassification index: 0.210 (95% CI 0.023-0.392)). Patients in the highest tercile of LAVImin had similar event rates to those with persistent atrial fibrillation. Measures of LA strain did not enhance model discrimination above LA volumetric measures. CONCLUSION Measure of left atrial structure and function offer important prognostic information in patients with DCM and enhance prediction of adverse outcomes. LA strain was not incremental to volumetric analysis for risk prediction.
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Affiliation(s)
- Daniel J Hammersley
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Srinjay Mukhopadhyay
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Xiuyu Chen
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Leanne Cheng
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Richard E Jones
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
- Essex Cardiothoracic Centre, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| | - Lukas Mach
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Lara Curran
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Momina Yazdani
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Alma Iacob
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Amrit S Lota
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Zohya Khalique
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Antonio De Marvao
- Department of Biomedical Engineering, King's College London, UK
- Department of Women and Children's Health, King's College London, United Kingdom
| | - Resham Baruah
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | | | - James S Ware
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
- MRC London Institute of Medical Sciences, Imperial College London, UK
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, UK
| | - Shihua Zhao
- Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Sanjay K Prasad
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
| | - Brian P Halliday
- National Heart and Lung Institute, Imperial College London, UK
- Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK
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Jones RE, Hammersley DJ, Zheng S, McGurk KA, de Marvao A, Theotokis PI, Owen R, Tayal U, Rea G, Hatipoglu S, Buchan RJ, Mach L, Curran L, Lota AS, Simard F, Reddy RK, Talukder S, Yoon WY, Vazir A, Pennell DJ, O'Regan DP, Baksi AJ, Halliday BP, Ware JS, Prasad SK. Assessing the association between genetic and phenotypic features of dilated cardiomyopathy and outcome in patients with coronary artery disease. Eur J Heart Fail 2024; 26:46-55. [PMID: 37702310 DOI: 10.1002/ejhf.3033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 08/17/2023] [Accepted: 09/11/2023] [Indexed: 09/14/2023] Open
Abstract
AIMS To examine the relevance of genetic and cardiovascular magnetic resonance (CMR) features of dilated cardiomyopathy (DCM) in individuals with coronary artery disease (CAD). METHODS AND RESULTS This study includes two cohorts. First, individuals with CAD recruited into the UK Biobank (UKB) were evaluated. Second, patients with CAD referred to a tertiary centre for evaluation with late gadolinium enhancement (LGE)-CMR were recruited (London cohort); patients underwent genetic sequencing as part of the research protocol and long-term follow-up. From 31 154 individuals with CAD recruited to UKB, rare pathogenic variants in DCM genes were associated with increased risk of death or major adverse cardiac events (hazard ratio 1.57, 95% confidence interval [CI] 1.22-2.01, p < 0.001). Of 1619 individuals with CAD included from the UKB CMR substudy, participants with a rare variant in a DCM-associated gene had lower left ventricular ejection fraction (LVEF) compared to genotype negative individuals (mean 47 ± 10% vs. 57 ± 8%, p < 0.001). Of 453 patients in the London cohort, 63 (14%) had non-infarct pattern LGE (NI-LGE) on CMR. Patients with NI-LGE had lower LVEF (mean 38 ± 18% vs. 48 ± 16%, p < 0.001) compared to patients without NI-LGE, with no significant difference in the burden of rare protein altering variants in DCM-associated genes between groups (9.5% vs. 6.7%, odds ratio 1.5, 95% CI 0.4-4.3, p = 0.4). NI-LGE was not independently associated with adverse clinical outcomes. CONCLUSION Rare pathogenic variants in DCM-associated genes impact left ventricular remodelling and outcomes in stable CAD. NI-LGE is associated with adverse remodelling but is not an independent predictor of outcome and had no rare genetic basis in our study.
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Affiliation(s)
- Richard E Jones
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Anglia Ruskin University, Chelmsford, UK
- Essex Cardiothoracic Centre, Basildon, UK
| | - Daniel J Hammersley
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sean Zheng
- National Heart and Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Kathryn A McGurk
- National Heart and Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Antonio de Marvao
- Department of Women and Children's Health, King's College London, London, UK
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Pantazis I Theotokis
- National Heart and Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Ruth Owen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gillian Rea
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Suzan Hatipoglu
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rachel J Buchan
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lukas Mach
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Lara Curran
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amrit S Lota
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - François Simard
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rohin K Reddy
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Suprateeka Talukder
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Won Young Yoon
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ali Vazir
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - A John Baksi
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Brian P Halliday
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James S Ware
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Sanjay K Prasad
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Hammersley DJ, Jones RE, Owen R, Mach L, Lota AS, Khalique Z, De Marvao A, Androulakis E, Hatipoglu S, Gulati A, Reddy RK, Yoon WY, Talukder S, Shah R, Baruah R, Guha K, Pantazis A, Baksi AJ, Gregson J, Cleland JG, Tayal U, Pennell DJ, Ware JS, Halliday BP, Prasad SK. Phenotype, outcomes and natural history of early-stage non-ischaemic cardiomyopathy. Eur J Heart Fail 2023; 25:2050-2059. [PMID: 37728026 PMCID: PMC10946699 DOI: 10.1002/ejhf.3037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS To characterize the phenotype, clinical outcomes and rate of disease progression in patients with early-stage non-ischaemic cardiomyopathy (early-NICM). METHODS AND RESULTS We conducted a prospective observational cohort study of patients with early-NICM assessed by late gadolinium enhancement cardiovascular magnetic resonance (CMR). Cases were classified into the following subgroups: isolated left ventricular dilatation (early-NICM H-/D+), non-dilated left ventricular cardiomyopathy (early-NICM H+/D-), or early dilated cardiomyopathy (early-NICM H+/D+). Clinical follow-up for major adverse cardiovascular events (MACE) included non-fatal life-threatening arrhythmia, unplanned cardiovascular hospitalization or cardiovascular death. A subset of patients (n = 119) underwent a second CMR to assess changes in cardiac structure and function. Of 254 patients with early-NICM (median age 46 years [interquartile range 36-58], 94 [37%] women, median left ventricular ejection fraction [LVEF] 55% [52-59]), myocardial fibrosis was present in 65 (26%). There was no difference in the prevalence of fibrosis between subgroups (p = 0.90), however fibrosis mass was lowest in early-NICM H-/D+, higher in early-NICM H+/D- and highest in early-NICM H+/D+ (p = 0.03). Over a median follow-up of 7.9 (5.5-10.0) years, 28 patients (11%) experienced MACE. Non-sustained ventricular tachycardia (hazard ratio [HR] 5.1, 95% confidence interval [CI] 2.36-11.00, p < 0.001), myocardial fibrosis (HR 3.77, 95% CI 1.73-8.20, p < 0.001) and diabetes mellitus (HR 5.12, 95% CI 1.73-15.18, p = 0.003) were associated with MACE in a multivariable model. Only 8% of patients progressed from early-NICM to dilated cardiomyopathy with LVEF <50% over a median of 16 (11-34) months. CONCLUSION Early-NICM is not benign. Fibrosis develops early in the phenotypic course. In-depth characterization enhances risk stratification and might aid clinical management.
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Affiliation(s)
- Daniel J. Hammersley
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Richard E. Jones
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Anglia Ruskin Medical School, UKCambridgeUK
- Essex Cardiothoracic CentreBasildonUK
| | - Ruth Owen
- London School of Hygiene and Tropical MedicineLondonUK
| | - Lukas Mach
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Amrit S. Lota
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Zohya Khalique
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Antonio De Marvao
- Department of Women and Children's HealthKing's College LondonLondonUK
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and SciencesKing's College LondonLondonUK
| | - Emmanuel Androulakis
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Suzan Hatipoglu
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - Rohin K. Reddy
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Won Young Yoon
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Suprateeka Talukder
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Riya Shah
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Resham Baruah
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - Antonis Pantazis
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - A. John Baksi
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - John Gregson
- London School of Hygiene and Tropical MedicineLondonUK
| | - John G.F. Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Upasana Tayal
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Dudley J. Pennell
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - James S. Ware
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- MRC London Institute of Medical SciencesImperial College LondonLondonUK
| | - Brian P. Halliday
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Sanjay K. Prasad
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
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4
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Jones RE, Gruszczyk AV, Schmidt C, Hammersley DJ, Mach L, Lee M, Wong J, Yang M, Hatipoglu S, Lota AS, Barnett SN, Toscano-Rivalta R, Owen R, Raja S, De Robertis F, Smail H, De-Souza A, Stock U, Kellman P, Griffin J, Dumas ME, Martin JL, Saeb-Parsy K, Vazir A, Cleland JGF, Pennell DJ, Bhudia SK, Halliday BP, Noseda M, Frezza C, Murphy MP, Prasad SK. Assessment of left ventricular tissue mitochondrial bioenergetics in patients with stable coronary artery disease. Nat Cardiovasc Res 2023; 2:733-745. [PMID: 38666037 PMCID: PMC11041759 DOI: 10.1038/s44161-023-00312-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 06/29/2023] [Indexed: 04/28/2024]
Abstract
Recurrent myocardial ischemia can lead to left ventricular (LV) dysfunction in patients with coronary artery disease (CAD). In this observational cohort study, we assessed for chronic metabolomic and transcriptomic adaptations within LV myocardium of patients undergoing coronary artery bypass grafting. During surgery, paired transmural LV biopsies were acquired on the beating heart from regions with and without evidence of inducible ischemia on preoperative stress perfusion cardiovascular magnetic resonance. From 33 patients, 63 biopsies were acquired, compared to analysis of LV samples from 11 donor hearts. The global myocardial adenosine triphosphate (ATP):adenosine diphosphate (ADP) ratio was reduced in patients with CAD as compared to donor LV tissue, with increased expression of oxidative phosphorylation (OXPHOS) genes encoding the electron transport chain complexes across multiple cell types. Paired analyses of biopsies obtained from LV segments with or without inducible ischemia revealed no significant difference in the ATP:ADP ratio, broader metabolic profile or expression of ventricular cardiomyocyte genes implicated in OXPHOS. Differential metabolite analysis suggested dysregulation of several intermediates in patients with reduced LV ejection fraction, including succinate. Overall, our results suggest that viable myocardium in patients with stable CAD has global alterations in bioenergetic and transcriptional profile without large regional differences between areas with or without inducible ischemia.
