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Kirkbride RR, Aviram G, Heidinger BH, Liberman Y, Libauske A, Liubauskas R, Tridente DM, Brook A, DaBreo DC, Monteiro Filho AC, Carroll BJ, Matos JD, McCormick IC, Manning WJ, Litmanovich DE. Adjusting Atrial Size Parameters for Body Surface Area: Does it Affect the Association with Pulmonary Embolism-related Adverse Events? J Thorac Imaging 2024:00005382-990000000-00130. [PMID: 38635472 DOI: 10.1097/rti.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
PURPOSE Small left atrial (LA) volume was recently reported to be one of the best predictors of acute pulmonary embolism (PE)-related adverse events (AE). There is currently no data available regarding the impact that body surface area (BSA)-indexing of atrial measurements has on the association with PE-related adverse events. Our aim is to assess the impact of indexing atrial measurements to BSA on the association between computed tomography (CT) atrial measurements and AE. MATERIALS AND METHODS Retrospective study (IRB: 2015P000425). A database of hospitalized patients with acute PE diagnosed on CT pulmonary angiography (CTPA) between May 2007 and December 2014 was reviewed. Right and left atrial volume, largest axial area, and axial diameters were measured. Patients undergo both echocardiographies (from which the BSA was extracted) and CTPAs within 48 hours of the procedure. The patient's body weight was measured during each admission. LA measurements were correlated to AE (defined as the need for advanced therapy or PE-related mortality at 30 days) before and after indexing for BSA. The area under the ROC curve was calculated to determine the predictive value of the atrial measurements in predicting AE. RESULTS The study included 490 acute PE patients; 62 (12.7%) had AE. There was a significant association of reduced BSA-indexed and non-indexed LA volume (both <0.001), area (<0.001 and 0.001, respectively), and short-axis diameters (both <0.001), and their respective RA/LA ratios (all <0.001) with AE. The AUC values were similar for BSA-indexed and non-indexed LA volume, diameters, and area with LA volume measurements being the best predictor of adverse outcomes (BSA-indexed AUC=0.68 and non-indexed AUC=0.66), followed by non-indexed LA short-axis diameter (indexed AUC=0.65, non-indexed AUC=0.64), and LA area (indexed AUC=0.64, non-indexed AUC=0.63). CONCLUSION Adjusting for BSA does not substantially affect the predictive ability of atrial measurements on 30-day PE-related adverse events, and therefore, this adjustment is not necessary in clinical practice. While LA volume is the better predictor of AE, LA short-axis diameter has a similar predictive value and is more practical to perform clinically.
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Affiliation(s)
- Rachael R Kirkbride
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Galit Aviram
- Department of Cardiothoracic Imaging, Tel-Aviv Medical Center, Tel-Aviv University, Israel
| | - Benedikt H Heidinger
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Yuval Liberman
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aurelija Libauske
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Rokas Liubauskas
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Daniela M Tridente
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Dominique C DaBreo
- Department of Radiology, Cardiothoracic Radiology, Queen's University, Kingston, Ontario, Canada
| | - Antonio C Monteiro Filho
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Brett J Carroll
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason D Matos
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ian C McCormick
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Warren J Manning
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Diana E Litmanovich
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Nakata K, Kucukseymen S, Cai X, Yankama T, Rodriguez J, Sai E, Pierce P, Ngo L, Nakamori S, Tung N, Manning WJ, Nezafat R. Cardiac MR Characterization of Myocardial Tissue Injury in a Miniature Swine Model of Cancer Therapy-related Cardiovascular Toxicity. J Cardiovasc Magn Reson 2024:101033. [PMID: 38460840 DOI: 10.1016/j.jocmr.2024.101033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/12/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) is the most commonly clinically used imaging parameter for assessing cancer therapy-related cardiac dysfunction (CTRCD). However, LVEF declines may occur late, after substantial injury. This study sought to investigate cardiovascular magnetic resonance (CMR) imaging markers of subclinical cardiac injury in a miniature swine model. METHODS Female Yucatan miniature swine (n=14) received doxorubicin (2mg/kg) every 3 weeks for 4 cycles. CMR, including cine, tissue characterization via T1 and T2 mapping, and late gadolinium enhancement (LGE) was performed on the same day as doxorubicin administration and three weeks after the final chemotherapy cycle. In addition, MR spectroscopy (MRS) was performed during the 3 weeks after the final chemotherapy in 7 pigs. A single CMR and MRS exam was also performed in three Yucatan miniature swine that were age- and weight-matched to the final imaging exam of the doxorubicin-treated swine to serve as controls. CTRCD was defined as histological early morphologic changes, including cytoplasmic vacuolization and myofibrillar loss of myocytes, based on post-mortem analysis of humanely euthanized pigs after the final CMR exam. RESULTS Of 13 swine completing five serial CMR scans, 10 (77%) had histological evidence of CTRCD. Three animals had neither histological evidence nor changes in LVEF from baseline. No absolute LVEF <40% or LGE were observed. Native T1, extracellular volume (ECV), and T2 at 12 weeks were significantly higher in swine with CTRCD than those without CTRCD (1178 ms vs. 1134 ms, p=0.002, 27.4% vs. 24.5%, p=0.03, and 38.1 ms vs. 36.4 ms, p=0.02, respectively). There were no significant changes in strain parameters. The temporal trajectories in native T1, ECV, and T2 in swine with CTRCD showed similar and statistically significant increases. At the same time, there were no differences in their temporal changes between those with and without CTRCD. MRS myocardial triglyceride content substantially differed among controls, swine with and without CTRCD (0.89%, 0.30%, 0.54%, respectively, ANOVA, p=0.01), and associated with the severity of histological findings and incidence of vacuolated cardiomyocytes. CONCLUSIONS Serial CMR imaging alone has a limited ability to detect histologic CTRCD beyond LVEF. Integrating MRS myocardial triglyceride content may be useful for detection of early potential CTRCD.
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Affiliation(s)
- Kei Nakata
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Selcuk Kucukseymen
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaoying Cai
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Siemens Medical Solutions USA, Inc., Boston, Massachusetts, USA
| | - Tuyen Yankama
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Rodriguez
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Eiryu Sai
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick Pierce
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Long Ngo
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Shiro Nakamori
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Nadine Tung
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Warren J Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Nezafat
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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Zhan Y, Friedrich MG, Dendukuri N, Lu Y, Chetrit M, Schiller I, Joseph L, Shaw JL, Chuang ML, Riffel JH, Manning WJ, Afilalo J. Meta-Analysis of Normal Reference Values for Right and Left Ventricular Quantification by Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2024; 17:e016090. [PMID: 38377242 DOI: 10.1161/circimaging.123.016090] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/12/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) reference values are relied upon to accurately diagnose left ventricular (LV) and right ventricular (RV) pathologies. To date, reference values have been derived from modest sample sizes with limited patient diversity and attention to 1 but not both commonly used tracing techniques for papillary muscles and trabeculations. We sought to overcome these limitations by meta-analyzing normal reference values for CMR parameters stemming from multiple countries, vendors, analysts, and patient populations. METHODS We comprehensively extracted published and unpublished data from studies reporting CMR parameters in healthy adults. A steady-state free-precession short-axis stack at 1.5T or 3T was used to trace either counting the papillary muscles and trabeculations in the LV volume or mass. We used a novel Bayesian hierarchical meta-analysis model to derive the pooled lower and upper reference values for each CMR parameter. Our model accounted for the expected differences between tracing techniques by including informative prior distributions from a large external data set. RESULTS A total of 254 studies from 25 different countries were systematically reviewed, representing 12 812 healthy adults, of which 52 were meta-analyzed. For LV parameters counting papillary muscles and trabeculations in the LV volume, pooled normative reference ranges in men and women, respectively, were as follows: LV ejection fraction of 52% to 73% and 54% to 75%, LV end-diastolic volume index of 60 to 109 and 56 to 96 mL/m2, LV end-systolic volume index of 18 to 45 and 16 to 38 mL/m2, and LV mass index of 41 to 76 and 33 to 57 g/m2. For LV parameters counting papillary muscles and trabeculations in the LV mass, pooled normative reference ranges in men and women, respectively, were as follows: LV ejection fraction of 57% to 74% and 57% to 75%, LV end-diastolic volume index of 60 to 97 and 55 to 88 mL/m2, LV end-systolic volume index of 18 to 37 and 15 to 34 mL/m2, and LV mass index of 50 to 83 and 38 to 65 g/m2. For RV parameters, pooled normative reference ranges in men and women, respectively, were as follows: RV ejection fraction of 47% to 68% and 49% to 71%, RV end-diastolic volume index of 64 to 115 and 57 to 99 mL/m2, RV end-systolic volume index of 23 to 52 and 18 to 42 mL/m2, and RV mass index of 14 to 29 and 13 to 25 g/m2. CONCLUSIONS Our Bayesian hierarchical meta-analysis provides normative reference values for CMR parameters of LV and RV size, systolic function, and mass, encompassing both tracing techniques across a diverse multinational sample of healthy men and women.
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Affiliation(s)
- Yang Zhan
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC (Y.Z., J.A.)
- Division of Cardiology, Regina General Hospital, University of Saskatchewan, MB (Y.Z.)
| | - Matthias G Friedrich
- Division of Cardiology, McGill University Health Center (M.G.F., M.L.C., J.A.), McGill University, Montreal, QC
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Germany (M.G.F., J.H.R.)
| | - Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, QC (N.D., Y.L., I.S.)
| | - Yang Lu
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, QC (N.D., Y.L., I.S.)
| | | | - Ian Schiller
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, QC (N.D., Y.L., I.S.)
| | - Lawrence Joseph
- Department of Epidemiology, Biostatistics, and Occupational Health (L.J., J.A.), McGill University, Montreal, QC
| | - Jaime L Shaw
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.L.S.)
| | - Michael L Chuang
- Division of Cardiology, McGill University Health Center (M.G.F., M.L.C., J.A.), McGill University, Montreal, QC
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (M.L.C., W.J.M.)
| | - Johannes H Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Germany (M.G.F., J.H.R.)
| | - Warren J Manning
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (M.L.C., W.J.M.)
| | - Jonathan Afilalo
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC (Y.Z., J.A.)
- Division of Cardiology, McGill University Health Center (M.G.F., M.L.C., J.A.), McGill University, Montreal, QC
- Department of Epidemiology, Biostatistics, and Occupational Health (L.J., J.A.), McGill University, Montreal, QC
- Division of Cardiology, Jewish General Hospital (J.A.), McGill University, Montreal, QC
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Morales MA, Manning WJ, Nezafat R. Present and Future Innovations in AI and Cardiac MRI. Radiology 2024; 310:e231269. [PMID: 38193835 PMCID: PMC10831479 DOI: 10.1148/radiol.231269] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 01/10/2024]
Abstract
Cardiac MRI is used to diagnose and treat patients with a multitude of cardiovascular diseases. Despite the growth of clinical cardiac MRI, complicated image prescriptions and long acquisition protocols limit the specialty and restrain its impact on the practice of medicine. Artificial intelligence (AI)-the ability to mimic human intelligence in learning and performing tasks-will impact nearly all aspects of MRI. Deep learning (DL) primarily uses an artificial neural network to learn a specific task from example data sets. Self-driving scanners are increasingly available, where AI automatically controls cardiac image prescriptions. These scanners offer faster image collection with higher spatial and temporal resolution, eliminating the need for cardiac triggering or breath holding. In the future, fully automated inline image analysis will most likely provide all contour drawings and initial measurements to the reader. Advanced analysis using radiomic or DL features may provide new insights and information not typically extracted in the current analysis workflow. AI may further help integrate these features with clinical, genetic, wearable-device, and "omics" data to improve patient outcomes. This article presents an overview of AI and its application in cardiac MRI, including in image acquisition, reconstruction, and processing, and opportunities for more personalized cardiovascular care through extraction of novel imaging markers.
