1
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Chia KSW, Shiner CT, Brown K, Holloway CJ, Moreyra C, Bart N, Wong PKK, Faux SG, Kotlyar E. The exercise in pulmonary arterial hypertension (ExPAH) study: a randomised controlled pilot of exercise training and multidisciplinary rehabilitation in pulmonary arterial hypertension. Pulm Circ 2022; 12:e12069. [PMID: 35795491 PMCID: PMC9248794 DOI: 10.1002/pul2.12069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- KSW Chia
- St Vincent's Clinical School, UNSWSydneyAustralia
- Department of Rehabiliation Medicine, St Vincent's HospitalSydneyNSWAustralia
- UNSW Rural Clinical School, Coffs HarbourNSWAustralia
| | - CT Shiner
- St Vincent's Clinical School, UNSWSydneyAustralia
- Department of Rehabiliation Medicine, St Vincent's HospitalSydneyNSWAustralia
| | - K Brown
- Department of Cardiology, St Vincent's HospitalSydneyNSWAustralia
| | - CJ Holloway
- Department of Cardiology, St Vincent's HospitalSydneyNSWAustralia
| | - C Moreyra
- Department of Cardiology, St Vincent's HospitalSydneyNSWAustralia
| | - N Bart
- Department of Cardiology, St Vincent's HospitalSydneyNSWAustralia
| | - PKK Wong
- UNSW Rural Clinical School, Coffs HarbourNSWAustralia
| | - SG Faux
- St Vincent's Clinical School, UNSWSydneyAustralia
- Department of Rehabiliation Medicine, St Vincent's HospitalSydneyNSWAustralia
| | - E Kotlyar
- Department of Cardiology, St Vincent's HospitalSydneyNSWAustralia
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2
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Krishnan A, Ellenberger KA, Phetsouphanh C, Kelleher AP, Matthews GV, Darley DR, Holloway CJ. Myocardial fibrosis occurs in non-hospitalised patients with chronic symptoms after COVID-19. Int J Cardiol Heart Vasc 2022; 39:100964. [PMID: 35097185 PMCID: PMC8789662 DOI: 10.1016/j.ijcha.2022.100964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 10/31/2022]
Affiliation(s)
- A Krishnan
- St Vincent's Hospital, Sydney, NSW, Australia
| | | | - C Phetsouphanh
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - A P Kelleher
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - G V Matthews
- St Vincent's Hospital, Sydney, NSW, Australia.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - D R Darley
- St Vincent's Hospital, Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - C J Holloway
- St Vincent's Hospital, Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
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3
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Nadel J, Holloway CJ. Closing the gap on rheumatic heart disease. Int J Cardiol 2020; 326:153-154. [PMID: 33160963 DOI: 10.1016/j.ijcard.2020.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 11/15/2022]
Affiliation(s)
- James Nadel
- St Vincent's Hospital, Darlinghurst, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | - Cameron J Holloway
- St Vincent's Hospital, Darlinghurst, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, Australia.
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4
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McGrath-Cadell L, Bart NK, Lin L, Ghaly S, Holloway CJ. Myocarditis in Crohn's disease: a case report. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 32974475 PMCID: PMC7501932 DOI: 10.1093/ehjcr/ytaa120] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/30/2019] [Accepted: 04/21/2020] [Indexed: 12/21/2022]
Abstract
Background Mobile valvular masses are often considered pathognomonic for infective endocarditis. We present a case of a young patient with mobile valvular masses in the context of myocarditis likely secondary to active ileal Crohn's disease. Cardiac magnetic resonance (CMR) imaging was crucial in diagnosing and monitoring our patient. Case summary A 27-year-old woman presented with pleuritic chest pain, dyspnoea, and a 3-day history of fevers. She also reported a 2-month history of intermittent visual loss in her right eye. She had a history of histologically proven ileal Crohn's disease, diagnosed 5 months prior. She was haemodynamically unstable on presentation. Abnormalities on a transthoracic echocardiogram necessitated a transoesophageal echocardiogram. After blood cultures were sent, the patient was commenced on empirical treatment for infective endocarditis with gentamicin and flucloxacillin. Eight days after her initial presentation, all blood cultures remained negative and she was changed to empirical treatment for culture negative endocarditis with ceftriaxone and vancomycin, according to local protocol. Despite 8 days of treatment for infective endocarditis she remained febrile. A CMR was organized on Day 9 and this showed myocarditis, which changed the treatment paradigm. She responded swiftly to steroids and anti-coagulation. Discussion In this case, echo-dense valvular lesions are not pathognomonic for infective endocarditis and a careful diagnostic process involving multi-modality imaging, including CMR, occurred to arrive at a diagnosis of myocarditis likely secondary to Crohn's disease.