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Affiliation(s)
- Richard E. Jones
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
- Anglia Ruskin University, Chelmsford, UK
- Essex Cardiothoracic Centre, Basildon, UK
| | - Anja V. Gruszczyk
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
| | | | - Daniel J. Hammersley
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Lukas Mach
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Michael Lee
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Joyce Wong
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Ming Yang
- MRC Cancer Unit, University of Cambridge, Cambridge, UK
- University of Cologne, CECAD, Cologne, Germany
| | - Suzan Hatipoglu
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Amrit S. Lota
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Sam N. Barnett
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Ruth Owen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Shahzad Raja
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Fabio De Robertis
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Hassiba Smail
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Anthony De-Souza
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Ulrich Stock
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Julian Griffin
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Marc-Emmanuel Dumas
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- European Genomic Institute of Diabetes, INSERM U1283, CNRS 8199, Institut Pasteur de Lille, Lille University Hospital, University of Lille, Lille, France
- McGill Genome Centre, McGill University, Montréal, QC Canada
| | - Jack L. Martin
- Department of Surgery and Cambridge NIHR Biomedical Research Centre, Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Kourosh Saeb-Parsy
- Department of Surgery and Cambridge NIHR Biomedical Research Centre, Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Ali Vazir
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | | | - Dudley J. Pennell
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Sunil K. Bhudia
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Brian P. Halliday
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Michela Noseda
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Michael P. Murphy
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
| | - Sanjay K. Prasad
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
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5
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Jones RE, Zaidi HA, Hammersley DJ, Hatipoglu S, Owen R, Balaban G, de Marvao A, Simard F, Lota AS, Mahon C, Almogheer B, Mach L, Musella F, Chen X, Gregson J, Lazzari L, Ravendren A, Leyva F, Zhao S, Vazir A, Lamata P, Halliday BP, Pennell DJ, Bishop MJ, Prasad SK. Comprehensive Phenotypic Characterization of Late Gadolinium Enhancement Predicts Sudden Cardiac Death in Coronary Artery Disease. JACC Cardiovasc Imaging 2023; 16:628-638. [PMID: 36752426 PMCID: PMC10151254 DOI: 10.1016/j.jcmg.2022.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) offers the potential to noninvasively characterize the phenotypic substrate for sudden cardiac death (SCD). OBJECTIVES The authors assessed the utility of infarct characterization by CMR, including scar microstructure analysis, to predict SCD in patients with coronary artery disease (CAD). METHODS Patients with stable CAD were prospectively recruited into a CMR registry. LGE quantification of core infarction and the peri-infarct zone (PIZ) was performed alongside computational image analysis to extract morphologic and texture scar microstructure features. The primary outcome was SCD or aborted SCD. RESULTS Of 437 patients (mean age: 64 years; mean left ventricular ejection fraction [LVEF]: 47%) followed for a median of 6.3 years, 49 patients (11.2%) experienced the primary outcome. On multivariable analysis, PIZ mass and core infarct mass were independently associated with the primary outcome (per gram: HR: 1.07 [95% CI: 1.02-1.12]; P = 0.002 and HR: 1.03 [95% CI: 1.01-1.05]; P = 0.01, respectively), and the addition of both parameters improved discrimination of the model (Harrell's C-statistic: 0.64-0.79). PIZ mass, however, did not provide incremental prognostic value over core infarct mass based on Harrell's C-statistic or risk reclassification analysis. Severely reduced LVEF did not predict the primary endpoint after adjustment for scar mass. On scar microstructure analysis, the number of LGE islands in addition to scar transmurality, radiality, interface area, and entropy were all associated with the primary outcome after adjustment for severely reduced LVEF and New York Heart Association functional class of >1. No scar microstructure feature remained associated with the primary endpoint when PIZ mass and core infarct mass were added to the regression models. CONCLUSIONS Comprehensive LGE characterization independently predicted SCD risk beyond conventional predictors used in implantable cardioverter-defibrillator (ICD) insertion guidelines. These results signify the potential for a more personalized approach to determining ICD candidacy in CAD.
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Affiliation(s)
- Richard E Jones
- National Heart and Lung Institute, Imperial College London, United Kingdom; Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom. https://twitter.com/DrREJones
| | - Hassan A Zaidi
- Department of Biomedical Engineering, School of Biomedical & Imaging Sciences, King's College London, United Kingdom
| | - Daniel J Hammersley
- National Heart and Lung Institute, Imperial College London, United Kingdom; Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Suzan Hatipoglu
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ruth Owen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gabriel Balaban
- Department of Biomedical Engineering, School of Biomedical & Imaging Sciences, King's College London, United Kingdom; Department of Computational Physiology, Simula Research Laboratory, Oslo, Norway
| | - Antonio de Marvao
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health, King's College London, London, United Kingdom; British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - François Simard
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Amrit S Lota
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ciara Mahon
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Batool Almogheer
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Lukas Mach
- National Heart and Lung Institute, Imperial College London, United Kingdom; Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Francesca Musella
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Xiuyu Chen
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Lazzari
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Andrew Ravendren
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Francisco Leyva
- Aston Medical School, Aston University, Birmingham, United Kingdom
| | - Shihua Zhao
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ali Vazir
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Pablo Lamata
- Department of Biomedical Engineering, School of Biomedical & Imaging Sciences, King's College London, United Kingdom
| | - Brian P Halliday
- National Heart and Lung Institute, Imperial College London, United Kingdom; Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College London, United Kingdom; Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Martin J Bishop
- Department of Biomedical Engineering, School of Biomedical & Imaging Sciences, King's College London, United Kingdom
| | - Sanjay K Prasad
- National Heart and Lung Institute, Imperial College London, United Kingdom; Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.
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6
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Zaidi HA, Jones RE, Hammersley DJ, Hatipoglu S, Balaban G, Mach L, Halliday BP, Lamata P, Prasad SK, Bishop MJ. Machine learning analysis of complex late gadolinium enhancement patterns to improve risk prediction of major arrhythmic events. Front Cardiovasc Med 2023; 10:1082778. [PMID: 36824460 PMCID: PMC9941157 DOI: 10.3389/fcvm.2023.1082778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/13/2023] [Indexed: 02/10/2023] Open
Abstract
Background Machine learning analysis of complex myocardial scar patterns affords the potential to enhance risk prediction of life-threatening arrhythmia in stable coronary artery disease (CAD). Objective To assess the utility of computational image analysis, alongside a machine learning (ML) approach, to identify scar microstructure features on late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) that predict major arrhythmic events in patients with CAD. Methods Patients with stable CAD were prospectively recruited into a CMR registry. Shape-based scar microstructure features characterizing heterogeneous ('peri-infarct') and homogeneous ('core') fibrosis were extracted. An ensemble of machine learning approaches were used for risk stratification, in addition to conventional analysis using Cox modeling. Results Of 397 patients (mean LVEF 45.4 ± 16.0) followed for a median of 6 years, 55 patients (14%) experienced a major arrhythmic event. When applied within an ML model for binary classification, peri-infarct zone (PIZ) entropy, peri-infarct components and core interface area outperformed a model representative of the current standard of care (LVEF<35% and NYHA>Class I): AUROC (95%CI) 0.81 (0.81-0.82) vs. 0.64 (0.63-0.65), p = 0.002. In multivariate cox regression analysis, these features again remained significant after adjusting for LVEF<35% and NYHA>Class I: PIZ entropy hazard ratio (HR) 1.88, 95% confidence interval (CI) 1.38-2.56, p < 0.001; number of PIZ components HR 1.34, 95% CI 1.08-1.67, p = 0.009; core interface area HR 1.6, 95% CI 1.29-1.99, p = <0.001. Conclusion Machine learning models using LGE-CMR scar microstructure improved arrhythmic risk stratification as compared to guideline-based clinical parameters; highlighting a potential novel approach to identifying candidates for implantable cardioverter defibrillators in stable CAD.
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Affiliation(s)
- Hassan A. Zaidi
- Department of Biomedical Engineering, School of Biomedical and Imaging Sciences, King’s College London, London, United Kingdom
| | - Richard E. Jones
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Daniel J. Hammersley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Suzan Hatipoglu
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Gabriel Balaban
- Department of Biomedical Engineering, School of Biomedical and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Computational Physiology, Simula Research Laboratory, Oslo, Norway
| | - Lukas Mach
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Brian P. Halliday
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Pablo Lamata
- Department of Biomedical Engineering, School of Biomedical and Imaging Sciences, King’s College London, London, United Kingdom
| | - Sanjay K. Prasad
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Martin J. Bishop
- Department of Biomedical Engineering, School of Biomedical and Imaging Sciences, King’s College London, London, United Kingdom
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7
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Lota AS, Hazebroek MR, Theotokis P, Wassall R, Salmi S, Halliday BP, Tayal U, Verdonschot J, Meena D, Owen R, de Marvao A, Iacob A, Yazdani M, Hammersley DJ, Jones RE, Wage R, Buchan R, Vivian F, Hafouda Y, Noseda M, Gregson J, Mittal T, Wong J, Robertus JL, Baksi AJ, Vassiliou V, Tzoulaki I, Pantazis A, Cleland JG, Barton PJ, Cook SA, Pennell DJ, Garcia-Pavia P, Cooper LT, Heymans S, Ware JS, Prasad SK. Genetic Architecture of Acute Myocarditis and the Overlap With Inherited Cardiomyopathy. Circulation 2022; 146:1123-1134. [PMID: 36154167 PMCID: PMC9555763 DOI: 10.1161/circulationaha.121.058457] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 07/15/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acute myocarditis is an inflammatory condition that may herald the onset of dilated cardiomyopathy (DCM) or arrhythmogenic cardiomyopathy (ACM). We investigated the frequency and clinical consequences of DCM and ACM genetic variants in a population-based cohort of patients with acute myocarditis. METHODS This was a population-based cohort of 336 consecutive patients with acute myocarditis enrolled in London and Maastricht. All participants underwent targeted DNA sequencing for well-characterized cardiomyopathy-associated genes with comparison to healthy controls (n=1053) sequenced on the same platform. Case ascertainment in England was assessed against national hospital admission data. The primary outcome was all-cause mortality. RESULTS Variants that would be considered pathogenic if found in a patient with DCM or ACM were identified in 8% of myocarditis cases compared with <1% of healthy controls (P=0.0097). In the London cohort (n=230; median age, 33 years; 84% men), patients were representative of national myocarditis admissions (median age, 32 years; 71% men; 66% case ascertainment), and there was enrichment of rare truncating variants (tv) in ACM-associated genes (3.1% of cases versus 0.4% of controls; odds ratio, 8.2; P=0.001). This was driven predominantly by DSP-tv in patients with normal LV ejection fraction and ventricular arrhythmia. In Maastricht (n=106; median age, 54 years; 61% men), there was enrichment of rare truncating variants in DCM-associated genes, particularly TTN-tv, found in 7% (all with left ventricular ejection fraction <50%) compared with 1% in controls (odds ratio, 3.6; P=0.0116). Across both cohorts over a median of 5.0 years (interquartile range, 3.9-7.8 years), all-cause mortality was 5.4%. Two-thirds of deaths were cardiovascular, attributable to worsening heart failure (92%) or sudden cardiac death (8%). The 5-year mortality risk was 3.3% in genotype-negative patients versus 11.1% for genotype-positive patients (Padjusted=0.08). CONCLUSIONS We identified DCM- or ACM-associated genetic variants in 8% of patients with acute myocarditis. This was dominated by the identification of DSP-tv in those with normal left ventricular ejection fraction and TTN-tv in those with reduced left ventricular ejection fraction. Despite differences between cohorts, these variants have clinical implications for treatment, risk stratification, and family screening. Genetic counseling and testing should be considered in patients with acute myocarditis to help reassure the majority while improving the management of those with an underlying genetic variant.