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Affiliation(s)
- Manuel A. Morales
- From the Department of Medicine, Cardiovascular Division (M.A.M.,
W.J.M., R.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess
Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA
02215
| | - Warren J. Manning
- From the Department of Medicine, Cardiovascular Division (M.A.M.,
W.J.M., R.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess
Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA
02215
| | - Reza Nezafat
- From the Department of Medicine, Cardiovascular Division (M.A.M.,
W.J.M., R.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess
Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA
02215
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Fahmy AS, Rowin EJ, Jaafar N, Chan RH, Rodriguez J, Nakamori S, Ngo LH, Pradella S, Zocchi C, Olivotto I, Manning WJ, Maron M, Nezafat R. Radiomics of Late Gadolinium Enhancement Reveals Prognostic Value of Myocardial Scar Heterogeneity in Hypertrophic Cardiomyopathy. JACC Cardiovasc Imaging 2024; 17:16-27. [PMID: 37354155 DOI: 10.1016/j.jcmg.2023.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/14/2022] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) scar burden by cardiac magnetic resonance is a major risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). However, there is currently limited data on the incremental prognostic value of integrating myocardial LGE radiomics (ie, shape and texture features) into SCD risk stratification models. OBJECTIVES The purpose of this study was to investigate the incremental prognostic value of myocardial LGE radiomics beyond current European Society of Cardiology (ESC) and American College of Cardiology (ACC)/American Heart Association (AHA) models for SCD risk prediction in HCM. METHODS A total of 1,229 HCM patients (62% men; age 52 ± 16 years) from 3 medical centers were included. Left ventricular myocardial radiomic features were calculated from LGE images. Principal component analysis was used to reduce the radiomic features and calculate 3 principal radiomics (PrinRads). Cox and logistic regression analyses were then used to evaluate the significance of the extracted PrinRads of LGE images, alone or in combination with ESC or ACC/AHA models, to predict SCD risk. The ACC/AHA risk markers include LGE burden using a dichotomized 15% threshold of LV scar. RESULTS SCD events occurred in 30 (2.4%) patients over a follow-up period of 49 ± 28 months. Risk prediction using PrinRads resulted in higher c-statistics than the ESC (0.69 vs 0.57; P = 0.02) and the ACC/AHA (0.69 vs 0.67; P = 0.75) models. Risk predictions were improved by combining the 3 PrinRads with ESC (0.73 vs 0.57; P < 0.01) or ACC/AHA (0.76 vs 0.67; P < 0.01) risk scores. The net reclassification index was improved by combining the PrinRads with ESC (0.25 [95% CI: 0.08-0.43]; P = 0.005) or ACC/AHA (0.05 [95% CI: -0.07 to 0.16]; P = 0.42) models. One PrinRad was a significant predictor of SCD risk (HR: 0.57 [95% CI: 0.39-0.84]; P = 0.01). LGE heterogeneity was a major component of PrinRads and a significant predictor of SCD risk (HR: 0.07 [95% CI: 0.01-0.75]; P = 0.03). CONCLUSIONS Myocardial LGE radiomics are strongly associated with SCD risk in HCM and provide incremental risk stratification beyond current ESC or AHA/ACC risk models. Our proof-of-concept study warrants further validation.
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Affiliation(s)
- Ahmed S Fahmy
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Narjes Jaafar
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond H Chan
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jennifer Rodriguez
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Shiro Nakamori
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Long H Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Silvia Pradella
- Department of Radiology, University Hospital Careggi, Florence, Italy
| | - Chiara Zocchi
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Iacopo Olivotto
- Department of Radiology, University Hospital Careggi, Florence, Italy
| | - Warren J Manning
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Maron
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Reza Nezafat
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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Morales MA, Yoon S, Fahmy A, Ghanbari F, Nakamori S, Rodriguez J, Yue J, Street JA, Herzka DA, Manning WJ, Nezafat R. Highly accelerated free-breathing real-time myocardial tagging for exercise cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:56. [PMID: 37784153 PMCID: PMC10544487 DOI: 10.1186/s12968-023-00961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (Ex-CMR) myocardial tagging would enable quantification of myocardial deformation after exercise. However, current electrocardiogram (ECG)-segmented sequences are limited for Ex-CMR. METHODS We developed a highly accelerated balanced steady-state free-precession real-time tagging technique for 3 T. A 12-fold acceleration was achieved using incoherent sixfold random Cartesian sampling, twofold truncated outer phase encoding, and a deep learning resolution enhancement model. The technique was tested in two prospective studies. In a rest study of 27 patients referred for clinical CMR and 19 healthy subjects, a set of ECG-segmented for comparison and two sets of real-time tagging images for repeatability assessment were collected in 2-chamber and short-axis views with spatiotemporal resolution 2.0 × 2.0 mm2 and 29 ms. In an Ex-CMR study of 26 patients with known or suspected cardiac disease and 23 healthy subjects, real-time images were collected before and after exercise. Deformation was quantified using measures of short-axis global circumferential strain (GCS). Two experienced CMR readers evaluated the image quality of all real-time data pooled from both studies using a 4-point Likert scale for tagline quality (1-excellent; 2-good; 3-moderate; 4-poor) and artifact level (1-none; 2-minimal; 3-moderate; 4-significant). Statistical evaluation included Pearson correlation coefficient (r), intraclass correlation coefficient (ICC), and coefficient of variation (CoV). RESULTS In the rest study, deformation was successfully quantified in 90% of cases. There was a good correlation (r = 0.71) between ECG-segmented and real-time measures of GCS, and repeatability was good to excellent (ICC = 0.86 [0.71, 0.94]) with a CoV of 4.7%. In the Ex-CMR study, deformation was successfully quantified in 96% of subjects pre-exercise and 84% of subjects post-exercise. Short-axis and 2-chamber tagline quality were 1.6 ± 0.7 and 1.9 ± 0.8 at rest and 1.9 ± 0.7 and 2.5 ± 0.8 after exercise, respectively. Short-axis and 2-chamber artifact level was 1.2 ± 0.5 and 1.4 ± 0.7 at rest and 1.3 ± 0.6 and 1.5 ± 0.8 post-exercise, respectively. CONCLUSION We developed a highly accelerated real-time tagging technique and demonstrated its potential for Ex-CMR quantification of myocardial deformation. Further studies are needed to assess the clinical utility of our technique.
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Affiliation(s)
- Manuel A Morales
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Siyeop Yoon
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Ahmed Fahmy
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Fahime Ghanbari
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Shiro Nakamori
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Yue
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jordan A Street
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | | | - Warren J Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA.
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Kholdani CA, Choudhary G, Furfaro DM, Markson LJ, Manning WJ, Strom JB. Echocardiographic Progression of Peak Tricuspid Regurgitant Velocity Among Medicare Beneficiaries. JACC Adv 2023; 2:100579. [PMID: 37854952 PMCID: PMC10583835 DOI: 10.1016/j.jacadv.2023.100579] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Peak tricuspid regurgitant velocity (TRV) on transthoracic echocardiography (TTE) is a commonly obtained parameter and robust predictor of subsequent adverse clinical outcomes. OBJECTIVES The purpose of this study was to determine the predictors and clinical significance of TRV progression. METHODS We retrospectively linked consecutive outpatient TTE reports from our institution to 2005 to 2017 Medicare claims. Individuals with prior tricuspid surgery, endocarditis, tricuspid stenosis, missing TRV values, TTEs performed during inpatient hospitalization, or <2 TTEs were excluded. RESULTS A total of 4,572 patients (mean age 67.8 ± 11.9 years, 50.4% female) received 13,273 TTEs over a median follow-up of 7.4 (IQR: 4.5-6.9) years. TRV increased by a mean of 0.23 (95% CI: 0.22 to 0.23 m/s/y, P < 0.001) (range, 0.01-0.80 m/s/y). Older age, depressed left ventricular ejection fraction, diabetes, hypertension, hyperlipidemia, atrial fibrillation, heart failure, and chronic kidney disease were associated with faster progression (all P < 0.05). Accounting for 23 demographic, clinical, and TTE variables, faster TRV progression was associated with a stepwise increased risk of all-cause mortality (TRV progression quartile 4 vs 1; adjusted HR: 2.17; 95% CI: 1.74-2.71; P < 0.001). Those with regression of TRV (n = 384 [8.4%]) had a lower mortality risk (adjusted HR: 0.40; 95% CI: 0.28-0.57; P < 0.001). CONCLUSIONS In this large, multidecade study of Medicare beneficiaries with serial TTEs performed in the outpatient setting, the mean rate of TRV progression was 0.23 m/s/y. Older age, left heart disease, and adverse metabolic features were associated with faster progression. Faster progression was associated with a graded risk for all-cause mortality.
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Affiliation(s)
- Cyrus A. Kholdani
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Gaurav Choudhary
- Lifespan Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - David M. Furfaro
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence J. Markson
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Warren J. Manning
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jordan B. Strom
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Yoon S, Nakamori S, Amyar A, Assana S, Cirillo J, Morales MA, Chow K, Bi X, Pierce P, Goddu B, Rodriguez J, H Ngo L, J Manning W, Nezafat R. Accelerated Cardiac MRI Cine with Use of Resolution Enhancement Generative Adversarial Inline Neural Network. Radiology 2023; 307:e222878. [PMID: 37249435 DOI: 10.1148/radiol.222878] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background Cardiac cine can benefit from deep learning-based image reconstruction to reduce scan time and/or increase spatial and temporal resolution. Purpose To develop and evaluate a deep learning model that can be combined with parallel imaging or compressed sensing (CS). Materials and Methods The deep learning model was built on the enhanced super-resolution generative adversarial inline neural network, trained with use of retrospectively identified cine images and evaluated in participants prospectively enrolled from September 2021 to September 2022. The model was applied to breath-hold electrocardiography (ECG)-gated segmented and free-breathing real-time cine images collected with reduced spatial resolution with use of generalized autocalibrating partially parallel acquisitions (GRAPPA) or CS. The deep learning model subsequently restored spatial resolution. For comparison, GRAPPA-accelerated cine images were collected. Diagnostic quality and artifacts were evaluated by two readers with use of Likert scales and compared with use of Wilcoxon signed-rank tests. Agreement for left ventricle (LV) function, volume, and strain was assessed with Bland-Altman analysis. Results The deep learning model was trained on 1616 patients (mean age ± SD, 56 years ± 16; 920 men) and evaluated in 181 individuals, 126 patients (mean age, 57 years ± 16; 77 men) and 55 healthy subjects (mean age, 27 years ± 10; 15 men). In breath-hold ECG-gated segmented cine and free-breathing real-time cine, the deep learning model and GRAPPA showed similar diagnostic quality scores (2.9 vs 2.9, P = .41, deep learning vs GRAPPA) and artifact score (4.4 vs 4.3, P = .55, deep learning vs GRAPPA). Deep learning acquired more sections per breath-hold than GRAPPA (3.1 vs one section, P < .001). In free-breathing real-time cine, the deep learning showed a similar diagnostic quality score (2.9 vs 2.9, P = .21, deep learning vs GRAPPA) and lower artifact score (3.9 vs 4.3, P < .001, deep learning vs GRAPPA). For both sequences, the deep learning model showed excellent agreement for LV parameters, with near-zero mean differences and narrow limits of agreement compared with GRAPPA. Conclusion Deep learning-accelerated cardiac cine showed similarly accurate quantification of cardiac function, volume, and strain to a standardized parallel imaging method. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Vannier and Wang in this issue.
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Affiliation(s)
- Siyeop Yoon
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Shiro Nakamori
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Amine Amyar
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Salah Assana
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Julia Cirillo
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Manuel A Morales
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Kelvin Chow
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Xiaoming Bi
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Patrick Pierce
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Beth Goddu
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Jennifer Rodriguez
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Long H Ngo
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Warren J Manning
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
| | - Reza Nezafat
- From the Department of Medicine (Cardiovascular Division) (S.Y., S.N., A.A., S.A., J.C., M.A.M., P.P., B.G., J.R., W.J.M., R.N.), Department of Medicine (General Medicine Division) (L.H.N.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Siemens Medical Solutions, Chicago, Ill (K.C., X.B.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.)
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Silva TQ, Bakker J, Baltzis D, Chan RH, Manning WJ, Gongora CA, Gilman H, Sama S, Ho JS, Nikolaidou S, Sposito AC, Filho OC, Hudson M, Jerosch-Herold M, Veves A, Malhotra A, Patel S, Neilan TG. CARDIOVASCULAR FITNESS IN A POPULATION WITH COMBINED DIABETES MELLITUS AND OBSTRUCTIVE SLEEP APNEA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01159-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Qazi S, Gona PN, Oyama-Manabe N, Salton CJ, O'Donnell CJ, Manning WJ, Chuang ML. Prevalence and distribution of aortic plaque by sex and age group among community-dwelling adults. Clin Imaging 2023; 94:79-84. [PMID: 36495849 DOI: 10.1016/j.clinimag.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/04/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
RATIONALE AND OBJECTIVES Atherosclerosis of the aorta is associated with increased risk of cardiovascular mortality and vascular events. We aim to describe the prevalence and distribution of non-calcified atherosclerotic plaque in the descending aorta as quantified by noncontrast cardiovascular magnetic resonance (CMR) in a community-dwelling cohort of adults. MATERIALS AND METHODS We used CMR to quantify noncalcified aortic plaque in 1726 participants (aged 65 ± 9 years, 46.7% men) from the Cohort Study Offspring cohort. ECG-gated, fat-suppressed, T2-weighted, black blood turbo spin echo sequence was used to acquire 36 transverse slices covering the descending aorta from just below the arch to the aortoiliac bifurcation. Plaque was defined as discrete luminal protrusions ≥1 mm; these were manually traced, then summed to determine total descending aortic plaque (DAP) and segmental thoracic and abdominal aortic plaque (TAP, AAP). Participants were stratified by sex and age group (<55, 55-64, 65-74, ≥75y). A healthy referent group (without clinical cardiovascular disease, smoking, diabetes, impaired renal function; (N = 768, 43.8% men) was used to determine upper 90th percentile cutpoints for DAP and AAP which were then applied to the overall study cohort. RESULTS Prevalence of DAP was similar between men (47.3%) and women (48.9%), p = 0.50, as was AAP prevalence (men: 44.5%, women: 46.7%, p = 0.16); TAP was less prevalent in both sexes (men: 8.9%, women: 7.1%, p = 0.15). Both prevalence and burden of DAP, AAP and TAP increased with advancing age. CONCLUSION Noncalcified plaque prevalence, visualized on CMR, in community-dwelling adults is similar between the sexes, and both prevalence and burden of aortic plaque increase with greater age.