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Affiliation(s)
- Lucy McGrath-Cadell
- Department of Cardiology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, 2010 NSW, Australia.,University of New South Wales, St Vincent's Clinical School, St Vincent's Hospital Campus, Darlinghurst, Sydney, 2010 NSW, Australia
| | - Nicole K Bart
- Department of Cardiology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, 2010 NSW, Australia
| | - Linda Lin
- Department of Cardiology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, 2010 NSW, Australia
| | - Simon Ghaly
- University of New South Wales, St Vincent's Clinical School, St Vincent's Hospital Campus, Darlinghurst, Sydney, 2010 NSW, Australia.,Department of Gastroenterology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, 2010 NSW, Australia
| | - Cameron J Holloway
- Department of Cardiology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, 2010 NSW, Australia.,University of New South Wales, St Vincent's Clinical School, St Vincent's Hospital Campus, Darlinghurst, Sydney, 2010 NSW, Australia.,Victor Chang Cardiac Research Institute, Lowy Packer Building, 405 Liverpool Street, Darlinghurst, Sydney, 2010 NSW, Australia
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5
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Situ Y, Lin L, Emmanuel S, Subbiah R, Watson B, Namasivayam M, McCrohon J, Jabbour A, Holloway CJ. The Usefulness of Cardiovascular Magnetic Resonance in the Assessment of Patients Before Pacemaker Implantation. JACC Cardiovasc Imaging 2020; 14:305-306. [PMID: 32950453 DOI: 10.1016/j.jcmg.2020.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/01/2022]
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6
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Abstract
Cardiovascular magnetic resonance (CMR) has increasingly become a powerful imaging technique over the past few decades due to increasing knowledge about clinical applications, operator experience and technological advances, including the introduction of high field strength magnets, leading to improved signal-to-noise ratio. Its success is attributed to the free choice of imaging planes, the wide variety of imaging techniques, and the lack of harmful radiation. Developments in CMR have led to the accurate evaluation of cardiac structure, function and tissues characterisation, so this non-invasive technique has become a powerful tool for a broad range of cardiac pathologies. This review will provide an introduction of magnetic resonance imaging (MRI) physics, an overview of the current techniques and clinical application of CMR in structural heart disease, and illustrated examples of its use in clinical practice.
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Affiliation(s)
- Yiling Situ
- St Vincent's Hospital Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Kensington, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | | | - Camila Moreyra
- St Vincent's Hospital Sydney, New South Wales, Australia
| | - Cameron J Holloway
- St Vincent's Hospital Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Kensington, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia
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7
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Emmanuel S, Nadel J, Fagan D, Teeraananchai S, Law M, Holloway CJ. Patients with HIV and coronary disease: are we meeting national guidelines? Sex Health 2019; 15:83-85. [PMID: 28724498 DOI: 10.1071/sh17035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/22/2017] [Indexed: 11/23/2022]
Abstract
Cardiovascular disease (CVD) has a higher incidence in patients with HIV infection. This study sought to determine whether HIV-infected patients with established CVD were being managed according to national guidelines. Data were collected from Australian general practitioners for 77 HIV-infected patients with a median age of 59 (range 54-64). There was good adherence to guidelines with regards to anti-platelet (84%; n=65; 95% confidence interval (CI) 74-92%) and statin therapy (97%; n=75; 95% CI 91-100%), despite a failure to meet cholesterol targets, with only 31% (n=24; 95% CI 21-42%) of the cohort meeting low-density lipoprotein target values. Similarly, there was limited adherence to guidelines regarding the prescriptions of medications for those with established hypertension (66%; n=51; 95% CI 55-77%), body mass index targets met (40%; n=31; 95% CI 29-52%), and depression screening (32%; n=25; 95% CI 22-44%). This Australian audit provides insight into adherence to guidelines for individuals with CVD and HIV, suggesting that current screening and management practices for these patients falls short of guidelines, particularly in relation to cholesterol management.