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Affiliation(s)
- Amrit S. Lota
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Mark R. Hazebroek
- Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (M.R.H., J.V., S.H.)
| | - Pantazis Theotokis
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Rebecca Wassall
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Sara Salmi
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Brian P. Halliday
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Upasana Tayal
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Job Verdonschot
- Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (M.R.H., J.V., S.H.)
| | - Devendra Meena
- Epidemiology and Biostatistics, School of Public Health (D.M., I.T.), Imperial College London, UK
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, UK (R.O., J.G.)
| | - Antonio de Marvao
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Alma Iacob
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Momina Yazdani
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Daniel J. Hammersley
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Richard E. Jones
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Riccardo Wage
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Rachel Buchan
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Fredrik Vivian
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Yakeen Hafouda
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Michela Noseda
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
| | - John Gregson
- London School of Hygiene and Tropical Medicine, UK (R.O., J.G.)
| | - Tarun Mittal
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Joyce Wong
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Jan Lukas Robertus
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - A. John Baksi
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Vassilios Vassiliou
- Norfolk and Norwich University Hospital and University of East Anglia, Norwich, UK (V.V.)
| | - Ioanna Tzoulaki
- Epidemiology and Biostatistics, School of Public Health (D.M., I.T.), Imperial College London, UK
| | - Antonis Pantazis
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - John G.F. Cleland
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Robertson Centre for Biostatistics, University of Glasgow, UK (J.G.F.C.)
| | - Paul J.R. Barton
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- MRC London Institute of Medical Sciences (P.J.R.B., S.A.C., J.S.W.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Stuart A. Cook
- MRC London Institute of Medical Sciences (P.J.R.B., S.A.C., J.S.W.), Imperial College London, UK
- National Heart Centre Singapore and Duke-National University of Singapore (S.A.C.)
| | - Dudley J. Pennell
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain (P.G.-P.)
- Universidad Francisco de Vitoria, Pozuelo de Alarcon, Spain (P.G.-P.)
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (P.G.-P.)
| | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (L.T.C.)
| | - Stephane Heymans
- Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (M.R.H., J.V., S.H.)
| | - James S. Ware
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- MRC London Institute of Medical Sciences (P.J.R.B., S.A.C., J.S.W.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Sanjay K. Prasad
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
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8
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Amin RJ, Morris-Rosendahl D, Edwards M, Tayal U, Buchan R, Hammersley DJ, Jones RE, Gati S, Khalique Z, Almogheer B, Pennell DJ, Baksi AJ, Pantazis A, Ware JS, Prasad SK, Halliday BP. The addition of genetic testing and cardiovascular magnetic resonance to routine clinical data for stratification of etiology in dilated cardiomyopathy. Front Cardiovasc Med 2022; 9:1017119. [PMID: 36277766 PMCID: PMC9582287 DOI: 10.3389/fcvm.2022.1017119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Guidelines recommend genetic testing and cardiovascular magnetic resonance (CMR) for the investigation of dilated cardiomyopathy (DCM). However, the incremental value is unclear. We assessed the impact of these investigations in determining etiology. Methods Sixty consecutive patients referred with DCM and recruited to our hospital biobank were selected. Six independent experts determined the etiology of each phenotype in a step-wise manner based on (1) routine clinical data, (2) clinical and genetic data and (3) clinical, genetic and CMR data. They indicated their confidence (1-3) in the classification and any changes to management at each step. Results Six physicians adjudicated 60 cases. The addition of genetics and CMR resulted in 57 (15.8%) and 26 (7.2%) changes in the classification of etiology, including an increased number of genetic diagnoses and a reduction in idiopathic diagnoses. Diagnostic confidence improved at each step (p < 0.0005). The number of diagnoses made with low confidence reduced from 105 (29.2%) with routine clinical data to 71 (19.7%) following the addition of genetics and 37 (10.3%) with the addition of CMR. The addition of genetics and CMR led to 101 (28.1%) and 112 (31.1%) proposed changes to management, respectively. Interobserver variability showed moderate agreement with clinical data (κ = 0.44) which improved following the addition of genetics (κ = 0.65) and CMR (κ = 0.68). Conclusion We demonstrate that genetics and CMR, frequently changed the classification of etiology in DCM, improved confidence and interobserver variability in determining the diagnosis and had an impact on proposed management.
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Affiliation(s)
- Ravi J. Amin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Deborah Morris-Rosendahl
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Clinical Genetics and Genomics Laboratory, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mat Edwards
- Clinical Genetics and Genomics Laboratory, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Upasana Tayal
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rachel Buchan
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Daniel J. Hammersley
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Richard E. Jones
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Sabiha Gati
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Zohya Khalique
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Batool Almogheer
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Arun John Baksi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Antonis Pantazis
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - James S. Ware
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Sanjay K. Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Brian P. Halliday
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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9
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Halliday BP, Owen R, Gregson J, Vazir A, Wassall R, Khalique Z, Lota AS, Tayal U, Hammersley DJ, Jones RE, Pennell DJ, Cowie MR, Cleland JG, Prasad SK. Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy. ESC Heart Fail 2022; 9:1616-1624. [PMID: 35257498 PMCID: PMC9065828 DOI: 10.1002/ehf2.13872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS This study aimed to profile the changes in non-invasive clinical, biochemical, and imaging markers during withdrawal of therapy in patients with recovered dilated cardiomyopathy, providing insights into the pathophysiology of relapse. METHODS AND RESULTS Clinical, biochemical, and imaging data from patients during phased withdrawal of therapy in the randomized or single-arm cross-over phases of TRED-HF were profiled. Clinical variables were measured at each study visit and imaging variables were measured at baseline, 16 weeks, and 6 months. Amongst the 49 patients [35% women, mean age 53.6 years (standard deviation 11.6)] who withdrew therapy, 20 relapsed. Increases in mean heart rate [7.6 beats per minute (95% confidence interval, CI, 4.5, 10.7)], systolic blood pressure [6.6 mmHg (95% CI 2.7, 10.5)], and diastolic blood pressure [5.8 mmHg (95% CI 3.1, 8.5)] were observed within 4-8 weeks of starting to withdraw therapy. A rise in mean left ventricular (LV) mass [5.1 g/m2 (95% CI 2.8, 7.3)] and LV end-diastolic volume [3.9 mL/m2 (95% CI 1.1, 6.7)] and a reduction in mean LV ejection fraction [-4.2 (95% CI -6.6, -1.8)] were seen by 16 weeks, the earliest imaging follow-up. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) fell immediately after withdrawing beta-blockers and only tended to increase 6 months after beginning therapy withdrawal [mean change in log NT-proBNP at 6 months: 0.2 (95% CI -0.1, 0.4)]. CONCLUSIONS Changes in plasma NT-proBNP are a late feature of relapse, often months after a reduction in LV function. A rise in heart rate and blood pressure is observed soon after withdrawing therapy in recovered dilated cardiomyopathy, typically accompanied or closely followed by early changes in LV structure and function.
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Affiliation(s)
- Brian P. Halliday
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Ruth Owen
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - John Gregson
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Ali Vazir
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Rebecca Wassall
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Zohya Khalique
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Amrit S. Lota
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Upasana Tayal
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Daniel J. Hammersley
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Richard E. Jones
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Dudley J. Pennell
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Martin R. Cowie
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
- Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - John G.F. Cleland
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Sanjay K. Prasad
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
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10
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Leyva F, Zegard A, Okafor O, Foley P, Umar F, Taylor RJ, Marshall H, Stegemann B, Moody W, Steeds RP, Halliday BP, Hammersley DJ, Jones RE, Prasad SK, Qiu T. Myocardial Fibrosis Predicts Ventricular Arrhythmias and Sudden Death After Cardiac Electronic Device Implantation. J Am Coll Cardiol 2022; 79:665-678. [PMID: 35177196 DOI: 10.1016/j.jacc.2021.11.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Increasing evidence supports a link between myocardial fibrosis (MF) and ventricular arrhythmias. OBJECTIVES The purpose of this study was to determine whether presence of myocardial fibrosis on visual assessment (MFVA) and gray zone fibrosis (GZF) mass predicts sudden cardiac death (SCD) and ventricular fibrillation/sustained ventricular tachycardia after cardiac implantable electronic device (CIED) implantation. METHODS In this prospective study, total fibrosis and GZF mass, quantified using cardiovascular magnetic resonance, was assessed in relation to the primary endpoint of SCD and the secondary, arrhythmic endpoint of SCD or ventricular arrhythmias after CIED implantation. RESULTS Among 700 patients (age 68.0 ± 12.0 years), 27 (3.85%) experienced a SCD and 121 (17.3%) met the arrhythmic endpoint over median 6.93 years (IQR: 5.82-9.32 years). MFVA predicted SCD (HR: 26.3; 95% CI: 3.7-3,337; negative predictive value: 100%). In competing risk analyses, MFVA also predicted the arrhythmic endpoint (subdistribution HR: 19.9; 95% CI: 6.4-61.9; negative predictive value: 98.6%). Compared with no MFVA, a GZF mass measured with the 5SD method (GZF5SD) >17 g was associated with highest risk of SCD (HR: 44.6; 95% CI: 6.12-5,685) and the arrhythmic endpoint (subdistribution HR: 30.3; 95% CI: 9.6-95.8). Adding GZF5SD mass to MFVA led to reclassification of 39% for SCD and 50.2% for the arrhythmic endpoint. In contrast, LVEF did not predict either endpoint. CONCLUSIONS In CIED recipients, MFVA excluded patients at risk of SCD and virtually excluded ventricular arrhythmias. Quantified GZF5SD mass added predictive value in relation to SCD and the arrhythmic endpoint.
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MESH Headings
- Aged
- Aged, 80 and over
- Cardiac Resynchronization Therapy/mortality
- Cardiac Resynchronization Therapy/trends
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/pathology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable/trends
- Female
- Fibrosis
- Follow-Up Studies
- Humans
- Magnetic Resonance Imaging, Cine/mortality
- Magnetic Resonance Imaging, Cine/trends
- Male
- Middle Aged
- Myocardium/pathology
- Predictive Value of Tests
- Prospective Studies
- Ventricular Fibrillation/diagnostic imaging
- Ventricular Fibrillation/mortality
- Ventricular Fibrillation/therapy
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Affiliation(s)
- Francisco Leyva
- Aston Medical School, Aston University, Birmingham, United Kingdom.
| | - Abbasin Zegard
- Aston Medical School, Aston University, Birmingham, United Kingdom; University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Osita Okafor
- Aston Medical School, Aston University, Birmingham, United Kingdom; University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Paul Foley
- The Great Western Hospital, Swindon, United Kingdom
| | - Fraz Umar
- The Ottawa Hospital, Ottawa Cardiovascular Centre, Ottawa, Ontario, Canada
| | - Robin J Taylor
- Worcestershire Acute Hospitals NHS Trust, Alexandra Hospital, Worcestershire, United Kingdom
| | - Howard Marshall
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | | | - William Moody
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Richard P Steeds
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Brian P Halliday
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Daniel J Hammersley
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Richard E Jones
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sanjay K Prasad
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tian Qiu
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
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11
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Hammersley DJ, Buchan RJ, Lota AS, Mach L, Jones RE, Halliday BP, Tayal U, Meena D, Dehghan A, Tzoulaki I, Baksi AJ, Pantazis A, Roberts AM, Prasad SK, Ware JS. Direct and indirect effect of the COVID-19 pandemic on patients with cardiomyopathy. Open Heart 2022; 9:e001918. [PMID: 35086919 PMCID: PMC8795929 DOI: 10.1136/openhrt-2021-001918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES (1) To evaluate the prevalence and hospitalisation rate of COVID-19 infections among patients with dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) in the Royal Brompton and Harefield Hospital Cardiovascular Research Centre (RBHH CRC) Biobank. (2) To evaluate the indirect impact of the pandemic on patients with cardiomyopathy through the Heart Hive COVID-19 study. (3) To assess the impact of the pandemic on national cardiomyopathy-related hospital admissions. METHODS (1) 1236 patients (703 DCM, 533 HCM) in the RBHH CRC Biobank were assessed for COVID-19 infections and hospitalisations; (2) 207 subjects (131 cardiomyopathy, 76 without heart disease) in the Heart Hive COVID-19 study completed online surveys evaluating physical health, psychological well-being, and behavioural adaptations during the pandemic and (3) 11 447 cardiomyopathy-related hospital admissions across National Health Service (NHS) England were studied from NHS Digital Hospital Episode Statistics over 2019-2020. RESULTS A comparable proportion of patients with cardiomyopathy in the RBHH CRC Biobank had tested positive for COVID-19 compared with the UK population (1.1% vs 1.6%, p=0.14), but a higher proportion of those infected were hospitalised (53.8% vs 16.5%, p=0.002). In the Heart Hive COVID-19 study, more patients with cardiomyopathy felt their physical health had deteriorated due to the pandemic than subjects without heart disease (32.3% vs 13.2%, p=0.004) despite only 4.6% of the cardiomyopathy cohort reporting COVID-19 symptoms. A 17.9% year-on-year reduction in national cardiomyopathy-related hospital admissions was observed in 2020. CONCLUSION Patients with cardiomyopathy had similar reported rates of testing positive for COVID-19 to the background population, but those with test-proven infection were hospitalised more frequently. Deterioration in physical health amongst patients could not be explained by COVID-19 symptoms, inferring a significant contribution of the indirect consequences of the pandemic. TRIAL REGISTRATION NUMBER NCT04468256.