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Affiliation(s)
- Saadia Qazi
- The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA, United States of America; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Philimon N Gona
- The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA, United States of America; Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, United States of America
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Carol J Salton
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Christopher J O'Donnell
- The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA, United States of America; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Warren J Manning
- Harvard Medical School, Boston, MA, United States of America; Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Department of Radiology Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Michael L Chuang
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
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11
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Stabenau HF, Marcus M, Matos JD, McCormick I, Litmanovich D, Manning WJ, Carroll BJ, Waks JW. The spatial ventricular gradient is associated with adverse outcomes in acute pulmonary embolism. Ann Noninvasive Electrocardiol 2023; 28:e13041. [PMID: 36691977 DOI: 10.1111/anec.13041] [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: 10/06/2022] [Revised: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The spatial ventricular gradient (SVG) is a vectorcardiographic measurement that reflects cardiac loading conditions via electromechanical coupling. OBJECTIVES We hypothesized that the SVG is correlated with right ventricular (RV) strain and is prognostic of adverse events in patients with acute pulmonary embolism (PE). METHODS Retrospective, single-center study of patients with acute PE. Electrocardiogram (ECG), imaging, and outcome data were obtained. SVG components were regressed on tricuspid annular plane systolic excursion (TAPSE), qualitative RV dysfunction, and RV/left ventricular (LV) ratio. Odds of adverse outcomes (30-day mortality, vasopressor requirement, or advanced therapy) after PE were regressed on demographics, RV/LV ratios, traditional ECG signs of RV dysfunction, and SVG components using a logit model. RESULTS ECGs from 317 patients (48% male, age 63.1 ± 16.6 years) with acute PE were analyzed; 36 patients (11.4%) experienced an adverse event. Worse RV hypokinesis, larger RV/LV ratio, and smaller TAPSE were associated with smaller SVG X and Y components, larger SVG Z components, and smaller SVG vector magnitude (p < .001 for all). In multivariable logistic regression, odds of adverse events after PE decreased with increasing SVG magnitude and TAPSE (OR 0.32 and 0.54 per standard deviation increase; p = .03 and p = .004, respectively). Receiver operating characteristic (ROC) analysis showed that, when combined with imaging, replacing traditional ECG criteria with the SVG significantly improved the area under the ROC from 0.70 to 0.77 (p = .01). CONCLUSION The SVG is correlated with RV dysfunction and adverse outcomes in acute PE and has a better prognostic value than traditional ECG markers.
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Affiliation(s)
- Hans Friedrich Stabenau
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mason Marcus
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason D Matos
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian McCormick
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Litmanovich
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Warren J Manning
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brett J Carroll
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan W Waks
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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12
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Manning WJ. 2021-2022 state of our JCMR. J Cardiovasc Magn Reson 2022; 24:75. [PMID: 36587219 PMCID: PMC9804242 DOI: 10.1186/s12968-022-00909-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023] Open
Abstract
In 2021, there were 136 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR), including 122 original research papers, six reviews, four technical notes, one Society for Cardiovascular Magnetic Resonance (SCMR) guideline, one SCMR position paper, one study protocol, and one obituary (Nathaniel Reichek). The volume was up 53% from 2020 (n = 89) with a corresponding 21% decrease in manuscript submissions from 435 to 345. This led to an increase in the acceptance rate from 24 to 32%. The quality of the submissions continues to be high. The 2021 JCMR Impact Factor (which is released in June 2022) markedly increased from 5.41 to 6.90 placing us in the top quartile of Society and cardiac imaging journals. Our 5 year impact factor similarly increased from 6.52 to 7.25. Fifteen years ago, the JCMR was at the forefront of medical and medical society journal migration to the Open-Access format. The Open-Access system has dramatically increased the availability and JCMR citation. Full-text article requests in 2021 approached 1.5 M!. As I have mentioned, it takes a village to run a journal. JCMR is very fortunate to have a group of very dedicated Associate Editors, Guest Editors, Journal Club Editors, and Reviewers. I thank each of them for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. My role, and the entire editorial process would not be possible without the ongoing high dedication and efforts of our managing editor, Jennifer Rodriguez. Her premier organizational skills have allowed for streamlining of the review process and marked improvement in our time-to-decision (see later). As I conclude my 6th and final year as your editor-in-chief, I thank you for entrusting me with the JCMR editorship and appreciate the time I have had at the helm. I am very confident that our Journal will reach new heights under the stewardship of Dr. Tim Leiner, currently at the Mayo Clinic with a seamless transition occurring as I write this in late November. I hope that you will continue to send your very best, high quality CMR manuscripts to JCMR, and that our readers will continue to look to JCMR for the very best/state-of-the-art CMR publications.
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Affiliation(s)
- Warren J Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School and JCMR Editorial Office, Boston, MA, 02215, USA.
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Spetko N, Rong J, Larson MG, Haidar M, Raber I, Peters K, Benjamin EJ, O'Donnell CJ, Manning WJ, Vasan RS, Mitchell GF, Tsao CW. Cross-Sectional Relationships of Proximal Aortic Stiffness and Left Ventricular Diastolic Function in Adults in the Community. J Am Heart Assoc 2022; 11:e027230. [PMID: 36533620 PMCID: PMC9798804 DOI: 10.1161/jaha.122.027230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Stiffness of the proximal aorta may play a critical role in adverse left ventricular (LV)-vascular interactions and associated LV diastolic dysfunction. In a community-based sample, we sought to determine the association between proximal aortic stiffness measured by cardiovascular magnetic resonance (CMR) and several clinical measures of LV diastolic mechanics. Methods and Results Framingham Heart Study Offspring adults (n=1502 participants, mean 67±9 years, 54% women) with available 1.5T CMR and transthoracic echocardiographic measures were included. Measures included proximal descending aortic strain and aortic arch pulse wave velocity by CMR (2002-2006) and diastolic function (mitral Doppler E and A wave velocity, E wave area, and LV tissue Doppler e' velocity) by echocardiography (2005-2008). Multivariable linear regression analysis was used to relate CMR aortic stiffness measures to measures of echocardiographic LV diastolic function. All continuous variables were standardized. In multivariable-adjusted regression analyses, aortic strain was inversely associated with E wave deceleration time (estimated β=-0.10±0.032, P=0.001), whereas aortic arch pulse wave velocity was inversely associated with E/A ratio (estimated β=-0.094±0.027, P=0.0006), E wave area (estimated β=-0.070±0.027, P=0.010), and e' (estimated β=-0.061±0.027, P=0.022), all indicating associations of higher aortic stiffness by CMR with less favorable LV diastolic function. Compared with men, women had a larger inverse relationship between pulse wave velocity and E/A ratio (interaction β=-0.085±0.031, P=0.0064). There was no significant effect modification by age or a U-shaped (quadratic) relation between aortic stiffness and LV diastolic function measures. Conclusions Higher proximal aortic stiffness is associated with less favorable LV diastolic function. Future studies may clarify temporal relations of aortic stiffness with varying patterns and progression of LV diastolic dysfunction.
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Affiliation(s)
- Nicholas Spetko
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Jian Rong
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA
| | - Martin G. Larson
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Department of Mathematics and StatisticsBoston UniversityBostonMA
| | | | - Inbar Raber
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Kevin Peters
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Emelia J. Benjamin
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Sections of Preventive Medicine and Epidemiology and Cardiology, Department of MedicineBoston University School of Medicine, Department of Epidemiology, Boston University School of Public HealthBostonMA
| | - Christopher J. O'Donnell
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, and Division of Cardiovascular Medicine, Brigham and Women’s HospitalHarvard Medical SchoolWest RoxburyMA
| | - Warren J. Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA,Department of Radiology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Ramachandran S. Vasan
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Sections of Preventive Medicine and Epidemiology and Cardiology, Department of MedicineBoston University School of Medicine, Department of Epidemiology, Boston University School of Public HealthBostonMA
| | | | - Connie W. Tsao
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
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Varghese MS, Strom JB, Kannam JP, Fostello SE, Riley MF, Manning WJ. Impact of the COVID-19 pandemic on cardiology fellow echocardiography education at a large academic center. BMC Med Educ 2022; 22:863. [PMID: 36514029 PMCID: PMC9747257 DOI: 10.1186/s12909-022-03880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/09/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In response to COVID-19 pandemic state restrictions, our institution deferred elective procedures from 3/15/2020 to 6/13/2020, and removed cardiology fellows from the echocardiography rotation to staff clinical services. We assessed the impact of the COVID-19 pandemic on fellow education and echocardiography volumes. METHODS Our institutional database was used to examine volumes of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) from 7/1/2018 to 10/10/2020. Study volumes were compared in three intervals: pre-pandemic (7/1/2018- 3/14/2020), pandemic (3/15/2020-6/13/2020), and pandemic recovery (6/14/2020-10/10/2020). We examined weekly number of TTEs performed or interpreted by cardiology fellows during the study period, and compared these to the two previous academic years. RESULTS Weekly TTE volume declined by 54% during the pandemic, and increased by 99% during pandemic recovery, (p < 0.05). SE and TEE revealed similar trends. A strong correlation between weekly TTE volume and inpatient admissions was observed during the study period (rs=0.67, p < 0.05). Weekly fellow TTE scans declined by 78% during the pandemic, with a 380% increase during pandemic recovery (p < 0.05). Weekly fellow TTE interpretations declined by 56% during the pandemic, with a 76% increase during pandemic recovery (p < 0.05). CONCLUSION COVID restrictions between 3/15/2020- 6/14/2020 coincided with a marked decline in TTE, SE, and TEE volumes, with an increase similar to near pre-pandemic volumes during the pandemic recovery period. A similar decline with the onset of COVID restrictions, and increase to pre-restriction volumes thereafter was observed with fellow scans and interpretations, but total academic year fellow training volumes remained depressed. With the ongoing COVID-19 pandemic and rise of multiple variants, training programs may need to adjust fellows' clinical responsibilities so as to support achievement of echocardiography training certification.
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Affiliation(s)
- Merilyn S. Varghese
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA USA
| | - Jordan B. Strom
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA USA
| | - Joseph P. Kannam
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
| | - Sarah E. Fostello
- Non-Invasive Cardiology Department, Beth Israel Lahey Health- Plymouth Hospital, Plymouth, MA USA
| | - Marilyn F. Riley
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
| | - Warren J. Manning
- Department of Medicine (Cardiovascular Diseases), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, 02215 Boston, MA USA
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
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Strom JB, Zhao Y, Shen C, Wasfy JH, Xu J, Yucel E, Tanguturi V, Hyland PM, Markson LJ, Kazi DS, Cui J, Hung J, Yeh RW, Manning WJ. Development and validation of an echocardiographic algorithm to predict long-term mitral and tricuspid regurgitation progression. Eur Heart J Cardiovasc Imaging 2022; 23:1606-1616. [PMID: 34849685 PMCID: PMC9989598 DOI: 10.1093/ehjci/jeab254] [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: 08/03/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Prediction of mitral (MR) and tricuspid (TR) regurgitation progression on transthoracic echocardiography (TTE) is needed to personalize valvular surveillance intervals and prognostication. METHODS AND RESULTS Structured TTE report data at Beth Israel Deaconess Medical Center, 26 January 2000-31 December 2017, were used to determine time to progression (≥1+ increase in severity). TTE predictors of progression were used to create a progression score, externally validated at Massachusetts General Hospital, 1 January 2002-31 December 2019. In the derivation sample (MR, N = 34 933; TR, N = 27 526), only 5379 (15.4%) individuals with MR and 3630 (13.2%) with TR had progression during a median interquartile range) 9.0 (4.1-13.4) years of follow-up. Despite wide inter-individual variability in progression rates, a score based solely on demographics and TTE variables identified individuals with a five- to six-fold higher rate of MR/TR progression over 10 years (high- vs. low-score tertile, rate of progression; MR 20.1% vs. 3.3%; TR 21.2% vs. 4.4%). Compared to those in the lowest score tertile, those in the highest tertile of progression had a four-fold increased risk of mortality. On external validation, the score demonstrated similar performance to other algorithms commonly in use. CONCLUSION Four-fifths of individuals had no progression of MR or TR over two decades. Despite wide interindividual variability in progression rates, a score, based solely on TTE parameters, identified individuals with a five- to six-fold higher rate of MR/TR progression. Compared to the lowest tertile, individuals in the highest score tertile had a four-fold increased risk of mortality. Prediction of long-term MR/TR progression is not only feasible but prognostically important.
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Affiliation(s)
- Jordan B Strom
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Yuansong Zhao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Changyu Shen
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jason H Wasfy
- Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jiaman Xu
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Evin Yucel
- Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Varsha Tanguturi
- Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick M Hyland
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Lawrence J Markson
- Harvard Medical School, Boston, MA, USA.,Information Systems, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dhruv S Kazi
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jinghan Cui
- Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Judy Hung
- Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert W Yeh
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA.,Harvard Medical School, Boston, MA, USA.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Jiang GY, Xu J, Manning WJ, Markson LJ, Khabbaz KR, Garan AR, Sabe MA, Strom JB. Mitral Regurgitation and Mortality Risk in Medicare Beneficiaries With Heart Failure and Preserved Ejection Fraction. Am J Cardiol 2022; 183:40-47. [PMID: 36100504 DOI: 10.1016/j.amjcard.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 11/01/2022]
Abstract
The association of mitral regurgitation (MR) severity and mortality in heart failure with preserved ejection fraction (HFpEF) is uncertain. We sought to evaluate the relation between MR severity on transthoracic echocardiography (TTE) and subsequent all-cause mortality in Medicare beneficiaries with HFpEF. We linked 57,608 patients referred for TTE at Beth Israel Deaconess Medical Center to Medicare inpatient claims from 2003 to 2017. In those with a history of HF and a physician-reported left ventricular ejection fraction ≥50%, we evaluated the relation of MR severity and time to the primary end point of all-cause mortality using Kaplan-Meier methods. A total of 7,778 individuals (14.5%) met inclusion criteria (mean age 75.5 years ± 11.9, 55.9% female). Over a median follow-up of 8.1 years, 2,016 (25.9%) died at a median (interquartile range) of 1.7 (0.3 to 4.1) years. At 1 year, 15.8% with 3 to 4+ MR had died versus 10.5% with 0 to 2+ MR (hazard ratio 1.54, 95% confidence interval 1.22 to 1.95, p <0.001). After multivariable adjustment, 3 to 4+ MR continued to be associated with increased all-cause mortality (hazard ratio 1.48, 95% confidence interval 1.14 to 1.94, p = 0.004) except in the subset with atrial fibrillation (interaction p = 0.03) or recent (<3 months) HF hospitalization (p = 0.54). In conclusion, in this large, single-institution retrospective study of Medicare beneficiaries with HFpEF who underwent TTE, moderate-to-severe and severe MR were significantly associated with an increased risk of all-cause mortality after multivariable adjustment, except in those with atrial fibrillation or recent HF. Prospective studies are needed to assess the role of MR reduction in mitigating this risk.
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Affiliation(s)
- Ginger Y Jiang
- Division of Cardiovascular Medicine, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts
| | - Jiaman Xu
- Division of Cardiovascular Medicine, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Warren J Manning
- Division of Cardiovascular Medicine, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Boston, Massachusetts
| | - Lawrence J Markson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Information Systems, Boston, Massachusetts
| | - Kamal R Khabbaz
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - A Reshad Garan
- Division of Cardiovascular Medicine, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Marwa A Sabe
- Division of Cardiovascular Medicine, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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17
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Neisius U, Gona PN, Oyama-Manabe N, Chuang ML, O’Donnell CJ, Manning WJ, Tsao CW. Relation of MRI Aortic Wall Area and Plaque to Incident Cardiovascular Events: The Framingham Heart Study. Radiology 2022; 304:542-550. [PMID: 35638924 PMCID: PMC9434818 DOI: 10.1148/radiol.210830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/31/2021] [Revised: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 01/21/2023]
Abstract
Background Arterial arteriosclerosis and atherosclerosis reflect vascular disease, the subclinical detection of which allows opportunity for cardiovascular disease (CVD) prevention. Larger cohort studies simultaneously quantifying anatomic thoracic and abdominal aortic pathologic abnormalities are lacking in the literature. Purpose To investigate the association of aortic wall area (AWA) and atherosclerotic plaque presence and burden as measured on MRI scans with incident CVD in a community sample. Materials and Methods In this prospective cohort study, participants in the Framingham Heart Study Offspring Cohort without prevalent CVD underwent 1.5-T MRI (between 2002-2005) of the descending thoracic and abdominal aorta with electrocardiogram-gated axial T2-weighted black-blood acquisitions. The wall thickness of the thoracic aorta was measured at the pulmonary bifurcation level and used to calculate the AWA as the difference between cross-sectional vessel area and lumen area. For primary or secondary analyses, multivariable Cox proportional hazards regression models were used to examine the association of aortic MRI measures with risk of first-incident CVD events or stroke and coronary heart disease, respectively. Results In 1513 study participants (mean age, 64 years ± 9 [SD]; 842 women [56%]), 223 CVD events occurred during follow-up (median, 13.1 years), of which 97 were major events (myocardial infarction, ischemic stroke, or CVD death). In multivariable analysis, thoracic AWA and prevalent thoracic plaque were associated with incident CVD (hazard ratio [HR], 1.20 per SD unit [95% CI: 1.05, 1.37] [P = .006] and HR, 1.63 [95% CI: 1.12, 2.35] [P = .01], respectively). AWA and prevalent thoracic plaque were associated with increased hazards: 1.32 (95% CI: 1.07, 1.62; P = .01) and 2.20 (95% CI: 1.28, 3.79; P = .005), for stroke and coronary heart disease, respectively. Conclusion In middle-aged community-dwelling adults, thoracic aortic wall area (AWA), plaque prevalence, and plaque volumes measured with MRI were independently associated with incident cardiovascular disease, with AWA associated in particular with stroke, and plaque associated with coronary heart disease. Clinical trial registration no. NCT00041418 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Peshock in this issue.
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Affiliation(s)
- Ulf Neisius
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Philimon N. Gona
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | | | - Michael L. Chuang
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Christopher J. O’Donnell
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Warren J. Manning
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Connie W. Tsao
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
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Castilla-Ojo N, Wood J, Turkson-Ocran RAN, Mukamal KJ, Matos JD, Manning WJ, Strom JB, Baptista C, Kolaci G, Picanzo A, Juraschek SP. Abstract P065: Standing Echocardiogram For Orthostatic Hypotension: A Feasibility Study. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Orthostatic hypotension (OH) is associated with cardiovascular disease, particularly in older adults. While standing transthoracic echocardiography (TTE) could identify changes in cardiac output to diagnose OH, no established protocols exist, and its feasibility is unknown.
Objective:
Determine the feasibility of standing TTE on adults in the outpatient setting.
Methods:
We recruited 72 adults scheduled for elective TTE. Consenting participants underwent recumbent TTE, followed by a focused standing TTE within 1-2 minutes of standing. The focused standing TTE used apical windows to measure left ventricular outflow tract velocity time integral, subsequently used to determine stroke volume and cardiac output. Standing blood pressure and heart rate were taken concurrently, and patients were monitored for symptoms.
Results:
Of the 72 enrolled participants, 60 (over 80%) completed the standing TTE. Mean age was 63 years (49% were ≥70 years), 49% were women, 42% had a BMI ≥30 kg/m
2
, and 18% had OH. The average duration of the study in the standing position was 127 seconds. Doppler quality was good-to-excellent in 87% of all our completing participants, 54% in those ≥70 years, and 86% in those with obesity. Only 5% of the participants experienced discomfort, and 9% experienced dizziness. There was no significant association between standing blood pressure and standing cardiac output.
Conclusions:
Standing focused TTE is safe, well-tolerated, and feasible in the ambulatory setting. While this clinical assessment is promising for identifying cardiogenic OH, further work is needed in larger at-risk cohorts to determine its clinical utility.
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Affiliation(s)
| | - Julia Wood
- Beth Israel Deaconess Med Cntr, Boston, MA
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Morales MA, Assana S, Cai X, Chow K, Haji-Valizadeh H, Sai E, Tsao C, Matos J, Rodriguez J, Berg S, Whitehead N, Pierce P, Goddu B, Manning WJ, Nezafat R. An inline deep learning based free-breathing ECG-free cine for exercise cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2022; 24:47. [PMID: 35948936 PMCID: PMC9367083 DOI: 10.1186/s12968-022-00879-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (Ex-CMR) is a promising stress imaging test for coronary artery disease (CAD). However, Ex-CMR requires accelerated imaging techniques that result in significant aliasing artifacts. Our goal was to develop and evaluate a free-breathing and electrocardiogram (ECG)-free real-time cine with deep learning (DL)-based radial acceleration for Ex-CMR. METHODS A 3D (2D + time) convolutional neural network was implemented to suppress artifacts from aliased radial cine images. The network was trained using synthetic real-time radial cine images simulated using breath-hold, ECG-gated segmented Cartesian k-space data acquired at 3 T from 503 patients at rest. A prototype real-time radial sequence with acceleration rate = 12 was used to collect images with inline DL reconstruction. Performance was evaluated in 8 healthy subjects in whom only rest images were collected. Subsequently, 14 subjects (6 healthy and 8 patients with suspected CAD) were prospectively recruited for an Ex-CMR to evaluate image quality. At rest (n = 22), standard breath-hold ECG-gated Cartesian segmented cine and free-breathing ECG-free real-time radial cine images were acquired. During post-exercise stress (n = 14), only real-time radial cine images were acquired. Three readers evaluated residual artifact level in all collected images on a 4-point Likert scale (1-non-diagnostic, 2-severe, 3-moderate, 4-minimal). RESULTS The DL model substantially suppressed artifacts in real-time radial cine images acquired at rest and during post-exercise stress. In real-time images at rest, 89.4% of scores were moderate to minimal. The mean score was 3.3 ± 0.7, representing increased (P < 0.001) artifacts compared to standard cine (3.9 ± 0.3). In real-time images during post-exercise stress, 84.6% of scores were moderate to minimal, and the mean artifact level score was 3.1 ± 0.6. Comparison of left-ventricular (LV) measures derived from standard and real-time cine at rest showed differences in LV end-diastolic volume (3.0 mL [- 11.7, 17.8], P = 0.320) that were not significantly different from zero. Differences in measures of LV end-systolic volume (7.0 mL [- 1.3, 15.3], P < 0.001) and LV ejection fraction (- 5.0% [- 11.1, 1.0], P < 0.001) were significant. Total inline reconstruction time of real-time radial images was 16.6 ms per frame. CONCLUSIONS Our proof-of-concept study demonstrated the feasibility of inline real-time cine with DL-based radial acceleration for Ex-CMR.
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Affiliation(s)
- Manuel A Morales
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Salah Assana
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Xiaoying Cai
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
- Siemens Medical Solutions USA, Inc, Chicago, IL, USA
| | - Kelvin Chow
- Siemens Medical Solutions USA, Inc, Chicago, IL, USA
| | - Hassan Haji-Valizadeh
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Eiryu Sai
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Connie Tsao
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jason Matos
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Sophie Berg
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Neal Whitehead
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Patrick Pierce
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Beth Goddu
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Warren J Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA.
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Kirkbride RR, Heidinger BH, Monteiro Filho AC, Brook A, Tridente DM, DaBreo DC, Carroll BJ, Matos JD, McCormick IC, Manning WJ, Burstein D, Aviram G, Litmanovich DE. Evidence for Left Atrial Volume Being an Indicator of Adverse Events in Patients With Acute Pulmonary Embolism: Retrospective Case-control Pilot Study. J Thorac Imaging 2022; 37:173-180. [PMID: 34387226 DOI: 10.1097/rti.0000000000000611] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the association between computed tomography pulmonary angiography (CTPA) atrial measurements and both 30-day pulmonary embolism (PE)-related adverse events and mortality, and non-PE-related mortality, and to identify the best predictors of these outcomes by comparing atrial measurements and widely used clinical and imaging variables. PATIENTS AND METHODS Retrospective single-center pilot study. Acute PE patients diagnosed on CTPA who also had a transthoracic echocardiogram, electrocardiogram, and troponin T were included. CTPA left atrial (LA) and right atrial (RA) volume and short-axis diameter were measured and compared between outcome groups, along with right ventricular/left ventricular diameter ratio, interventricular septal bowing, tricuspid annular plane systolic excursion, electrocardiogram, and troponin T. RESULTS A total of 350 patients. LA volume and diameter were associated with PE-related adverse events (P≤0.01). LA volume was the only atrial measurement associated with PE-related mortality (P=0.03), with no atrial measurements associated with non-PE-related mortality. Troponin was most associated with PE-related adverse events and mortality (both area under the curve [AUC]=0.77). On multivariate analysis, combination models did not greatly improve PE-related adverse events prediction compared with troponin alone. For PE-related mortality, the best models were the combination of troponin, age, and either LA volume (AUC=0.86) or diameter (AUC=0.87). CONCLUSION Among patients with acute PE, CTPA LA volume is the only imaging parameter associated with PE-related mortality and is the best imaging predictor of this outcome. Reduced CTPA LA volume and diameter, along with increased RA/LA volume and diameter ratios, are significantly associated with 30-day PE-related adverse events, but not with non-PE-related mortality.