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Affiliation(s)
- Daniel J Hammersley
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rachel J Buchan
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- MRC London Institute of Medical Sciences, Imperial College, London, UK
| | - Amrit S Lota
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lukas Mach
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard E Jones
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Brian P Halliday
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Devendra Meena
- Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
- British Heart Foundation Centre of Excellence, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece
| | - A John Baksi
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Antonis Pantazis
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Angharad M Roberts
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sanjay K Prasad
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James S Ware
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- MRC London Institute of Medical Sciences, Imperial College, London, UK
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12
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Abstract
Ionogels (IGs) are a unique class of composite materials with attributes that make them promising materials for applications in electrochemical energy storage. Due to the solid porous matrix that confines the ionic liquid (IL) in the IG, they can be used as self-supporting electrolytes. Furthermore, interactions of the IL with the porous matrix can have beneficial effects on transport, such as lowering the freezing/glass transition temperature of the conducting IL. In this work, we employ molecular dynamics simulations to investigate the influence of the porous morphology and solid volume fraction on ionic conductivity and Li+ diffusivity using a representative 0.5 M Li-bis(trifluoromethane)sulfonimide (TFSI)-pyrrolidinium (Pyr1.3) IL confined in a nanoporous silica matrix. The effect of the morphology of the confining matrix is compared using the pure IL as a baseline. We find that the tracer and collective Li+ diffusion and ionic conductivity of all the model IGs have significantly lower temperature dependence than the corresponding pure IL. In general, low-silica IGs with wide pores displayed the best transport properties at high temperatures, but the trends with the morphology for the nested set of transport coefficients we examined changed as the collective behavior of the Li+ ions and the molecular IL components were considered. Remarkably, some of the model IGs displayed better transport properties on a volume of fluid basis at low temperatures than the constituent IL. These trends were tied to structural changes revealed by the radial distribution functions of the IL components and the silica surface, including a decreasing Li+ adsorption peak of the surface silica indicating a change in the relative contributions of bulk-like and surface-like transport in the confined IL.
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Affiliation(s)
- R Skelton
- Sandia National Laboratories, P.O. Box 969, Livermore, California 94551, United States
| | - R E Jones
- Sandia National Laboratories, P.O. Box 969, Livermore, California 94551, United States
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13
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Hammersley DJ, Buchan RJ, Mach L, Jones RE, Halliday BP, Prasad SK, Roberts A, Ware JS. The direct and indirect effect of the COVID-19 pandemic on patients with cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The disease-specific impact of COVID-19 on different cardiac conditions requires further investigation. Whilst direct effects are observed for those infected with SARS-CoV-2, the indirect effects of the pandemic arising from interruption to clinical care may represent a further source of morbidity and mortality.
Purpose
To evaluate the direct and indirect effects of the COVID-19 pandemic on patients with dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM).
Methods
(i) Patients with DCM or HCM previously recruited to a single centre registry were studied using NHS Spine Summary Care Records, hospital records and patient questionnaires. The primary outcome was test-proven COVID-19 infection. Secondary outcomes were the proportion of COVID-19 cases requiring hospitalisation and the proportion of subjects advised to shield. Outcomes were compared with published UK COVID-19 statistics.
(ii) The Heart Hive COVID-19 study is an international online prospective observational cohort study. Subjects registered on an online platform with cardiomyopathy or without heart disease (controls) were invited to enrol. Enrolled subjects complete online surveys, adapted from a WHO Survey tool for behavioural insights on COVID-19.
Results
(i) Of 1236 eligible patients in our registry (703 DCM, 533 HCM), 13 (1.1%) had tested positive for COVID-19 compared to 1.6% in the UK population (p=0.14) up to 2nd November 2020, a higher proportion of whom required hospitalisation compared with the UK population (53.8% vs 16.5%, p=0.002). More patients with cardiomyopathy in our registry were advised to shield than in the UK population (21.9% vs 6.8%, p<0.ehab724.17361, Fig. 1).
(ii) Of 207 subjects enrolled in the Heart Hive COVID-19 study (131 cardiomyopathy, 76 controls), more patients with cardiomyopathy felt their physical health had deteriorated due to the pandemic than controls (32.3% vs 13.2%, p=0.0042) despite only 4.6% reporting COVID-19 symptoms. Of those with cardiomyopathy, 38 (29.0%) reported a rescheduled clinic visit, 21 (16.0%) a cancelled clinic visit, 51 (38.9%) had missed investigations, 10 (7.6%) had cancelled/postponed procedures, 7 (5.3%) had missed medication doses due to the pandemic and 53 (40.4%) felt their health needs could not be met by telemedicine (Fig. 2). The psychological impact of the pandemic was comparable between cardiomyopathy patients and controls.
Conclusions
Patients with cardiomyopathy in our registry were not at a greater risk of testing positive for COVID-19 than the UK population, but a higher proportion of those that tested positive required hospitalisation. Many more patients with cardiomyopathy reported a subjective deterioration in physical health than had experienced COVID-19 symptoms, inferring a significant contribution of the indirect effects of the pandemic. Our findings have implications for both the health needs of these patients and the reorganisation of clinical services to meet these.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Wellcome Trust, Medical Research Council (UK) Figure 1Figure 2
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Affiliation(s)
- D J Hammersley
- National Heart and Lung Institute Imperial College, London, United Kingdom
| | - R J Buchan
- Imperial College London, London, United Kingdom
| | - L Mach
- Imperial College London, London, United Kingdom
| | - R E Jones
- National Heart and Lung Institute Imperial College, London, United Kingdom
| | - B P Halliday
- National Heart and Lung Institute Imperial College, London, United Kingdom
| | - S K Prasad
- Imperial College London, London, United Kingdom
| | - A Roberts
- Imperial College London, London, United Kingdom
| | - J S Ware
- Imperial College London, London, United Kingdom
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14
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Abstract
Ionogels are hybrid materials formed by impregnating the pore space of a solid matrix with a conducting ionic liquid. By combining the properties of both component materials, ionogels can act as self-supporting electrolytes in Li batteries. In this study, molecular dynamics simulations are used to investigate the dependence of mechanical properties of silica ionogels on solid fraction, temperature, and pore width. Comparisons are made with corresponding aerogels. We find that the solid matrix fraction increases the moduli and strength of the ionogel. This varies nonlinearly with temperature and strain rate, according to the contribution of the viscous ionic liquid to resisting deformation. Owing to the temperature and strain sensitivity of the ionic liquid viscosity, the mechanical properties approach a linear mixing law at high temperature and low strain rates. The median pore width of the solid matrix plays a complex role, with its influence varying qualitatively with deformation mode. Narrower pores increase the relevant elastic modulus under shear and uniaxial compression but reduce the modulus obtained under uniaxial tension. Conversely, shear and tensile strength are increased by narrowing the pore width. All of these pore size effects become more pronounced as the silica fraction increases. Pore size effects, similar to the effects of temperature and strain rate, are linked to the ease of fluid redistribution within the pore space during deformation-induced changes in the geometry of the pores.
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Affiliation(s)
- R Skelton
- Sandia National Laboratories, Livermore, California 94550, United States
| | - R E Jones
- Sandia National Laboratories, Livermore, California 94550, United States
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15
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Halliday BP, Vazir A, Owen R, Gregson J, Wassall R, Lota AS, Khalique Z, Tayal U, Jones RE, Hammersley D, Pantazis A, Baksi AJ, Rosen S, Pennell DJ, Cowie MR, Cleland JGF, Prasad SK. Heart Rate as a Marker of Relapse During Withdrawal of Therapy in Recovered Dilated Cardiomyopathy. JACC Heart Fail 2021; 9:509-517. [PMID: 34119469 PMCID: PMC8259664 DOI: 10.1016/j.jchf.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/03/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this study was to determine the relationship between heart rate and relapse among patients in the TRED-HF (Therapy withdrawal in REcovered Dilated cardiomyopathy trial). BACKGROUND Understanding markers and mechanisms of relapse among patients with recovered dilated cardiomyopathy (DCM) may enable personalized management. METHODS The relationship between serial heart rate measurements and relapse was examined among patients in the TRED-HF trial, a randomized trial which examined the safety and feasibility of withdrawing heart failure therapy from 51 patients with recovered DCM over 6 months. In total, 25 patients were randomized to therapy withdrawal and 26 to continue therapy, of whom 25 subsequently began therapy withdrawal in a single arm crossover phase. RESULTS The mean ± SD heart rate for those who had therapy withdrawn and did not relapse was 64.6 ± 10.7 beats/min at baseline and 74.7 ± 10.4 beats/min at follow-up, compared to 68.3 ± 11.3 beats/min at baseline and 86.1 ± 11.8 beats/min at follow-up for those who relapsed. After adjusting for differences in heart rate at baseline, patients who had therapy withdrawn and relapsed had a 10.4 beats/min (95% CI: 4.0-16.8) greater rise in heart rate than patients who had therapy withdrawn and did not relapse (P = 0.002). After data were adjusted for age, log N-terminal pro-B-type natriuretic peptide, and left ventricular ejection fraction (LVEF), heart rate (per 10 beats/min; hazard ratio [HR]: 1.65; 95% CI: 1.10-2.57; P = 0.01) and change in heart rate from baseline (per 10 beats/min; HR: 1.70; 95% CI: 1.12-2.57; p = 0.01) were associated with relapse. The results remained qualitatively the same after adjusting for beta-blocker dose. CONCLUSIONS For patients with DCM and improved LVEF, the rise in heart rate after treatment is withdrawn treatment identifies patients who are more likely to relapse. Whether the increase in heart rate is a marker or a mediator of relapse requires investigation. (Therapy withdrawal in REcovered Dilated cardiomyopathy trial [TRED]; NCT02859311).
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Affiliation(s)
- Brian P Halliday
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Ali Vazir
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Ruth Owen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rebecca Wassall
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Amrit S Lota
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Zohya Khalique
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Upasana Tayal
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Richard E Jones
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Daniel Hammersley
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Antonis Pantazis
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - A John Baksi
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Stuart Rosen
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Dudley J Pennell
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Martin R Cowie
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom
| | - John G F Cleland
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom; Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Sanjay K Prasad
- Cardiovascular Research Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College, London, United Kingdom.