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Affiliation(s)
| | - Benedikt H Heidinger
- Departments of Radiology
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - Brett J Carroll
- Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason D Matos
- Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ian C McCormick
- Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Warren J Manning
- Departments of Radiology
- Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Galit Aviram
- Department of Cardiothoracic Imaging, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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Fahmy AS, Csecs I, Arafati A, Assana S, Yankama TT, Al-Otaibi T, Rodriguez J, Chen YY, Ngo LH, Manning WJ, Kwong RY, Nezafat R. An Explainable Machine Learning Approach Reveals Prognostic Significance of Right Ventricular Dysfunction in Nonischemic Cardiomyopathy. JACC Cardiovasc Imaging 2022; 15:766-779. [PMID: 35033500 DOI: 10.1016/j.jcmg.2021.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/25/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The authors implemented an explainable machine learning (ML) model to gain insight into the association between cardiac magnetic resonance markers and adverse outcomes of cardiovascular hospitalization and all-cause death (composite endpoint) in patients with nonischemic dilated cardiomyopathy (NICM). BACKGROUND Risk stratification of patients with NICM remains challenging. An explainable ML model has the potential to provide insight into the contributions of different risk markers in the prediction model. METHODS An explainable ML model based on extreme gradient boosting (XGBoost) machines was developed using cardiac magnetic resonance and clinical parameters. The study cohorts consist of patients with NICM from 2 academic medical centers: Beth Israel Deaconess Medical Center (BIDMC) and Brigham and Women's Hospital (BWH), with 328 and 214 patients, respectively. XGBoost was trained on 70% of patients from the BIDMC cohort and evaluated based on the other 30% as internal validation. The model was externally validated using the BWH cohort. To investigate the contribution of different features in our risk prediction model, we used Shapley additive explanations (SHAP) analysis. RESULTS During a mean follow-up duration of 40 months, 34 patients from BIDMC and 33 patients from BWH experienced the composite endpoint. The area under the curve for predicting the composite endpoint was 0.71 for the internal BIDMC validation and 0.69 for the BWH cohort. SHAP analysis identified parameters associated with right ventricular (RV) dysfunction and remodeling as primary markers of adverse outcomes. High risk thresholds were identified by SHAP analysis and thus provided thresholds for top predictive continuous clinical variables. CONCLUSIONS An explainable ML-based risk prediction model has the potential to identify patients with NICM at risk for cardiovascular hospitalization and all-cause death. RV ejection fraction, end-systolic and end-diastolic volumes (as indicators of RV dysfunction and remodeling) were determined to be major risk markers.
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Affiliation(s)
- Ahmed S Fahmy
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Ibolya Csecs
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Arghavan Arafati
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Salah Assana
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Tuyen T Yankama
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Talal Al-Otaibi
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Rodriguez
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Yun Chen
- Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Long H Ngo
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Raymond Y Kwong
- Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Reza Nezafat
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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Manning WJ. 2021 - State of our JCMR. J Cardiovasc Magn Reson 2022; 24:14. [PMID: 35246157 PMCID: PMC8896069 DOI: 10.1186/s12968-021-00840-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
There were 89 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2020, including 71 original research papers, 5 technical notes, 6 reviews, 4 Society for Cardiovascular Magnetic Resonance (SCMR) position papers/guidelines/protocols and 3 corrections. The volume was up 12.7% from 2019 (n = 79) with a corresponding 17.9% increase in manuscript submissions from 369 to 435. This led to a slight increase in the acceptance rate from 22 to 23%. The quality of the submissions continues to be high. The 2020 JCMR Impact Factor (which is published in June 2020) slightly increased from 5.361 to 5.364 placing us in the top quartile of Society and cardiac imaging journals. Our 5 year impact factor increased from 5.18 to 6.52. Fourteen years ago, the JCMR was at the forefront of medical and medical society journal migration to the Open-Access format. The Open-Access system has dramatically increased the availability and citation of JCMR publications with accesses now exceeding 1.2 M! It takes a village to run a journal. JCMR is blessed to have a group of very dedicated Associate Editors, Guest Editors, Journal Club Editors, and Reviewers. I thank each of them for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. My role, and the entire process would not be possible without the dedication and efforts of our new managing editor, Jennifer Rodriguez, whose premier organizational efforts have allowed for streamlining of the review process and marked improvement in our time-to-decision (see later). As I begin my 6th and final year as your editor-in-chief, I thank you for entrusting me with the JCMR editorship. I hope that you will continue to send us your very best, high quality manuscripts for JCMR consideration and that our readers will continue to look to JCMR for the very best/state-of-the-art CMR publications. The editorial process continues to be a tremendously fulfilling experience and the opportunity to review manuscripts that reflect the best in our field remains a great joy and true highlight of my week!
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Affiliation(s)
- Warren J Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215, USA.
- JCMR Editorial Office, Boston, Massachusetts, 02215, USA.
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Shams RB, Xu J, Orkaby AR, Markson L, Manning WJ, Strom JB. PHENOMAPPING TO DISTINGUISH UNIQUE PHENOTYPES OF FRAILTY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Fahmy A, Cirillo J, Rodriguez J, Paskavitz A, Sadhwani T, Waks JW, Manning WJ, Kramer DB, Nezafat R. EXPLAINABLE MACHINE LEARNING MODEL FOR RISK STRATIFICATION OF VENTRICULAR ARRHYTHMIA: A CARDIAC MRI STUDY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02172-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rano J, Jalal S, Sedlak T, Butler J, Khan MS, Manning WJ, Khosa F. Sex Disparity Among Canadian Cardiologists in Academic Medicine: Differences in Scholarly Productivity and Academic Rank. Cureus 2021; 13:e18687. [PMID: 34786263 PMCID: PMC8580548 DOI: 10.7759/cureus.18687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/05/2022] Open
Abstract
Background Women remain relatively underrepresented in all subspecialties of academic medicine. While sex disparity is prevalent in a number of specialties, the association between academic productivity and sex in academic cardiology has not been assessed in the Canadian context. Methods Academic faculty of accredited Canadian Resident Matching Service (CaRMS) programs were included from cardiology division websites across 17 universities. Cardiology faculty members’ names, academic ranks, leadership positions, and sex were obtained from each institutions’ website. The Elsevier database Scopus© was used to extract the Hirsch index (H-index), years of active research, and number of publications of each faculty member. The H-index was used as a metric of academic output and research productivity. Univariate regression was run with the H-Index as the outcome of interest, and multiple linear regression analysis was used to determine factors associated with higher H-index. Results Sex was identified for 1,040 members, of whom 836 (80%) were male. Male members had higher numbers of publications (p <0.001). There was a trend for males in a leadership position to have a higher H-index (p = 0.07). Median H-index was lower for women (p = 0.02). Males across assistant and associate professor ranks had a higher H-index. Women achieving professor rank demonstrated greater productivity with a higher median H-index (p = 0.002). Conclusions There is a prevalent sex gap in academic cardiology with regard to scholarly productivity and academic achievement. Factors that may help narrow the sex gap need to be identified and corrective measures implemented to enhance sex equity.
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Affiliation(s)
- Jacqueline Rano
- Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain (RCSI - MUB), Busaiteen, BHR.,Medical Education and Simulation, Vancouver General Hospital, Vancouver, CAN
| | - Sabeena Jalal
- Radiology, Vancouver General Hospital/University of British Columbia, Vancouver, CAN
| | - Tara Sedlak
- Medicine, University of British Columbia, Vancouver, CAN
| | - Javed Butler
- Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Muhammad S Khan
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Warren J Manning
- Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.,Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Faisal Khosa
- Radiology, Vancouver General Hospital/University of British Columbia, Vancouver, CAN
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26
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Tang GH, Wang A, Markson LJ, Manning WJ, Strom JB. Risk factors for left ventricular thrombus formation on transthoracic echocardiography in a propensity-matched case control study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The specific risk factors for left ventricular thrombus (LVT) formation on transthoracic echocardiography (TTE) independent of age, sex, and left ventricular ejection fraction (LVEF) remain uncertain.
Purpose
To conduct a propensity-matched case control study of LVT.
Methods
We queried structured TTE report data from 113,673 patients at our institution to identify individuals with LVT on TTE, 2000–2011. Cases were matched 1:1 with controls on age, sex, LVEF, inpatient/outpatient status, image quality, test year, blood pressure, heart rate, height, and weight. using propensity scores. Risk factors for LVT formation were determined using medical chart review.
Results
Over 12 years, we identified 132 patients with LVT and 132 matched controls (mean age 62.0±16.1 years, 73.1% male, mean LVEF 27.0% ± 16.0%). Cases were similar to controls across all matched variables except height (cases vs. controls, mean height 172.2±8.8 vs. 174.8±9.3 cm, p=0.03). Compared with controls, TTEs for cases were more frequently performed for the indications of myocardial infarction (MI; 28.0% vs. 9.9%, p<0.001) and source of embolism (3.8% vs. 0.0%, p=0.008). Despite no differences between cases and controls in rates of hypertension, hyperlipidemia, diabetes, and thrombophilia (Table), a history of peripheral arterial disease was associated with a 3.4-fold increased odds of LVT formation (univariate odds ratio [OR], 3.35, 1.50–7.47, p=0.003). This association persisted despite adjustment for history of MI, stroke, height, history of recent major bleeding, and receipt of percutaneous coronary intervention (PCI) (adjusted OR, 4.33, 1.66–11.29, p=0.003). On presentation, 22.0% of cases were on anticoagulation including 20.5% on warfarin, none on a direct oral anticoagulant (DOAC), and 1.5% on heparin products. Additionally, 48.5% of cases were on antiplatelet medications. Of the 27 patients on warfarin on diagnosis of LVT, 25.9% had an International Normalized Range (INR) value <2.0. All TTE parameters were similar across groups (p>0.05 for all). Of those with LVT, 54 (40.9%) had LVT resolution over a median of 4.4 (0.9 to 13.6) months.
Conclusions
In this single center, propensity-matched case-control study of individuals with LVT on TTE, a history of peripheral arterial disease was associated with a 4.3-fold increased odds of LVT formation independent of age, sex, LVEF, history of MI, stroke, or PCI. Of those with LVT, anticoagulation was used on presentation in 22.0%. Nearly half had LVT resolution within 4.4 months.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The project was funded by a grant from the National, Heart, Lung, and Blood Institute (1K23HL144907 - Strom).
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Affiliation(s)
- G H Tang
- Beth Israel Deaconess Medical Center & Harvard Medical School, Department of Medicine, Boston, United States of America
| | - A Wang
- Beth Israel Deaconess Medical Center & Harvard Medical School, Department of Medicine, Boston, United States of America
| | - L J Markson
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, United States of America
| | - W J Manning
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, United States of America
| | - J B Strom
- Beth Israel Deaconess Medical Center & Harvard Medical School, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, United States of America
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Hyland PM, Xu J, Shen C, Markson LJ, Manning WJ, Strom JB. Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system. Heart 2021; 108:956-963. [PMID: 34615667 DOI: 10.1136/heartjnl-2021-319951] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/08/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify potential race, sex and age disparities in performance of transthoracic echocardiography (TTE) over several decades. METHODS TTE reports from five academic and community sites within a single integrated healthcare system were linked to 100% Medicare fee-for-service claims from 1 January 2005 to 31 December 2017. Multivariable Poisson regression was used to estimate adjusted rates of TTE utilisation after the index TTE according to baseline age, sex, race and comorbidities among individuals with ≥2 TTEs. Non-white race was defined as black, Asian, North American Native, Hispanic or other categories using Medicare-assigned race categories. RESULTS A total of 15 870 individuals (50.1% female, mean 72.2±12.7 years) underwent a total of 63 535 TTEs (range 2-55/person) over a median (IQR) follow-up time of 4.9 (2.4-8.5) years. After the index TTE, the median TTE use was 0.72 TTEs/person/year (IQR 0.43-1.33; range 0.12-26.76). TTE use was lower in older individuals (relative risk (RR) for 10-year increase in age, 0.91, 95% CI 0.89 to 0.92, p<0.001), women (RR 0.97, 95% CI 0.95 to 0.99, p<0.001) and non-white individuals (RR 0.95, 95% CI 0.93 to 0.97, p<0.001). Black women in particular had the lowest relative use of TTE (RR 0.92, 95% CI 0.88 to 0.95, p<0.001). The only clinical conditions associated with increased TTE use after multivariable adjustment were heart failure (RR 1.04, 95% CI 1.00 to 1.08, p=0.04) and chronic obstructive pulmonary disease (RR 1.05, 95% CI 1.00 to 1.10, p=0.04). CONCLUSIONS Among Medicare beneficiaries with multiple TTEs in a single large healthcare system, the median TTE use after the index TTE was 0.72 TTEs/person/year, although this varied widely. Adjusted for comorbidities, female sex, non-white race and advancing age were associated with decreased TTE utilisation.