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16
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Christiansen M, Bartee A, Lalonde A, Jones RE, Katz M, Wolpert H, Brazg R. Performance of an Automated Insulin Delivery System: Results of Early Phase Feasibility Studies. Diabetes Technol Ther 2021; 23:187-194. [PMID: 32940537 PMCID: PMC7906863 DOI: 10.1089/dia.2020.0318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Automated insulin delivery (AID) systems have demonstrated improvements in time-in-range (TIR, blood glucose 70-180 mg/dL) without increasing hypoglycemia. Testing a closed-loop system in an inpatient environment with supervised challenges allows for initial evaluation of performance and safety of the system. Methods: Adults with type 1 diabetes (T1D) were enrolled into two similar studies (n = 10 per study), with 3-day inpatient analysis periods. Participants tested a Lilly hybrid closed-loop (HCL) system comprising an investigational insulin pump, insulin lispro, a pump-embedded model predictive control algorithm, a continuous glucose monitor (CGM), and an external dedicated controller. Each protocol included meal-related and exercise challenges to simulate real-world diabetes self-management errors. Only study staff interacted with the HCL system. Performance was assessed using standard CGM metrics overall and within prespecified periods. Results: Participants (25% male) had mean ± standard deviation (SD) age 44.7 ± 14.2 years, T1D duration 30.2 ± 11.1 years, A1C 7.2% ± 0.8%, and insulin usage 0.53 ± 0.21 U/(kg·day). Percentage TIR 70-180 mg/dL (mean ± SD) was 81.2 ± 8.4 overall, 85.2 ± 8.1 outside of challenge periods, 97.3 ± 5.3 during the nocturnal periods, and 74.5 ± 16.2 for the postprandial periods. During challenge periods, percentage TIR for the overbolus challenge was 65.4 ± 29.2 and that for the delayed bolus challenge was 57.1 ± 25.1. No adverse events (AEs), serious AEs, or unanticipated adverse device events occurred while participants were using the HCL system. Conclusions: In participants with T1D, Lilly AID system demonstrated expected algorithm performance and safety with satisfactory glycemic outcomes overall and in response to simulated diabetes management challenges. Additional studies in less supervised conditions and with broader patient populations are warranted. ClinicalTrials.gov Registration number NCT03743285, NCT03849612.
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Affiliation(s)
- Mark Christiansen
- Diablo Clinical Research, Walnut Creek, California, USA
- Address correspondence to: Mark Christiansen, MD, Diablo Clinical Research, 2255 Ygnacio Valley Road Suite M, Walnut Creek, CA 94598, USA
| | - Amy Bartee
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Amy Lalonde
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | - Ronald Brazg
- Ranier Clinical Research Center, Renton, West Virginia, USA
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17
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Halliday BP, Owen R, Gregson J, S Vassiliou V, Chen X, Wage R, Lota AS, Khalique Z, Tayal U, Hammersley DJ, Jones RE, Baksi AJ, Cowie MR, Cleland JGF, Pennell DJ, Prasad SK. Myocardial remodelling after withdrawing therapy for heart failure in patients with recovered dilated cardiomyopathy: insights from TRED-HF. Eur J Heart Fail 2021; 23:293-301. [PMID: 33225554 DOI: 10.1002/ejhf.2063] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS To characterize adverse ventricular remodelling after withdrawing therapy in recovered dilated cardiomyopathy (DCM). METHODS AND RESULTS TRED-HF was a randomized controlled trial with a follow-on single-arm cross-over phase that examined the safety and feasibility of therapy withdrawal in patients with recovered DCM over 6 months. The primary endpoint was relapse of heart failure defined by (i) a reduction in left ventricular (LV) ejection fraction >10% and to <50%, (ii) >10% increase in LV end-diastolic volume and to above the normal range, (iii) a twofold rise in N-terminal pro-B-type natriuretic peptide and to >400 ng/L, or (iv) evidence of heart failure. LV mass, LV and right ventricular (RV) global longitudinal strain (GLS) and extracellular volume were measured using cardiovascular magnetic resonance at baseline and follow-up (6 months or relapse) for 48 patients. LV cell and extracellular matrix masses were derived. The effect of withdrawing therapy, stratified by relapse and genotype, was investigated in the randomized and follow-on phases. In the randomized comparison, withdrawing therapy led to an increase in mean LV mass [5.4 g/m2 ; 95% confidence interval (CI) 1.3-9.5] and cell mass (4.2 g/m2 ; 95% CI 0.5-8.0) and a reduction in LV (3.5; 95% CI 1.6-5.5) and RV (2.4; 95% CI 0.1-4.7) GLS. In a non-randomized comparison of all patients (n = 47) who had therapy withdrawn in either phase, there was an increase in LV mass (6.2 g/m2 ; 95% CI 3.6-8.9; P = 0.0001), cell mass (4.0 g/m2 ; 95% CI 1.8-6.2; P = 0.0007) and matrix mass (1.7 g/m2 ; 95% CI 0.7-2.6; P = 0.001) and a reduction in LV GLS (2.7; 95% CI 1.5-4.0; P = 0.0001). Amongst those who had therapy withdrawn and did not relapse, similar changes were observed (n = 28; LV mass: 5.1 g/m2 , 95% CI 1.5-8.8, P = 0.007; cell mass: 3.7 g/m2 , 95% CI 0.3-7.0, P = 0.03; matrix mass: 1.7 g/m2 , 95% CI 0.4-3.0, P = 0.02; LV GLS: 1.7, 95% CI 0.1-3.2, P = 0.04). Patients with TTN variants (n = 10) who had therapy withdrawn had a greater increase in LV matrix mass (mean effect of TTN: 2.6 g/m2 ; 95% CI 0.4-4.8; P = 0.02). CONCLUSION In TRED-HF, withdrawing therapy caused rapid remodelling, with early tissue and functional changes, even amongst patients who did not relapse.
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Affiliation(s)
- Brian P Halliday
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, London, UK
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, UK
| | - Vassilios S Vassiliou
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Xiuyu Chen
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - Ricardo Wage
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - Amrit S Lota
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - Zohya Khalique
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - Upasana Tayal
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - Daniel J Hammersley
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - Richard E Jones
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - A John Baksi
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - Martin R Cowie
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - John G F Cleland
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Dudley J Pennell
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
| | - Sanjay K Prasad
- Cardiovascular Research Centre, Royal Brompton Hospital & National Heart Lung Institute, Imperial College, London, UK
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18
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Hammersley DJ, Jones RE, Mach L, Halliday BP, Prasad SK. Cardiovascular Magnetic Resonance in Heritable Cardiomyopathies. Heart Fail Clin 2020; 17:25-39. [PMID: 33220885 DOI: 10.1016/j.hfc.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cardiovascular magnetic resonance represents the imaging modality of choice for the investigation of patients with heritable cardiomyopathies. The combination of gold-standard volumetric analysis with tissue characterization can deliver precise phenotypic evaluation of both cardiac morphology and the underlying myocardial substrate. Cardiovascular magnetic resonance additionally has an established role in risk-stratifying patients with heritable cardiomyopathy and an emerging role in guiding therapies. This article explores the application and utility of cardiovascular magnetic resonance techniques with specific focus on the major heritable cardiomyopathies.
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Affiliation(s)
- Daniel J Hammersley
- National Heart & Lung Institute, Imperial College, London SW3 6LY, UK; CMR Unit, The Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Richard E Jones
- National Heart & Lung Institute, Imperial College, London SW3 6LY, UK; CMR Unit, The Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Lukas Mach
- National Heart & Lung Institute, Imperial College, London SW3 6LY, UK; CMR Unit, The Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Brian P Halliday
- National Heart & Lung Institute, Imperial College, London SW3 6LY, UK; CMR Unit, The Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Sanjay K Prasad
- National Heart & Lung Institute, Imperial College, London SW3 6LY, UK; CMR Unit, The Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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19
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Jones RE, Karamasis GV, Dungu JN, Mohdnazri SR, Al-Janabi F, Hammersley DJ, Prasad SK, Tang KH, Kelly PA, Gedela S, Davies JR, Keeble TR. Stress perfusion cardiovascular magnetic resonance and serial fractional flow reserve assessment of the left anterior descending artery in patients undergoing right coronary artery chronic total occlusion revascularization. Cardiol J 2020; 29:80-87. [PMID: 32037503 PMCID: PMC8890403 DOI: 10.5603/cj.a2020.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/21/2020] [Accepted: 12/25/2019] [Indexed: 11/25/2022] Open
Abstract
Background Fractional flow reserve (FFR) assessment of remote arteries, in the context of a bystander chronic total occlusion (CTO), can lead to false positive results. Adenosine stress cardiovascular magnetic resonance (CMR) evaluates perfusion defects across the entire myocardium and may therefore be a reliable tool in the work-up of remote lesions in CTO patients. The IMPACT-CTO study investigated donor artery invasive physiology before, immediately post, and at 4 months following right coronary artery (RCA) CTO percutaneous coronary intervention (PCI). The aim of this subanalysis was to assess the concordance between baseline perfusion CMR and serial FFR evaluation of left anterior descending artery (LAD) ischemia in patients from the IMPACT-CTO study. Methods Baseline adenosine stress CMR examinations from 26 patients were analyzed for qualitative evidence of LAD ischemia. The results were correlated with the serial LAD FFR measurements. Results The present findings demonstrated that before RCA CTO PCI, there was 62% agreement between perfusion CMR and FFR (ischemic threshold ≤ 0.8) in the assessment of LAD ischemia (k = 0.29; fair concordance). At 4 months after revascularization, there was 77% agreement (k = 0.52; moderate concordance) between the index CMR assessment of LAD ischemia and the follow-up LAD FFR. Concordance was improved at a LAD FFR ischemic threshold of ≤ 0.75. Conclusions In this hypothesis generating study, baseline CMR assessment of LAD ischemia correlated better with the 4 months LAD FFR data (threshold ≤ 0.8) as compared to the FFR measurements taken prior to RCA CTO revascularization.
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Affiliation(s)
- Richard E Jones
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom.
| | - Grigoris V Karamasis
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom.,School of Medicine, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, United Kingdom
| | - Jason N Dungu
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Shah R Mohdnazri
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom.,School of Medicine, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, United Kingdom
| | - Firas Al-Janabi
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom.,School of Medicine, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, United Kingdom
| | | | - Sanjay K Prasad
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Kare H Tang
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Paul A Kelly
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Swamy Gedela
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - John R Davies
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom.,School of Medicine, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, United Kingdom
| | - Thomas R Keeble
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom.,School of Medicine, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, United Kingdom
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20
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Jones RE, Tucker WC, Mills MJL, Mukerjee S. Insight into hydrogen production through molecular simulation of an electrode-ionomer electrolyte system. J Chem Phys 2019; 151:034702. [PMID: 31325927 DOI: 10.1063/1.5097609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In this work, we examine metal electrode-ionomer electrolyte systems at high voltage (negative surface charge) and at high pH to assess factors that influence hydrogen production efficiency. We simulate the hydrogen evolution electrode interface investigated experimentally in the work of Bates et al. [J. Phys. Chem. C 119, 5467 (2015)] using a combination of first principles calculations and classical molecular dynamics. With this detailed molecular information, we explore the hypotheses posed in the work of Bates et al. In particular, we examine the response of the system to increased bias voltage and oxide coverage in terms of the potential profile, changes in solvation and species concentrations away from the electrode, surface concentrations, and orientation of water at reactive surface sites. We discuss this response in the context of hydrogen production.
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Affiliation(s)
- R E Jones
- Sandia National Laboratories, Livermore, California 94551, USA
| | - W C Tucker
- Sandia National Laboratories, Livermore, California 94551, USA
| | - M J L Mills
- Sandia National Laboratories, Livermore, California 94551, USA
| | - S Mukerjee
- Northeastern University, Boston, Massachusetts 02115, USA
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21
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Jones RE, Groom KM, Singh A, Lai H, Dungu JN, Medeiros F, Lal A, Barbagallo RM. Non-Valvular Cardiac Aspergilloma: A Rare Presentation of a Rare Condition. Heart Lung Circ 2019; 28:e115-e116. [DOI: 10.1016/j.hlc.2019.02.002] [Citation(s) in RCA: 1] [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] [Received: 09/06/2018] [Revised: 12/13/2018] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
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22
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Jones RE, Mohdnazri SR, Karamasis GV, Al-Janabi F, Toor I, Dungu JN, Gedela S, Tang KH, Kelly PA, Davies JR, Keeble TR. P3662The use of stress perfusion cardiovascular magnetic resonance imaging and fractional flow reserve in the assessment of remote artery ischaemia in patients with a chronic total occlusion. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3662] [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)
- R E Jones
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - S R Mohdnazri
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - G V Karamasis
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - F Al-Janabi
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - I Toor
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - J N Dungu
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - S Gedela
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - K H Tang
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - P A Kelly
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - J R Davies
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
| | - T R Keeble
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Cardiology, Basildon, United Kingdom
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Jones RE, Rimsza JM, Criscenti LJ. An atomic-scale evaluation of the fracture toughness of silica glass. J Phys Condens Matter 2018; 30:245901. [PMID: 29726844 DOI: 10.1088/1361-648x/aac28b] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Using an atomistic technique consistent with continuum balance laws and drawing on classical fracture mechanics theory, we estimate the resistance to fracture propagation of amorphous silica. We discuss correspondence and deviations from classical linear elastic fracture mechanics theory including size dependence, rigid/floppy modes of deformation, and the effects of surface energy and stress.
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Affiliation(s)
- R E Jones
- Mechanics of Materials Department, Sandia National Laboratories, PO Box 969, Livermore, CA 94551, United States of America
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Garcia-Martin I, Janssen AB, Jones RE, Grimstead JW, Penketh RJA, Baird DM, John RM. Telomere length heterogeneity in placenta revealed with high-resolution telomere length analysis. Placenta 2017; 59:61-68. [PMID: 29108638 PMCID: PMC5687939 DOI: 10.1016/j.placenta.2017.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Telomeres, are composed of tandem repeat sequences located at the ends of chromosomes and are required to maintain genomic stability. Telomeres can become shorter due to cell division and specific lifestyle factors. Critically shortened telomeres are linked to cellular dysfunction, senescence and aging. A number of studies have used low resolution techniques to assess telomere length in the placenta. In this study, we applied Single Telomere Length Analysis (STELA) which provides high-resolution chromosome specific telomere length profiles to ask whether we could obtain more detailed information on the length of individual telomeres in the placenta. METHODS Term placentas (37-42 weeks) were collected from women delivering at University Hospital of Wales or Royal Gwent Hospital within 2 h of delivery. Multiple telomere-length distributions were determined using STELA. Intraplacental variation of telomere length was analysed (N = 5). Telomere length distributions were compared between labouring (N = 10) and non-labouring (N = 11) participants. Finally, telomere length was compared between female (N = 17) and male (N = 20) placenta. RESULTS There were no significant influences of sampling site, mode of delivery or foetal sex on the telomere-length distributions obtained. The mean telomere length was 7.7 kb ranging from 5.0 kb to 11.7 kb across all samples (N = 42) and longer compared with other human tissues at birth. STELA also revealed considerable telomere length heterogeneity within samples. CONCLUSIONS We have shown that STELA can be used to study telomere length homeostasis in the placenta regardless of sampling site, mode of delivery and foetal sex. Moreover, as each amplicon is derived from a single telomeric molecule, from a single cell, STELA can reveal the full detail of telomere-length distributions, including telomeres within the length ranges observed in senescent cells. STELA thus provides a new tool to interrogate the relationship between telomere length and pregnancy complications linked to placental dysfunction.
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Affiliation(s)
- I Garcia-Martin
- Division of Biomedicine, Cardiff School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK
| | - A B Janssen
- Division of Biomedicine, Cardiff School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK
| | - R E Jones
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, Wales CF14 4XN, UK
| | - J W Grimstead
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, Wales CF14 4XN, UK
| | - R J A Penketh
- Department of Obstetrics and Gynaecology, University Hospital Wales, Cardiff, Wales CF14 4XW, UK
| | - D M Baird
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, Wales CF14 4XN, UK
| | - R M John
- Division of Biomedicine, Cardiff School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK.
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Matthews EO, Rowbotham SE, Moxon JV, Jones RE, Vega de Ceniga M, Golledge J. Meta-analysis of the association between peripheral artery disease and growth of abdominal aortic aneurysms. Br J Surg 2017; 104:1765-1774. [DOI: 10.1002/bjs.10675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/14/2017] [Accepted: 07/11/2017] [Indexed: 12/23/2022]
Abstract
Abstract
Background
The role of atherosclerosis in the pathogenesis of abdominal aortic aneurysm (AAA) is controversial. Atherosclerosis-associated peripheral artery disease (PAD) has been reported to be a risk factor for AAA in population screening studies; its relationship with AAA growth is controversial.
Methods
A systematic search of MEDLINE, Scopus, CINAHL and the Cochrane Central Register of Controlled Trials was conducted in April 2016 and repeated in January 2017. Databases were screened for studies reporting AAA growth rates in patients with, and without PAD. The included studies underwent quality assessment and, where possible, were included in the meta-analysis. A subgroup analysis was performed, including only studies that adjusted for confounding factors.
Results
Seventeen studies, including a total of 4873 patients, met the review entry criteria. Data from 15 studies were included in the meta-analysis. There was marked heterogeneity in study design, methodology and statistical analyses used. In the main analysis, PAD was associated with reduced AAA growth (mean difference – 0·13, 95 per cent c.i. –0·27 to –0·00; P = 0·04). However, statistical significance was not maintained in sensitivity analysis. In a subanalysis that included only data adjusted for other risk factors, no significant association between PAD and AAA growth was found (mean difference –0·11, –0·23 to 0·00; P = 0·05).
Conclusion
This systematic review suggests that currently reported studies demonstrate no robust and consistent association between PAD and reduced AAA growth.
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Affiliation(s)
- E O Matthews
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - S E Rowbotham
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - J V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - R E Jones
- Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - M Vega de Ceniga
- Department of Angiology and Vascular Surgery, Hospital de Galdakao-Usansolo, Bizkaia, Spain
| | - J Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Queensland, Australia
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26
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Gruber J, Zhou XW, Jones RE, Lee SR, Tucker GJ. Molecular dynamics studies of defect formation during heteroepitaxial growth of InGaN alloys on (0001) GaN surfaces. J Appl Phys 2017; 121:195301. [PMID: 28611488 PMCID: PMC5432374 DOI: 10.1063/1.4983066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/20/2017] [Indexed: 05/14/2023]
Abstract
We investigate the formation of extended defects during molecular-dynamics (MD) simulations of GaN and InGaN growth on (0001) and ([Formula: see text]) wurtzite-GaN surfaces. The simulated growths are conducted on an atypically large scale by sequentially injecting nearly a million individual vapor-phase atoms towards a fixed GaN surface; we apply time-and-position-dependent boundary constraints that vary the ensemble treatments of the vapor-phase, the near-surface solid-phase, and the bulk-like regions of the growing layer. The simulations employ newly optimized Stillinger-Weber In-Ga-N-system potentials, wherein multiple binary and ternary structures are included in the underlying density-functional-theory training sets, allowing improved treatment of In-Ga-related atomic interactions. To examine the effect of growth conditions, we study a matrix of >30 different MD-growth simulations for a range of In x Ga 1-x N-alloy compositions (0 ≤ x ≤ 0.4) and homologous growth temperatures [0.50 ≤ T/T*m (x) ≤ 0.90], where T*m (x) is the simulated melting point. Growths conducted on polar (0001) GaN substrates exhibit the formation of various extended defects including stacking faults/polymorphism, associated domain boundaries, surface roughness, dislocations, and voids. In contrast, selected growths conducted on semi-polar ([Formula: see text]) GaN, where the wurtzite-phase stacking sequence is revealed at the surface, exhibit the formation of far fewer stacking faults. We discuss variations in the defect formation with the MD growth conditions, and we compare the resulting simulated films to existing experimental observations in InGaN/GaN. While the palette of defects observed by MD closely resembles those observed in the past experiments, further work is needed to achieve truly predictive large-scale simulations of InGaN/GaN crystal growth using MD methodologies.
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Affiliation(s)
| | - X W Zhou
- Mechanics of Materials Department, Sandia National Laboratories, Livermore, California 94550, USA
| | - R E Jones
- Mechanics of Materials Department, Sandia National Laboratories, Livermore, California 94550, USA
| | - S R Lee
- Advanced Materials Sciences Department, Sandia National Laboratories, Albuquerque, New Mexico 87123, USA
| | - G J Tucker
- Materials Science and Engineering Department, Drexel University, Philadelphia, Pennsylvania 19104, USA
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Abstract
Surface energies of silicates influence crack propagation during brittle fracture and decrease with surface relaxation caused by annealing and hydroxylation. Molecular-level simulations are particularly suited for the investigation of surface processes. In this work, classical MD simulations of silica surfaces are performed with two force fields (ClayFF and ReaxFF) to investigate the effect of force field reactivity on surface structure and energy as a function of surface hydroxylation. An unhydroxylated fracture surface energy of 5.1 J/m2 is calculated with the ClayFF force field, and 2.0 J/m2 is calculated for the ReaxFF force field. The ClayFF surface energies are consistent with the experimental results from double cantilever beam fracture tests (4.5 J/m2), whereas ReaxFF underestimated these surface energies. Surface relaxation via annealing and hydroxylation was performed by creating a low-energy equilibrium surface. Annealing condensed neighboring siloxane bonds increased the surface connectivity, and decreased the surface energies by 0.2 J/m2 for ClayFF and 0.8 J/m2 for ReaxFF. Posthydroxylation surface energies decreased further to 4.6 J/m2 with the ClayFF force field and to 0.2 J/m2 with the ReaxFF force field. Experimental equilibrium surface energies are ∼0.35 J/m2, consistent with the ReaxFF force field. Although neither force field was capable of replicating both the fracture and equilibrium surface energies reported from experiment, each was consistent with one of these conditions. Therefore, future computational investigations that rely on accurate surface energy values should consider the surface state of the system and select the appropriate force field.