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Affiliation(s)
- Patrick M Hyland
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jiaman Xu
- Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA
| | - Changyu Shen
- Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA
| | - Lawrence J Markson
- Harvard Medical School, Boston, Massachusetts, USA.,Information Systems, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Warren J Manning
- Harvard Medical School, Boston, Massachusetts, USA.,Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jordan B Strom
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA .,Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA
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Fahmy AS, Rowin EJ, Chan RH, Manning WJ, Maron MS, Nezafat R. Improved Quantification of Myocardium Scar in Late Gadolinium Enhancement Images: Deep Learning Based Image Fusion Approach. J Magn Reson Imaging 2021; 54:303-312. [PMID: 33599043 PMCID: PMC8359184 DOI: 10.1002/jmri.27555] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Quantification of myocardium scarring in late gadolinium enhanced (LGE) cardiac magnetic resonance imaging can be challenging due to low scar-to-background contrast and low image quality. To resolve ambiguous LGE regions, experienced readers often use conventional cine sequences to accurately identify the myocardium borders. PURPOSE To develop a deep learning model for combining LGE and cine images to improve the robustness and accuracy of LGE scar quantification. STUDY TYPE Retrospective. POPULATION A total of 191 hypertrophic cardiomyopathy patients: 1) 162 patients from two sites randomly split into training (50%; 81 patients), validation (25%, 40 patients), and testing (25%; 41 patients); and 2) an external testing dataset (29 patients) from a third site. FIELD STRENGTH/SEQUENCE 1.5T, inversion-recovery segmented gradient-echo LGE and balanced steady-state free-precession cine sequences ASSESSMENT: Two convolutional neural networks (CNN) were trained for myocardium and scar segmentation, one with and one without LGE-Cine fusion. For CNN with fusion, the input was two aligned LGE and cine images at matched cardiac phase and anatomical location. For CNN without fusion, only LGE images were used as input. Manual segmentation of the datasets was used as reference standard. STATISTICAL TESTS Manual and CNN-based quantifications of LGE scar burden and of myocardial volume were assessed using Pearson linear correlation coefficients (r) and Bland-Altman analysis. RESULTS Both CNN models showed strong agreement with manual quantification of LGE scar burden and myocardium volume. CNN with LGE-Cine fusion was more robust than CNN without LGE-Cine fusion, allowing for successful segmentation of significantly more slices (603 [95%] vs. 562 (89%) of 635 slices; P < 0.001). Also, CNN with LGE-Cine fusion showed better agreement with manual quantification of LGE scar burden than CNN without LGE-Cine fusion (%ScarLGE-cine = 0.82 × %Scarmanual , r = 0.84 vs. %ScarLGE = 0.47 × %Scarmanual , r = 0.81) and myocardium volume (VolumeLGE-cine = 1.03 × Volumemanual , r = 0.96 vs. VolumeLGE = 0.91 × Volumemanual , r = 0.91). DATA CONCLUSION CNN based LGE-Cine fusion can improve the robustness and accuracy of automated scar quantification. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: 1.
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Affiliation(s)
- Ahmed S. Fahmy
- Department of Medicine (Cardiovascular Division)Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Ethan J. Rowin
- Hypertrophic Cardiomyopathy Center, Division of CardiologyTufts Medical CenterBostonMassachusettsUSA
| | - Raymond H. Chan
- Toronto General HospitalUniversity Health NetworkTorontoCanada
| | - Warren J. Manning
- Department of Medicine (Cardiovascular Division)Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
- RadiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Martin S. Maron
- Hypertrophic Cardiomyopathy Center, Division of CardiologyTufts Medical CenterBostonMassachusettsUSA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division)Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
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Fahmy AS, Rowin EJ, Manning WJ, Maron MS, Nezafat R. Machine Learning for Predicting Heart Failure Progression in Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2021; 8:647857. [PMID: 34055932 PMCID: PMC8155292 DOI: 10.3389/fcvm.2021.647857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Development of advanced heart failure (HF) symptoms is the most common adverse pathway in hypertrophic cardiomyopathy (HCM) patients. Currently, there is a limited ability to identify HCM patients at risk of HF. Objectives: In this study, we present a machine learning (ML)-based model to identify individual HCM patients who are at high risk of developing advanced HF symptoms. Methods: From a consecutive cohort of HCM patients evaluated at the Tufts HCM Institute from 2001 to 2018, we extracted a set of 64 potential risk factors measured at baseline. Only patients with New York Heart Association (NYHA) functional class I/II and LV ejection fraction (LVEF) by echocardiography >35% were included. The study cohort (n = 1,427 patients) was split into three disjoint subsets: development (50%), model selection (10%), and independent validation (40%). The least absolute shrinkage and selection operator was used to select the most influential clinical variables. An ensemble of ML classifiers, including logistic regression, was used to identify patients with high risk of developing a HF outcome. Study outcomes were defined as progression to NYHA class III/IV, drop in LVEF below 35%, septal reduction procedure, and/or heart transplantation. Results: During a mean follow-up of 4.7 ± 3.7 years, advanced HF occurred in 283 (20% out of 1,427) patients. The model features included patients' sex, NYHA class (I or II), HCM type (i.e., obstructive or not), LV wall thickness, LVEF, presence of HF symptoms (e.g., dyspnea, presyncope), comorbidities (atrial fibrillation, hypertension, mitral regurgitation, and systolic anterior motion), and type of cardiac medications. The developed risk stratification model showed strong differentiation power to identify patients at advanced HF risk in the testing dataset (c-statistics = 0.81; 95% confidence interval [CI]: 0.76, 0.86). The model allowed correct identification of high-risk patients with accuracy 74% (CI: 0.70, 0.78), sensitivity 80% (CI: 0.77, 0.83), and specificity 72% (CI: 0.68, 0.76). The model performance was comparable among different sex and age groups. Conclusions: A 5-year risk prediction of progressive HF in HCM patients can be accurately estimated using ML analysis of patients' clinical and imaging parameters. A set of 17 clinical and imaging variables were identified as the most important predictors of progressive HF in HCM.
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Affiliation(s)
- Ahmed S Fahmy
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Ethan J Rowin
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA, United States
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.,Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Martin S Maron
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA, United States
| | - Reza Nezafat
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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Mohebali D, Heidinger BH, Feldman SA, Matos JD, Dabreo D, McCormick I, Litmanovich D, Manning WJ, Carroll BJ. Right ventricular strain in patients with pulmonary embolism and syncope. J Thromb Thrombolysis 2021; 50:157-164. [PMID: 31667788 DOI: 10.1007/s11239-019-01976-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patients with acute pulmonary embolism (PE) can present with various clinical manifestations including syncope. The mechanism of syncope in PE is not fully elucidated and data of right ventricular (RV) function in patients has been limited. We retrospectively identified 477 consecutive patients hospitalized with acute PE diagnosed with a computed tomogram (CT) who also had a transthoracic echocardiogram (TTE) 24 h prior to or 48 h after diagnosis. Parameters of RV strain on CT, TTE, electrocardiogram (ECG), and clinical characteristics and adverse outcomes were collected. Patients with all three studies available for assessment were included (n = 369) and those with syncope (n = 34) were compared to patients without syncope (n = 335). Patients with syncope were more likely to demonstrate RV strain on all three modes of assessment compared to those without syncope [17 (50%) vs. 67 (20%); p = 0.001], and those patients were more likely to receive advanced therapies [9 (53%) vs. 15 (22%); p = 0.02]. PE-related mortality was highest among those presenting with high-risk PE and syncope (36%, OR 20.1, 95% CI 5.3-81.1; p < 0.001) and was low in patients with syncope without criteria for high-risk PE (3%, OR 1.2, 95% CI 0.2-10.0; p < 0.001). In conclusion, acute PE patients with syncope are more likely to demonstrate multimodality evidence of RV strain and to receive advanced therapies. Syncope was only associated with increased PE-related mortality in patients presenting with a high-risk PE. Syncope alone without evidence of RV strain is associated with low short-term adverse events and is similar to those without syncope.
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Affiliation(s)
- Donya Mohebali
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA
| | - Benedikt H Heidinger
- Radiology and Harvard Medical School, Boston, MA, USA.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephanie A Feldman
- Department of Medicine (Section of Cardiovascular Medicine), Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jason D Matos
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA
| | | | - Ian McCormick
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA
| | - Diana Litmanovich
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Radiology and Harvard Medical School, Boston, MA, USA
| | - Warren J Manning
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA.,Radiology and Harvard Medical School, Boston, MA, USA
| | - Brett J Carroll
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA.
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Strom JB, Markson LJ, Tsao CW, Manning WJ. Impact of Redefinition of Normal Limits for Echocardiographic Left Ventricular Ejection Fraction on All-Cause Mortality. J Am Soc Echocardiogr 2021; 34:802-803. [PMID: 33675943 DOI: 10.1016/j.echo.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Jordan B Strom
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Lawrence J Markson
- Information Systems, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Connie W Tsao
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Warren J Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Abstract
There were 79 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2019, including 65 original research papers, 2 reviews, 8 technical notes, 1 Society for Cardiovascular Magnetic Resonacne (SCMR) guideline, and 3 corrections. The volume was down slightly from 2018 (n = 89) with a corresponding 5.5% increase in manuscript submissions from 345 to 366. This led to a slight decrease in the acceptance rate from 25 to 22%. The quality of the submissions continues to be high. The 2019 JCMR Impact Factor (which is published in June 2020) increased from 5.07 to 5.36. The 2020 impact factor means that on average, each JCMR published in 2017 and 2018 was cited 5.36 times in 2019. Our 5 year impact factor was 5.2. We are now finishing the 13th year of JCMR as an open-access publication with BMC. As outlined in this report, the Open-Access system has dramatically increased the reading and citation of JCMR publications. I hope that our authors will continue to send their very best, high quality manuscripts for JCMR consideration and that our readers will continue to look to JCMR for the very best/state-of-the-art publications in our field. It takes a village to run a journal. JCMR is blessed to have very dedicated Associate Editors, Guest Editors, and Reviewers. I thank each of them for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. My role, and the entire process would not be possible without the dedication and efforts of our managing editor, Diana Gethers (who will leaving the journal in the coming months) and our assistant managing editor, Jennifer Rodriguez, who has agreed to increase her reponsibilities. Finally, I thank you for entrusting me with the editorship of the JCMR. As I begin my 5th year as your editor-in-chief, please know that I fully recognize we are not perfect in our review process. We try our best to objectively assess every submission in a timely manner, but sometimes don't get it "right." The editorial process is a tremendously fulfilling experience for me. The opportunity to review manuscripts that reflect the best in our field remains a great joy and a highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
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Hammond MM, Shen C, Li S, Kazi DS, Sabe MA, Garan AR, Markson LJ, Manning WJ, Klein AL, Nagueh SF, Strom JB. Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience. PLoS One 2020; 15:e0244379. [PMID: 33351853 PMCID: PMC7755281 DOI: 10.1371/journal.pone.0244379] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/08/2020] [Indexed: 01/28/2023] Open
Abstract
Background Limited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function. Methods We linked 15 years of TTE report data (1/6/2003-5/3/2018) at Beth Israel Deaconess Medical Center to complete Medicare claims. In those with recent HF, we evaluated the relationship between variables on baseline TTE and HF readmission, stratified by LVEF. Results After excluding TTEs with uninterpretable diastology, 5,900 individuals (mean age: 76.9 years; 49.1% female) were included, of which 2545 individuals (41.6%) were admitted for HF. Diastolic variables augmented prediction compared to demographics, comorbidities, and echocardiographic structural variables (p < 0.001), though discrimination was modest (c-statistic = 0.63). LV dimensions and eccentric hypertrophy predicted HF in HF with reduced (HFrEF) but not preserved (HFpEF) systolic function, whereas LV wall thickness, NT-proBNP, pulmonary vein D- and Ar-wave velocities, and atrial dimensions predicted HF in HFpEF but not HFrEF (all interaction p < 0.10). Prediction of HF readmission was not different in HFpEF and HFrEF (p = 0.93). Conclusions In this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF. Regardless of LVEF, diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone. The additional role of medication adherence, readmission history, and functional status in differential prediction of HF readmission by LVEF category should be considered for future study.