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Affiliation(s)
- J M Rimsza
- Geochemistry Department, Sandia National Laboratories , Albuquerque, New Mexico 87185, United States
| | - R E Jones
- Science-Based Material Modeling Department, Sandia National Laboratories , Livermore, California 94551, United States
| | - L J Criscenti
- Geochemistry Department, Sandia National Laboratories , Albuquerque, New Mexico 87185, United States
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Morris DR, Singh TP, Moxon JV, Smith A, Stewart F, Jones RE, Golledge J. Assessment and validation of a novel angiographic scoring system for peripheral artery disease. Br J Surg 2017; 104:544-554. [PMID: 28140457 DOI: 10.1002/bjs.10460] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 10/30/2016] [Accepted: 11/16/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Angiography is used routinely in the assessment of lower-limb arteries, but there are few well validated angiographic scoring systems. The aim of this study was to develop and validate a novel angiographic scoring system for peripheral artery disease. METHODS An angiographic scoring system (the ANGIO score) was developed and applied to a sample of patients from a single vascular surgical department who underwent CT angiography of the lower limbs. The reproducibility of the ANGIO score was compared with those of the Bollinger and Trans-Atlantic inter-Society Consensus (TASC) IIb systems in a series of randomly selected patients. Associations between the ANGIO score and lower-limb ischaemia, as measured by the ankle : brachial pressure index (ABPI), and outcome events (major lower-limb amputations and cardiovascular events - myocardial infarction, stroke and cardiovascular death) were assessed. RESULTS Some 256 patients undergoing CT angiography were included. The interobserver reproducibility of the ANGIO score was better than that of the other scoring systems examined (κ = 0·90, P = 0·002). There was a negative correlation between the ANGIO score and ABPI (ρ = -0·33, P = 0·008). A higher ANGIO score was associated with an increased risk of major lower-limb amputation (hazard ratio (HR) for highest versus lowest tertile 9·30, 95 per cent c.i. 1·95 to 44·38; P = 0·005) and cardiovascular events (HR 2·73, 1·31 to 5·70; P = 0·007) following adjustment for established risk factors. CONCLUSION The ANGIO score provided a reproducible and valid assessment of the severity of lower-limb ischaemia and risk of major amputation and cardiovascular events in these patients with peripheral artery disease.
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Affiliation(s)
- D R Morris
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia
| | - T P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia
| | - J V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia
| | - A Smith
- Department of Anatomy, School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - F Stewart
- Department of Anatomy, School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - R E Jones
- Division of Tropical Health and Medicine, James Cook University, Queensland, Australia
| | - J Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
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Abstract
BACKGROUND Disc golf is a sport played much like traditional golf, but rather than using a ball and club, players throw flying discs with various throwing motions. It has been played by an estimated 8 to 12 million people in the United States. Like all sports, injuries sustained while playing disc golf are not uncommon. Although formalized in the 1970s, it has grown at a rapid pace; however, disc golf-related injuries have yet to be described in the medical literature. PURPOSE To describe the most common injuries incurred by disc golf players while comparing the different types of throwing styles. STUDY DESIGN Descriptive epidemiology study. METHODS The data in this study were collected from 883 disc golf players who responded to an online survey collected over a 1-month period. Respondents answered 49 questions related to demographics, experience, style of play, and injury details. Using a chi-square analysis, common injuries sustained in players using backhand and forehand throwing styles were compared. RESULTS More than 81% of respondents stated that they had sustained an injury playing disc golf, including injuries to the elbow (n = 325), shoulder (n = 305), back (n = 218), and knee (n = 199). The injuries were most commonly described as a muscle strain (n = 241), sprain (n = 162), and tendinitis (n = 145). The type of throw primarily used by players varied, with 86.2% using backhand, 12.7% using forehand, and 1.1% using an overhead throw. Players using a forehand throw were more likely to sustain an elbow injury (P = .014). Many players (n = 115) stated they had undergone surgery due to a disc golf-related injury, with the most common surgeries including meniscal, shoulder, spine, and foot/ankle surgeries. CONCLUSION The majority of surveyed disc golfers sustained at least 1 injury while playing disc golf, with many requiring surgery. The types of injuries sustained by players varied by the types of throw primarily used. As the sport of disc golf continues to expand, health professionals should be aware of injuries sustained, with future studies focusing on injury prevention and education strategies.
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Affiliation(s)
- Joseph T Nelson
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Richard E Jones
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Michael Runstrom
- Rosalind Franklin University of Medicine and Science, Traverse City, Michigan, USA
| | - Jolene Hardy
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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Golledge J, Moxon JV, Jones RE, Hankey GJ, Yeap BB, Flicker L, Norman PE. Reported Amount of Salt Added to Food Is Associated with Increased All-Cause and Cancer-Related Mortality in Older Men in a Prospective Cohort Study. J Nutr Health Aging 2015; 19:805-11. [PMID: 26412284 DOI: 10.1007/s12603-015-0483-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 02/02/2023]
Abstract
BACKGROUND The effect of dietary salt intake on important population outcomes such as mortality is controversial. The aim of this study was to examine the association between the dietary habit of adding salt to food and mortality in older men. Design, participants, setting and measurements: A risk factor questionnaire which contained a question about the dietary habit of adding salt to food was completed by 11742 community recruited older men between 1996 and 1999. The men were followed by means of the Western Australia Data Linkage System until November 30th 2010. Deaths due to cardiovascular diseases and cancers were identified using ICD-10 codes in the ranges I00-I99 and C00-D48, respectively. The association between the frequencies of adding salt to food and mortality was assessed using Kaplan Meier estimates and Cox proportional hazard analysis. RESULTS Median follow-up for survivors was 12.5 years (inter-quartile range 8.3-13.2 years). A total of 5399 deaths occurred of which the primary cause registered was cancer and cardiovascular disease in 1962 (36.3%) and 1835 (34.0%) men, respectively. The reported frequency of adding salt to food was strongly positively associated with all-cause (p<0.001), cancer-related (p<0.001) but not cardiovascular-related (p=0.649) mortality. Men reporting adding salt to their food always had a 1.12-fold (95% CI 1.05-1.20, p<0.001) and a 1.20-fold (95% CI 1.07-1.34, p=0.001) increased risk of all-cause and cancer-related mortality, respectively, after adjusting for other risk factors. Men reporting adding salt to their food sometimes had a 1.16-fold (95% CI 1.04-1.29, p=0.007) increased risk of cancer-related mortality after adjusting for other risk factors. CONCLUSION A history of adding salt to food is associated with increased cancer-related mortality in older men.
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Affiliation(s)
- J Golledge
- Professor Jonathan Golledge, Director, The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, School of Medicine and Dentistry, James Cook University Townsville, QLD, Australia 4811, Fax +61 7 4433 1401 Telephone +61 7 4433 1417,
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Lepeschkin E, Jones JL, Jones RE. Effect of premature stimulation on fast and slow excitation channels in cultured myocardial cells. Adv Cardiol 2015; 21:259-67. [PMID: 619550 DOI: 10.1159/000400462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Myocardial cells from chick embryos were cultured using a method which results in cell morphology and action potentials showing greater similarity to that of adult cells than to cells grown with standard methods of culture. The cells were paced by means of rectangular field stimuli (2 msec 2-5 times diastolic threshold). When the stimulus was given during the descending branch of the previous action potential, the action potential developed dissociation between a fast-rise component with short duration and a slow-rise component with longer duration. This dissociation was best in cells with an intermediate rate of rise of the spontaneous action potential and may be caused by different rates of reactivation of the slow and fast membrane excitation channels.
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Lepeschkin E, Jones JL, Rush S, Jones RE. Local potential gradients as a unifying measure for thresholds of stimulation, standstill, tachyarrhythmia and fibrillation appearing after strong capacitor discharges. Adv Cardiol 2015; 21:268-78. [PMID: 619552 DOI: 10.1159/000400463] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The pattern of arrhythmias following capacitor discharges of increasing amplitude, which have been observed by the authors in cultured myocardial cells from chick embryos, was compared to the arrhythmia patterns caused by similar discharges in experimental animals and humans, as reported in the literature. While the absolute voltages and currents causing each type of arrhythmia showed great variation, the scatter decreased considerably when the stimulus level was recalculated on the basis of peak current density in myocardial tissue, and was reduced further when the peak potential gradient at the cell level was used as the common basis of comparison. The similarity in the arrhythmia patterns and in the voltage gradients at which they occur indicates that the mechanism of these arrhythmias may be similar in cultured cells and intact animals and humans.
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Simpson K, Jones RE, Grimstead JW, Hills R, Pepper C, Baird DM. Telomere fusion threshold identifies a poor prognostic subset of breast cancer patients. Mol Oncol 2015; 9:1186-93. [PMID: 25752197 PMCID: PMC4449122 DOI: 10.1016/j.molonc.2015.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/29/2015] [Accepted: 02/06/2015] [Indexed: 11/05/2022] Open
Abstract
Telomere dysfunction and fusion can drive genomic instability and clonal evolution in human tumours, including breast cancer. Telomere length is a critical determinant of telomere function and has been evaluated as a prognostic marker in several tumour types, but it has yet to be used in the clinical setting. Here we show that high‐resolution telomere length analysis, together with a specific telomere fusion threshold, is highly prognostic for overall survival in a cohort of patients diagnosed with invasive ductal carcinoma of the breast (n = 120). The telomere fusion threshold defined a small subset of patients with an extremely poor clinical outcome, with a median survival of less than 12 months (HR = 21.4 (7.9–57.6), P < 0.0001). Furthermore, this telomere length threshold was independent of ER, PGR, HER2 status, NPI, or grade and was the dominant variable in multivariate analysis. We conclude that the fusogenic telomere length threshold provides a powerful, independent prognostic marker with clinical utility in breast cancer. Larger prospective studies are now required to determine the optimal way to incorporate high‐resolution telomere length analysis into multivariate prognostic algorithms for patients diagnosed with breast cancer. High‐resolution telomere length analysis is highly prognostic for overall survival. Independent of ER, PGR, HER2 status, NPI and grade. Dominant variable in multivariate analysis.
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Affiliation(s)
- K Simpson
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - R E Jones
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - J W Grimstead
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - R Hills
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - C Pepper
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - D M Baird
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
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Abstract
We present a Green-Kubo method to spatially resolve transport coefficients in compositionally heterogeneous mixtures. We develop the underlying theory based on well-known results from mixture theory, Irving-Kirkwood field estimation, and linear response theory. Then, using standard molecular dynamics techniques, we apply the methodology to representative systems. With a homogeneous salt water system, where the expectation of the distribution of conductivity is clear, we demonstrate the sensitivities of the method to system size, and other physical and algorithmic parameters. Then we present a simple model of an electrochemical double layer where we explore the resolution limit of the method. In this system, we observe significant anisotropy in the wall-normal vs. transverse ionic conductances, as well as near wall effects. Finally, we discuss extensions and applications to more realistic systems such as batteries where detailed understanding of the transport properties in the vicinity of the electrodes is of technological importance.
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Affiliation(s)
- R E Jones
- Mechanics of Materials Department, Sandia National Laboratories, Livermore, California 94550, USA
| | - D K Ward
- Materials Chemistry Department, Sandia National Laboratories, Livermore, California 94550, USA
| | - J A Templeton
- Thermal/Fluid Science and Engineering Department, Sandia National Laboratories, Livermore, California 94550, USA
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Abstract
Satisfactory primary wound healing following total joint replacement is essential. Wound healing problems can have devastating consequences for patients. Assessment of their healing capacity is useful in predicting complications. Local factors that influence wound healing include multiple previous incisions, extensive scarring, lymphoedema, and poor vascular perfusion. Systemic factors include diabetes mellitus, inflammatory arthropathy, renal or liver disease, immune compromise, corticosteroid therapy, smoking, and poor nutrition. Modifications in the surgical technique are necessary in selected cases to minimise potential wound complications. Prompt and systematic intervention is necessary to address any wound healing problems to reduce the risks of infection and other potential complications.