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Affiliation(s)
- Michael M. Hammond
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Changyu Shen
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Stephanie Li
- Harvard Medical School, Boston, MA, United States of America
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Dhruv S. Kazi
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Marwa A. Sabe
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - A. Reshad Garan
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Lawrence J. Markson
- Harvard Medical School, Boston, MA, United States of America
- Information Systems, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Warren J. Manning
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Allan L. Klein
- The Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States of America
| | - Sherif F. Nagueh
- Department of Cardiology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, United States of America
| | - Jordan B. Strom
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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Hajhosseiny R, Bustin A, Munoz C, Rashid I, Cruz G, Manning WJ, Prieto C, Botnar RM. Coronary Magnetic Resonance Angiography: Technical Innovations Leading Us to the Promised Land? JACC Cardiovasc Imaging 2020; 13:2653-2672. [PMID: 32199836 DOI: 10.1016/j.jcmg.2020.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 05/24/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 02/07/2023]
Abstract
Coronary artery disease remains the leading cause of cardiovascular morbidity and mortality. Invasive X-ray angiography and coronary computed tomography angiography are established gold standards for coronary luminography. However, they expose patients to invasive complications, ionizing radiation, and iodinated contrast agents. Among a number of imaging modalities, coronary cardiovascular magnetic resonance (CMR) angiography may be used in some cases as an alternative for the detection and monitoring of coronary arterial stenosis, with advantages including its versatility, excellent soft tissue characterization, and avoidance of ionizing radiation and iodinated contrast agents. In this review, we explore the recent advances in motion correction, image acceleration, and reconstruction technologies that are bringing coronary CMR angiography closer to widespread clinical implementation.
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Affiliation(s)
- Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Aurelien Bustin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Camila Munoz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Imran Rashid
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Gastao Cruz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Warren J Manning
- Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Heidinger BH, DaBreo D, Kirkbride RR, Santos M, Carroll BJ, Feldman SA, Mohebali D, McCormick I, Matos JD, Manning WJ, Litmanovich DE. Correction to: Risk assessment of acute pulmonary embolism utilizing coronary artery calcifications in patients that have undergone CT pulmonary angiography and transthoracic echocardiography. Eur Radiol 2020; 31:4395. [PMID: 33201288 DOI: 10.1007/s00330-020-07442-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Benedikt H Heidinger
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Dominique DaBreo
- Cardiothoracic Radiology, Department of Radiology, Queen's University, Kingston, Ontario, Canada
| | - Rachael R Kirkbride
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Mario Santos
- Cardiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Brett J Carroll
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie A Feldman
- Department of Medicine (Section of Cardiovascular Medicine), Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Donya Mohebali
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ian McCormick
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jason D Matos
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Warren J Manning
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Diana E Litmanovich
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
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Strom JB, Gelfand EV, Markson LJ, Tsao CA, Manning WJ. Relation of Transthoracic Echocardiographic Aortic Regurgitation to Pressure Half-time and All-Cause Mortality. Am J Cardiol 2020; 135:113-119. [PMID: 32861736 DOI: 10.1016/j.amjcard.2020.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022]
Abstract
To evaluate the relation of aortic regurgitation (AR) pressure half-time (PHT) on transthoracic echocardiography (TTE) and all-cause mortality, we screened 118,647 baseline TTE reports from 2000 to 2017, to identify patients with any AR and PHT data. Patients with infective endocarditis or previous aortic valve replacement were excluded. The relation of baseline PHT on time to all-cause mortality was evaluated using Cox regression. A total of 2,653 patients were included (73.1 ± 14.3 years; 53.8% female; PHT, 530 ± 162 ms). Patients with shorter PHTs more frequently had 3-4+ AR (PHT ≤ 200 ms vs > 500 ms, 17.9% vs 0.6%, p < 0.0001). Diastolic parameters (E/e', E/A ratio, mitral valve deceleration time, and pulmonary artery systolic pressure) all significantly correlated with PHT (all p < 0.05). Over a median (IQR) follow-up of 8 (4 to 11 years), there were 799 (30.1%) deaths at a median (IQR) of 1.9 (0.4 to 4.3) years. On a univariate basis, a PHT ≤ 320 ms or > 750 ms was significantly related to increased mortality, even amongst those with nonsevere AR. After multivariable adjustment (in particular for E/e'), PHT was no longer significantly related to death. In conclusion, in this large, single center, retrospective study, AR PHT was not independently related to mortality. While a PHT ≤ 320 ms was associated with increased mortality in patients without severe AR, this relation was no longer significant after adjusting for diastolic functional variables. Thus, a PHT ≤ 320 ms in patients without significant AR may indicate prognostically-relevant diastolic dysfunction.
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Affiliation(s)
- Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts; Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Eli V Gelfand
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Lawrence J Markson
- Harvard Medical School, Boston, Massachusetts; Information Systems, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Connie A Tsao
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Warren J Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Lorinsky MK, Belanger MJ, Shen C, Markson LJ, Delling FN, Manning WJ, Strom JB. Characteristics and Significance of Tricuspid Valve Prolapse in a Large Multidecade Echocardiographic Study. J Am Soc Echocardiogr 2020; 34:30-37. [PMID: 33071045 DOI: 10.1016/j.echo.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/21/2020] [Revised: 06/17/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Characteristics of tricuspid valve prolapse (TVP) on transthoracic echocardiography are not well defined. As tricuspid valve interventions are increasingly considered, information on the definition and clinical significance of TVP is needed. METHODS At the authors' institution, between January 26, 2000, and September 20, 2018, 410 patients (0.3%) were determined to have suspected TVP. These transthoracic echocardiograms and those of 97 age- and sex-matched normal control subjects were reviewed. Interrater agreement on TVP by visual inspection was assessed in a blinded subset. Leaflet atrial displacement (AD) > 2 SDs above the mean in normal control subjects was used to identify an empiric definition of TVP Features of patients meeting this definition were evaluated. RESULTS Three hundred twelve transthoracic echocardiograms with available and interpretable images (76.1%) were included. Interrater agreement on TVP diagnosis by visual inspection was moderate. Normal values of AD were up to 4 mm in the right ventricular inflow view and 2 mm in all other views. AD > 2 mm in the parasternal short-axis view had the best accuracy against suspected TVP to identify TVP. Those with TVP by this definition more frequently had 3 to 4+ tricuspid regurgitation (22.2% vs 3.1%; P < .001), mitral valve prolapse (MVP; 75.0% vs 3.1%; P < .001), and more clinically significant MVP (greater prevalence of 3 to 4+ mitral regurgitation). No difference in mortality was observed in those with isolated TVP versus TVP and MVP (log-rank P = .93). CONCLUSIONS In the largest study of TVP to date, interrater agreement on TVP diagnosis by visual inspection was moderate. A cutoff of >2-mm AD in the parasternal short-axis view was optimal to define TVP. Those with TVP by this definition had more significant tricuspid regurgitation, larger right ventricles, and more clinically significant MVP. Overall, these results suggest an increased role for surveillance for TVP and the need for clear diagnostic criteria in updated guidelines.
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Affiliation(s)
- Michael K Lorinsky
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matthew J Belanger
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts; Cardiovascular Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lawrence J Markson
- Information Systems, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Francesca N Delling
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Warren J Manning
- Cardiovascular Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts; Cardiovascular Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Csecs I, Pashakhanloo F, Paskavitz A, Jang J, Al-Otaibi T, Neisius U, Manning WJ, Nezafat R. Association Between Left Ventricular Mechanical Deformation and Myocardial Fibrosis in Nonischemic Cardiomyopathy. J Am Heart Assoc 2020; 9:e016797. [PMID: 33006296 PMCID: PMC7792406 DOI: 10.1161/jaha.120.016797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In patients with nonischemic cardiomyopathy, nonischemic fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is related to adverse cardiovascular outcomes. However, its relationship with left ventricular (LV) mechanical deformation parameters remains unclear. We sought to investigate the association between LV mechanics and the presence, location, and extent of fibrosis in patients with nonischemic cardiomyopathy. Methods and Results We retrospectively identified 239 patients with nonischemic cardiomyopathy (67% male; 55±14 years) referred for a clinical cardiovascular magnetic resonance. LGE was present in 109 patients (46%), most commonly (n=52; 22%) in the septum. LV deformation parameters did not differentiate between LGE‐positive and LGE‐negative groups. Global longitudinal, radial, and circumferential strains, twist and torsion showed no association with extent of fibrosis. Patients with septal fibrosis had a more depressed LV ejection fraction (30±12% versus 35±14%; P=0.032) and more impaired global circumferential strain (−7.9±3.5% versus −9.7±4.4%; P=0.045) and global radial strain (10.7±5.2% versus 13.3±7.7%; P=0.023) than patients without septal LGE. Global longitudinal strain was similar in both groups. While patients with septal‐only LGE (n=28) and free wall–only LGE (n=32) had similar fibrosis burden, the septal‐only LGE group had more impaired LV ejection fraction and global circumferential, longitudinal, and radial strains (all P<0.05). Conclusions There is no association between LV mechanical deformation parameters and presence or extent of fibrosis in patients with nonischemic cardiomyopathy. Septal LGE was associated with poor global LV function, more impaired global circumferential and radial strains, and more impaired global strain rates.
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Affiliation(s)
- Ibolya Csecs
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Farhad Pashakhanloo
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Amanda Paskavitz
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Jihye Jang
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Talal Al-Otaibi
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Ulf Neisius
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Warren J Manning
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Reza Nezafat
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
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Kucukseymen S, Yavin H, Barkagan M, Jang J, Shapira-Daniels A, Rodriguez J, Shim D, Pashakhanloo F, Pierce P, Botzer L, Manning WJ, Anter E, Nezafat R. Discordance in Scar Detection Between Electroanatomical Mapping and Cardiac MRI in an Infarct Swine Model. JACC Clin Electrophysiol 2020; 6:1452-1464. [DOI: 10.1016/j.jacep.2020.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/29/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022]
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Mukhopadhyay A, Shen C, Kiefer N, Kriegel A, Ali K, Manning WJ. Evaluating Syncope. JACC Cardiovasc Imaging 2020; 13:2260-2262. [DOI: 10.1016/j.jcmg.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 10/23/2022]
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Tsao CW, Manning WJ. Response by Tsao and Manning to Letter Regarding Article, “COVID-19-Associated Stress (Takotsubo) Cardiomyopathy”. Circ Cardiovasc Imaging 2020; 13:e011614. [DOI: 10.1161/circimaging.120.011614] [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: 11/16/2022]
Affiliation(s)
- Connie W. Tsao
- Department of Medicine, Cardiovascular Division (C.W.T., W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA (C.W.T., W.J.M.)
| | - Warren J. Manning
- Department of Medicine, Cardiovascular Division (C.W.T., W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
- Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA (C.W.T., W.J.M.)
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Fraiche AM, Manning WJ, Nagueh SF, Main ML, Markson LJ, Strom JB. Identification of Need for Ultrasound Enhancing Agent Study (the IN-USE Study). J Am Soc Echocardiogr 2020; 33:1500-1508. [PMID: 32919859 DOI: 10.1016/j.echo.2020.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ultrasound enhancing agents (UEAs) are routinely used to improve transthoracic echocardiographic (TTE) image quality, yet anticipation of UEA need is a barrier to their use. METHODS Structured report data from 171,509 consecutive TTE studies in 97,515 patients who underwent TTE imaging from January 26, 2000, to September 20, 2018, were analyzed. Trends in UEA use and suboptimal image quality were examined. Among outpatients (92,291 TTE examinations, n = 56,479), the data set was randomly split into a 75% derivation sample and a 25% validation sample. Logistic regression was used to model the composite of either UEA receipt or suboptimal image quality (two or more nonvisualized segments) using only variables available at the start of the TTE examination. Model performance was tested in the validation sample. RESULTS A total of 4,444 TTE examinations (2.6%) in 3,827 patients (3.9%) involved UEAs, and 28,468 TTE examinations (16.6%) in 21,994 patients (22.5%) were suboptimal. UEA use increased over the observation period. Among TTE studies with suboptimal image quality, UEA use was lower in women (P < .0001). Among outpatients referred for TTE imaging, older age, greater weight, and higher heart rate best predicted UEA use or suboptimal image quality. Model performance in the validation sample was excellent (C statistic = 0.74 [95% CI, 0.73-0.75]; calibration slope = 1.11 [95% CI, 1.06-1.15]). CONCLUSIONS In this large, single-center, retrospective study, UEA use remained substantially below rates of suboptimal image quality, despite increases over time. Among outpatients, a simple prediction rule using three routinely collected variables available before TTE image acquisition predicted potential benefit from UEAs with high accuracy. If confirmed in other cohorts, this rule may be used to identify patients who may benefit from intravenous placement for UEA administration before TTE image acquisition, thus potentially improving work-flow efficiency.
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Affiliation(s)
- Ariane M Fraiche
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sherif F Nagueh
- Division of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Michael L Main
- St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Lawrence J Markson
- Information Systems, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jordan B Strom
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Allen BD, Wong TC, Bucciarelli-Ducci C, Bryant J, Chen T, Dall'Armellina E, Finn JP, Fontana M, Francone M, Han Y, Hays AG, Jacob R, Lawton C, Manning WJ, Ordovas K, Parwani P, Plein S, Powell AJ, Raman SV, Salerno M, Carr JC. Society for Cardiovascular Magnetic Resonance (SCMR) guidance for re-activation of cardiovascular magnetic resonance practice after peak phase of the COVID-19 pandemic. J Cardiovasc Magn Reson 2020; 22:58. [PMID: 32772930 PMCID: PMC7415346 DOI: 10.1186/s12968-020-00654-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/12/2020] [Indexed: 12/23/2022] Open
Abstract
During the peak phase of the COVID-19 pandemic, alterations of standard operating procedures were necessary for health systems to protect patients and healthcare workers and ensure access to vital hospital resources. As the peak phase passes, re-activation plans are required to safely manage increasing clinical volumes. In the context of cardiovascular magnetic resonance (CMR), re-activation objectives include continued performance of urgent CMR studies and resumption of CMR in patients with semi-urgent and elective indications in an environment that is safe for both patients and health care workers.