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Affiliation(s)
- R E Jones
- University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, Texas, 75390, USA
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Rizzi F, Jones RE, Debusschere BJ, Knio OM. Uncertainty quantification in MD simulations of concentration driven ionic flow through a silica nanopore. I. Sensitivity to physical parameters of the pore. J Chem Phys 2013; 138:194104. [PMID: 23697406 DOI: 10.1063/1.4804666] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this article, uncertainty quantification is applied to molecular dynamics (MD) simulations of concentration driven ionic flow through a silica nanopore. We consider a silica pore model connecting two reservoirs containing a solution of sodium (Na(+)) and chloride (Cl(-)) ions in water. An ad hoc concentration control algorithm is developed to simulate a concentration driven counter flow of ions through the pore, with the ionic flux being the main observable extracted from the MD system. We explore the sensitivity of the system to two physical parameters of the pore, namely, the pore diameter and the gating charge. First we conduct a quantitative analysis of the impact of the pore diameter on the ionic flux, and interpret the results in terms of the interplay between size effects and ion mobility. Second, we analyze the effect of gating charge by treating the charge density over the pore surface as an uncertain parameter in a forward propagation study. Polynomial chaos expansions and Bayesian inference are exploited to isolate the effect of intrinsic noise and quantify the impact of parametric uncertainty on the MD predictions. We highlight the challenges arising from the heterogeneous nature of the system, given the several components involved, and from the substantial effect of the intrinsic thermal noise.
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Affiliation(s)
- F Rizzi
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
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Jones RE. Should dentistry be a profession or a retail industry? J Indiana Dent Assoc 2013; 92:7. [PMID: 25286490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Lombardi AV, Cameron HU, Della Valle CJ, Jones RE, Paprosky WG, Ranawat CS. What would you do?: challenges in hip surgery. J Bone Joint Surg Br 2012; 94:70-74. [PMID: 23118386 DOI: 10.1302/0301-620x.94b11.30510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A moderator and panel of five experts led an interactive session in discussing five challenging and interesting patient case presentations involving surgery of the hip. The hip pathologies reviewed included failed open reduction internal fixation of subcapital femoral neck fracture, bilateral hip disease, evaluation of pain after metal-on-metal hip arthroplasty, avascular necrosis, aseptic loosening secondary to osteolysis and polyethylene wear, and management of ceramic femoral head fracture.
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Affiliation(s)
- A V Lombardi
- The Ohio State University, Department of Orthopaedics and Department of Biomedical Engineering, 7277 Smith's Mill Road, Suite 200, New Albany, Ohio 43054, USA.
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Zhou XW, Jones RE. Effects of nano-void density, size and spatial population on thermal conductivity: a case study of GaN crystal. J Phys Condens Matter 2012; 24:325804-15. [PMID: 22785076 DOI: 10.1088/0953-8984/24/32/325804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The thermal conductivity of a crystal is sensitive to the presence of surfaces and nanoscale defects. While this opens tremendous opportunities to tailor thermal conductivity, true 'phonon engineering' of nanocrystals for a specific electronic or thermoelectric application can only be achieved when the dependence of thermal conductivity on the defect density, size and spatial population is understood and quantified. Unfortunately, experimental studies of the effects of nanoscale defects are quite challenging. While molecular dynamics simulations are effective in calculating thermal conductivity, the defect density range that can be explored with feasible computing resources is unrealistically high. As a result, previous work has not generated a fully detailed understanding of the dependence of thermal conductivity on nanoscale defects. Using GaN as an example, we have combined a physically motivated analytical model and highly converged large-scale molecular dynamics simulations to study the effects of defects on thermal conductivity. An analytical expression for thermal conductivity as a function of void density, size, and population has been derived and corroborated with the model, simulations, and experiments.
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Affiliation(s)
- X W Zhou
- Mechanics of Materials Department, Sandia National Laboratories, Livermore, CA 94550, USA.
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Jones RE. Dental ethics: an obituary. J Indiana Dent Assoc 2012; 91:18-22. [PMID: 23097855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Britt-Compton B, Lin TT, Ahmed G, Weston V, Jones RE, Fegan C, Oscier DG, Stankovic T, Pepper C, Baird DM. Extreme telomere erosion in ATM-mutated and 11q-deleted CLL patients is independent of disease stage. Leukemia 2011; 26:826-30. [DOI: 10.1038/leu.2011.281] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Surgeons want to perform a perfect total hip arthroplasty (THA) with every operation. Human performance has limitations, especially when performing a mechanical operation in a biological environment. Recent suggested changes to improve outcomes have been large femoral heads and anterior incisions, but unfortunately, neither has resulted in any scientific data that change has been effected. The scientific data tell us that poor component positions and impingement are the source of increasing mechanical complications. Therefore, attempts have been made to improve the surgeon's performance by precise quantitative knowledge in the operating room. Robotic-guided navigation provides numerical data for cup inclination plus anteversion and center of rotation; femoral leg length and offset; and combined anteversion of the cup and stem. The acetabular bone preparation is done with a reamer connected to a robotic arm, which prevents human error by the surgeon of reaming off line or too deep. This technology provides predictable and reproducible results.
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Affiliation(s)
- Lawrence D Dorr
- Dorr Arthritis Institute at Good Samaritan Hospital, Los Angeles, California 90017, USA.
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Van Hennekeler K, Jones RE, Skerratt LF, Muzari MO, Fitzpatrick LA. Meteorological effects on the daily activity patterns of tabanid biting flies in northern Queensland, Australia. Med Vet Entomol 2011; 25:17-24. [PMID: 20636479 DOI: 10.1111/j.1365-2915.2010.00900.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Information on the daily activity patterns of tabanid flies is important in the development of strategies that decrease the risk of pathogens transmitted by them. In addition, this information is useful to maximize numbers of tabanids trapped during short-term studies and to target feeding behavior studies of certain tabanid species to their times of peak activity. The current study examined the effects of various meteorological factors on the daily activity patterns of common tropical species of tabanids in north Queensland. Each species studied responded differently to weather factors. Tabanus townsvilli Ricardo (Diptera: Tabanidae) was most active during late morning and early afternoon, whereas Pseudotabanus silvester (Bergroth) and Tabanus pallipennis Macquart were most active in the late afternoon. Tabanus dorsobimaculatus Macquart was most active in the morning and early afternoon. Data on daily activity patterns of tabanid flies indicates that in an area such as Townsville, North Queensland, where several species of tabanid are present concurrently in high numbers, the overlapping periods of high activity for these species indicate a high risk of pathogen transmission for most of the day (10.00-19.00 hours). Similarly, because each species responds differently to weather variables, only extreme weather conditions are likely to inhibit activity of all species. These data also indicate that for maximal results, trapping and feeding behavior studies should be tailored to the preferred activity period of the species under investigation.
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Affiliation(s)
- K Van Hennekeler
- School of Veterinary and Biomedical Sciences, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, Queensland, Australia.
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Jones RE, Zimmerman JA, Oswald J, Belytschko T. An atomistic J-integral at finite temperature based on Hardy estimates of continuum fields. J Phys Condens Matter 2011; 23:015002. [PMID: 21406817 DOI: 10.1088/0953-8984/23/1/015002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this work we apply a material-frame, kernel-based estimator of continuum fields to atomic data in order to estimate the J-integral for the analysis of an atomically sharp crack at finite temperatures. Instead of the potential energy appropriate for zero temperature calculations, we employ the quasi-harmonic free energy as an estimator of the Helmholtz free energy required by the Eshelby stress in isothermal conditions. We employ the simplest of the quasi-harmonic models, the local harmonic model of LeSar and co-workers, and verify that it is adequate for correction of the zero temperature J-integral expression for various deformation states for our Lennard-Jones test material. We show that this method has the properties of: consistency among the energy, stress and deformation fields; path independence of the contour integrals of the Eshelby stress; and excellent correlation with linear elastic fracture mechanics theory.
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Affiliation(s)
- R E Jones
- Sandia National Laboratories, Livermore, CA 94551-0969, USA.
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Abstract
Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound.
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Affiliation(s)
- Richard E Jones
- Department Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.
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Jones RE, Kaler L, Murphy S, Offner H. Tissue-Dependent Expression of Estrogen Receptor β in 17β-Estradiol-Mediated Attenuation of Autoimmune CNS Inflammation. ACTA ACUST UNITED AC 2010; 2:197-204. [PMID: 22242109 PMCID: PMC3254147 DOI: 10.2174/1876894601002010197] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Treatment strategies using therapeutic estrogen are being developed and tested for multiple sclerosis (MS). MS is an autoimmune inflammatory disease that attacks the central nervous system, damages myelin and produces neurode-generative changes associated with periodic and chronic progression of functional neurological deficit. Experimental studies in chimeric bone marrow transplant mice treated with 17β-estradiol (E2) have revealed that the estrogen receptor-1 (Esr-1, or -alpha) expressed exclusively within the non-hematopoietic tissue compartment is sufficient for mediating a beneficial neuroprotective therapeutic response in mice lacking Esr-1 expression on T lymphocytes or other bone marrow-derived cells. Less is known regarding requirements for estrogen receptor-2 (Esr-2, or -beta) expression in E2-mediated therapy. Here, we tested and compared requirements for Esr-2 expression within distinct tissue compartments in bone marrow transplant mice. Our studies support a crucial role for Esr-1 in E2 treatment and demonstrate that Esr-2 expressed by non-bone marrow-derived cells plays a role in sustaining the neuroprotective response mediated through Esr-1.
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Affiliation(s)
- Richard E Jones
- Department of Neurology, Oregon Health & Science University, Portland VA Medical Center, Oregon USA
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Jones RE, John DN, Luscombe DK. Exploratory interviews with the first pharmacists to complete training as supplementary prescribers in Wales. International Journal of Pharmacy Practice 2010. [DOI: 10.1211/096176705777341208] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- R E Jones
- Health and Medicines, Welsh School of Pharmacy, Cardiff University, Cardiff CF10 3XF, Wales, UK
| | - D N John
- Health and Medicines, Welsh School of Pharmacy, Cardiff University, Cardiff CF10 3XF, Wales, UK
| | - D K Luscombe
- Health and Medicines, Welsh School of Pharmacy, Cardiff University, Cardiff CF10 3XF, Wales, UK
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Robinson KM, Njus JM, Phillips DA, Proctor TM, Rooney WD, Jones RE. MR imaging of inflammation during myelin-specific T cell-mediated autoimmune attack in the EAE mouse spinal cord. Mol Imaging Biol 2009; 12:240-9. [PMID: 19949987 DOI: 10.1007/s11307-009-0272-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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: 02/23/2009] [Revised: 05/13/2009] [Accepted: 07/09/2009] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study is to detect myelin-specific T cells, key pathological mediators in early multiple sclerosis, and the corresponding animal model, experimental autoimmune encephalomyelitis (EAE), in the mouse spinal cord. PROCEDURES T cells were labeled with the iron-based, magnetic resonance (MR) contrast reagent, Feridex, and the transfection reagent, protamine sulfate, resulting in approximately 100% iron-labeling efficiency. Feridex-labeling did not alter the induction of EAE by T cells, and recipients were imaged by a 12-T MR instrument. RESULTS Focal hypointense lesions were resolvable to gray or white matter of the lumbar spinal cord in T(2)-weighted images of the recipients of Feridex-labeled T cells. Lesions corresponded to histological evidence of inflammatory lesions and iron-labeled cells in eight-of-eight mice. In contrast, hypointense lesions were not observed eight-of-eight recipients of unlabeled T cells. CONCLUSIONS These results demonstrate and provide methodologies for labeling, detecting, and extracting MRI-detectable foci of iron-labeled cells.
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Affiliation(s)
- Kristine M Robinson
- V.A. Medical Center, VA R&D 23, Bldg 101, 3710 SW US Veteran's Hospital Rd, Portland, OR 97239, USA
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