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Affiliation(s)
- Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Timothy C Wong
- Department of Medicine (Cardiology), University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Jennifer Bryant
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Tiffany Chen
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - J Paul Finn
- Departments of Radiology and Medicine, UCLA, Los Angeles, California, USA
| | | | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Yuchi Han
- Departments of Medicine (Cardiovascular Division) and Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison G Hays
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ron Jacob
- The Heart and Vascular Institute, Lancaster General Health/PENN Medicine, Lancaster, PA, USA
| | - Chris Lawton
- Bristol Heart Institute, Bristol NIHR Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Warren J Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Karen Ordovas
- Departments of Radiology and Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Purvi Parwani
- Department of Medicine (Cardiology), Loma Linda University, Loma Linda, California, USA
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael Salerno
- Departments of Medicine, Radiology, and Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Affiliation(s)
- Connie W Tsao
- Department of Medicine, Cardiovascular Division (C.W.T., J.B.S., J.D.C., W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (C.W.T., J.B.S., J.D.C., W.J.M.)
| | - Jordan B Strom
- Department of Medicine, Cardiovascular Division (C.W.T., J.B.S., J.D.C., W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (C.W.T., J.B.S., J.D.C., W.J.M.)
| | - James D Chang
- Department of Medicine, Cardiovascular Division (C.W.T., J.B.S., J.D.C., W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (C.W.T., J.B.S., J.D.C., W.J.M.)
| | - Warren J Manning
- Department of Medicine, Cardiovascular Division (C.W.T., J.B.S., J.D.C., W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA.,Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (C.W.T., J.B.S., J.D.C., W.J.M.)
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Nakamori S, Ngo LH, Rodriguez J, Neisius U, Manning WJ, Nezafat R. T 1 Mapping Tissue Heterogeneity Provides Improved Risk Stratification for ICDs Without Needing Gadolinium in Patients With Dilated Cardiomyopathy. JACC Cardiovasc Imaging 2020; 13:1917-1930. [PMID: 32653543 DOI: 10.1016/j.jcmg.2020.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 10/16/2019] [Revised: 02/27/2020] [Accepted: 03/27/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study sought to determine whether myocardial tissue heterogeneity scanned by native T1 mapping could improve risk stratification in patients with nonischemic dilated cardiomyopathy (NICM) evaluated for primary prevention by ICD. BACKGROUND The benefit of insertable cardiac-defibrillator (ICD) as primary prevention ICD in patients with NICM remains to be fully clarified. METHODS A total of 115 NICM candidates for primary prevention and 55 healthy controls with similar distributions of age and sex were prospectively enrolled. Imaging was performed at 1.5-T using a protocol that included cine magnetic resonance for left ventricular function, late gadolinium enhancement (LGE) for focal scarring, and 5-slice native T1 mapping for diffuse fibrosis and heterogeneity. The last method was assessed by mean absolute deviation of the segmental pixel-SD from the average pixel-SD (Mad-SD). The primary endpoint was a composite of appropriate ICD therapy and sudden cardiac death. RESULTS During a median follow-up of 24 months, 13 patients (11%) experienced the primary endpoint. Dichotomized Mad-SD >0.24 provided a comparable outcome to the presence of LGE for the primary endpoint (annual event rate: 9.8% vs. 10.9%). The integration of Mad-SD to global native T1 showed excellent arrhythmic event-free survival (annual event rate: 0%), and high sensitivity of 85% (95% confidence interval [CI]: 55% to 98%) and moderate specificity of 72% (95% CI: 62% to 80%), with a C-statistic of 0.76 (95% CI: 0.64 to 0.87), which was comparable to the presence, location, or extent of LGE in its ability to predict arrhythmic events. CONCLUSIONS Combined myocardium tissue heterogeneity and interstitial fibrosis assessment by native T1 mapping is an important predictor of ventricular tachycardia and ventricular fibrillation and provides additive risk stratification for primary prevention ICD in NICM patients without the need for gadolinium contrast.
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Affiliation(s)
- Shiro Nakamori
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Long H Ngo
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Rodriguez
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Ulf Neisius
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Warren J Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Reza Nezafat
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Nakamori S, Neisius U, Nezafat M, Jang J, Ngo LH, Rodriguez J, Manning WJ, Nezafat R. Multiparametric Mapping Approach for Detection of Cardiac Involvement in Systemic Sarcoidosis. JACC Cardiovasc Imaging 2020; 13:2058-2060. [PMID: 32563633 DOI: 10.1016/j.jcmg.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022]
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Matos JD, Balachandran I, Heidinger BH, Mohebali D, Feldman SA, McCormick I, Litmanovich D, Manning WJ, Carroll BJ. Mitral annular plane systolic excursion and tricuspid annular plane systolic excursion for risk stratification of acute pulmonary embolism. Echocardiography 2020; 37:1008-1013. [DOI: 10.1111/echo.14761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jason D. Matos
- Departments of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
- Cardiovascular Division Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Isabel Balachandran
- Departments of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Benedikt H. Heidinger
- Departments of Radiology Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
- Department of Biomedical Imaging and Image‐guided Therapy Medical University of Viena Vienna Austria
| | - Donya Mohebali
- Departments of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
- Cardiovascular Division Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Stephanie A. Feldman
- Department of Medicine Boston University School of MedicineBoston Medical Center Boston MA USA
- Section of Cardiovascular Medicine Boston University School of MedicineBoston Medical Center Boston MA USA
| | - Ian McCormick
- Departments of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
- Cardiovascular Division Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Diana Litmanovich
- Departments of Radiology Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Warren J. Manning
- Departments of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
- Cardiovascular Division Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
- Departments of Radiology Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Brett J. Carroll
- Departments of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
- Cardiovascular Division Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
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Han Y, Chen T, Bryant J, Bucciarelli-Ducci C, Dyke C, Elliott MD, Ferrari VA, Friedrich MG, Lawton C, Manning WJ, Ordovas K, Plein S, Powell AJ, Raman SV, Carr J. Society for Cardiovascular Magnetic Resonance (SCMR) guidance for the practice of cardiovascular magnetic resonance during the COVID-19 pandemic. J Cardiovasc Magn Reson 2020; 22:26. [PMID: 32340614 PMCID: PMC7184243 DOI: 10.1186/s12968-020-00628-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023] Open
Abstract
The aim of this document is to provide general guidance and specific recommendations on the practice of cardiovascular magnetic resonance (CMR) in the era of the COVID-19 pandemic. There are two major considerations. First, continued urgent and semi-urgent care for the patients who have no known active COVID-19 should be provided in a safe manner for both patients and staff. Second, when necessary, CMR on patients with confirmed or suspected active COVID-19 should focus on the specific clinical question with an emphasis on myocardial function and tissue characterization while optimizing patient and staff safety.
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Affiliation(s)
- Yuchi Han
- Departments of Medicine (Cardiovascular Division) and Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Tiffany Chen
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Jennifer Bryant
- National Heart Research Institute Singaore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | | | | | - Victor A. Ferrari
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Matthias G. Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, Canada
| | - Chris Lawton
- Bristol Heart Institute, Bristol NIHR Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Warren J. Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Karen Ordovas
- Departments of Radiology and Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Sven Plein
- Leeds Institute for Genetics Health and Therapeutics & Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Andrew J. Powell
- Department of Cardiology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Subha V. Raman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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Khan MS, Hayat J, Marsia S, Yamani N, Doukky R, Butler J, Manning WJ, Mookadam F, Khosa F. How well do we represent ourselves: an analysis of cardiology fellowships website content. Future Cardiol 2020; 16:281-287. [PMID: 32314590 DOI: 10.2217/fca-2019-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The Internet is the primary source of information for prospective cardiology fellowship aspirants. The objective of this study was to evaluate cardiology fellowship programs' online profile. Materials & methods: Two independent reviewers accessed 221 US based cardiology fellowship program websites obtained through Fellowship and Residency Electronic Interactive Database for pre-selected 20 criteria. The update status of websites was assessed using 6-point criteria. Results: Only 25 (11.3%) websites were fully up-to-date; 23 (10.4%) fulfilled 80% of the 20-point criteria and 85 (38.5%) program websites had fewer than 50% of the criteria listed. Conclusion: Most cardiology fellowship program websites lack crucial details. In this technology driven age, efforts should be made to ensure updated websites.
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Affiliation(s)
- Muhammad Shahzeb Khan
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Javeria Hayat
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Shayan Marsia
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Naser Yamani
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Rami Doukky
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MI 39216, USA
| | - Warren J Manning
- Cardiovascular Division, Beth Israel Deaconess Medical Center & Department of Medicine, Harvard Medical School, Boston, MA 02120, USA
| | - Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Faisal Khosa
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Bakker JP, Baltzis D, Tecilazich F, Chan RH, Manning WJ, Neilan TG, Wallace ML, Hudson M, Malhotra A, Patel SR, Veves A. The Effect of Continuous Positive Airway Pressure on Vascular Function and Cardiac Structure in Diabetes and Sleep Apnea. A Randomized Controlled Trial. Ann Am Thorac Soc 2020; 17:474-483. [PMID: 31922899 PMCID: PMC7175977 DOI: 10.1513/annalsats.201905-378oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
Rationale: Although both type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are independently recognized as risk factors for cardiovascular disease, little is known about their interaction.Objectives: We hypothesized that T2DM and OSA act synergistically to increase vascular risk, and that treatment of OSA would improve vascular reactivity in patients with T2DM plus OSA.Methods: Cross-sectional study of 141 adults with T2DM, OSA, T2DM plus OSA, and control subjects, followed by a 3-month, parallel-arm, randomized, placebo-controlled trial comparing active and sham continuous positive airway pressure (CPAP) in 53 adults with T2DM plus OSA. Endothelium-dependent macro- and microvascular reactivity (flow-mediated dilation [FMD] of the brachial artery and acetylcholine-induced dilation of forearm microvasculature, respectively) and cardiovascular magnetic resonance to assess left- and right-ventricular mass/volume.Results: Mean (±SD) FMD was 6.1 (±4.0)%, 7.3 (±3.6)%, 6.8 (±4.5)%, and 4.8 (±2.9)% in control subjects, T2DM only, OSA only, and T2DM plus OSA, respectively. We observed a significant T2DM × OSA interaction on FMD, such that the mean effect of OSA in those with T2DM was 3.1% (95% confidence interval [CI], 0.6 to 5.6) greater than the effect of OSA in those without T2DM. A total of 3 months of CPAP resulted in a mean absolute increase in FMD of 0.3% (95% CI, -1.9 to 2.5; primary endpoint), with a net improvement of 1.1% (95% CI, -1.4 to 3.6) among those with adherence of 4 h/night or greater. A significant T2DM × OSA interaction was found for both left ventricular (LV) and right ventricular end-diastolic volume, such that OSA was associated with a 22.4 ml (95% CI, 3.2 to 41.6) greater LV end-diastolic volume and 23.2 ml (95% CI, 2.6 to 43.8) greater right ventricular end-diastolic volume in those with T2DM compared with the impact of OSA in those without T2DM. We observed a net improvement in LV end-diastolic volume of 8.7 ml (95% CI, -7.0 to 24.4).Conclusions: The combination of T2DM plus OSA is associated with macrovascular endothelial dysfunction beyond that observed with either disease alone. CPAP for 3 months did not significantly improve macrovascular endothelial function in the intent-to-treat analysis; however, cardiovascular magnetic resonance results suggest that there may be a beneficial effect of CPAP on LV diastolic volume.Clinical trial registered with www.clinicaltrials.gov (NCT01629862).
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Affiliation(s)
- Jessie P. Bakker
- Division of Sleep & Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Dimitrios Baltzis
- The Rongxiang Xu MD Center for Regenerative Therapeutics
- Microcirculation Laboratory
- Diabetes–Diabetic Foot Center, Mouwasat Hospital, Khobar, Kingdom of Saudi Arabia
| | - Francesco Tecilazich
- The Rongxiang Xu MD Center for Regenerative Therapeutics
- Microcirculation Laboratory
- Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Hospital, Milan, Italy
| | - Raymond H. Chan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cardiovascular Division, and
| | - Warren J. Manning
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cardiovascular Division, and
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Tomas G. Neilan
- Division of Cardiology, Department of Medicine and the Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Margo Hudson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts and
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, San Diego, California
| | - Sanjay R. Patel
- Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aristidis Veves
- The Rongxiang Xu MD Center for Regenerative Therapeutics
- Microcirculation Laboratory
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