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Affiliation(s)
- Sam Emmanuel
- St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - James Nadel
- St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Damien Fagan
- Gilead Sciences, 417St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Sirinya Teeraananchai
- Kirby Institute, University of New South Wales, High Street, Kensington, NSW 2052, Australia
| | - Matthew Law
- Kirby Institute, University of New South Wales, High Street, Kensington, NSW 2052, Australia
| | - Cameron J Holloway
- St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
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8
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Affiliation(s)
- James Iliff
- Department of Cardiology (J.I., N.K.B., C.J.H.), University of New South Wales, Sydney, Australia
| | - Nicole K Bart
- Department of Cardiology (J.I., N.K.B., C.J.H.), University of New South Wales, Sydney, Australia.,St Vincent's Clinical School (N.K.B., S.G., C.J.H.), University of New South Wales, Sydney, Australia
| | - Simon Ghaly
- Department of Gastroenterology (S.G.), University of New South Wales, Sydney, Australia.,St Vincent's Clinical School (N.K.B., S.G., C.J.H.), University of New South Wales, Sydney, Australia
| | - Emily Granger
- Department of Cardiothoracic Surgery (E.G.), University of New South Wales, Sydney, Australia
| | - Cameron J Holloway
- Department of Cardiology (J.I., N.K.B., C.J.H.), University of New South Wales, Sydney, Australia.,St Vincent's Hospital, Victor Chang Cardiac Research Institute (C.J.H.), University of New South Wales, Sydney, Australia.,St Vincent's Clinical School (N.K.B., S.G., C.J.H.), University of New South Wales, Sydney, Australia
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9
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McGrath-Cadell L, Hesselson S, Iismaa SE, Mishra K, Wong CMY, Fatkin D, Dunwoodie SL, Harvey R, Holloway CJ, Muller DWM, Giannoulatou E, Graham RM. P5540Familial clustering of spontaneous coronary artery dissection. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is increasing evidence that patients with spontaneous coronary artery dissection (SCAD) have an underlying genetic susceptibility (Goel et al JAMA Intern Med175:821–826, 2015). Moreover, in a collaborative study involving 1,055 SCAD cases and 7,190 controls, we recently reported the first risk allele for SCAD, a variant (rs9349379-A) in the PHACTR1/EDN1 genetic locus (Adlam et al J Amer Coll Cardiol73:58–66, 2019).
Purpose
We sought to determine the clinical characteristics and initial genetic data for 11 families, in which more than one member has had an episode of SCAD.
Methods
Participants were recruited largely via a social media platform. Informed consent was obtained in all cases for analysis of genetic information using whole genome sequencing, as well as collection of clinical information. SCAD was confirmed by review of coronary angiogram images and clinical data collected by phone interview, as well as review of specialist letters and hospital records.
Results
Of 235 participants recruited to date, 23 cases showed familial clustering involving sister-sister pairs in six families, three first-degree cousins in one family (picture), two first-degree cousins in two families, a mother-son pair, and a family with concordant monozygotic twins, that is both twins having had SCAD. In an additional family, SCAD is discordant in monozygotic twins. A comparison of symptoms, age at SCAD, clinical syndrome, cardiovascular risk factors, SCAD risk factors, environmental triggers, SCAD location, acute management, left ventricular function and recurrent SCAD events in these families versus isolated cases, will be presented. Three sister-sister pairs have undergone whole genome sequencing and these data sets are undergoing segregation analysis to identify rare variants that are present exclusively in affected family members.
Family E Pedigree. Shaded circles represent first cousins affected with SCAD. The top number represents age (in years) of the SCAD event and the bottom number represents current age (in years).
Conclusions
To our knowledge, this is the largest assembly of SCAD cases with familial clustering reported to date. It provides strong evidence supporting an underlying genetic basis for SCAD, which most likely is a multi-genic disorder that also involves important gene-environment interactions.
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Affiliation(s)
| | - S Hesselson
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - S E Iismaa
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - K Mishra
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - C M Y Wong
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - D Fatkin
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - S L Dunwoodie
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - R Harvey
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | | | - E Giannoulatou
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - R M Graham
- Victor Chang Cardiac Research Institute, Sydney, Australia
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10
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Rayner JJ, Banerjee R, Holloway CJ, Lewis AJM, Peterzan MA, Francis JM, Neubauer S, Rider OJ. Correction: The Relative Contribution of Metabolic and Structural Abnormalities to Diastolic Dysfunction in Obesity. Int J Obes (Lond) 2019; 43:1652. [PMID: 31227797 PMCID: PMC7608285 DOI: 10.1038/s41366-019-0404-2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - R Banerjee
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - C J Holloway
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - A J M Lewis
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - M A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - J M Francis
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - S Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - O J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK.
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11
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Molan N, Emmanuel S, Langley T, Holloway CJ. Evaluating the Effectiveness of an Online Cardiac Rehabilitation Resource (www.svhhearthealth.com.au) in Improving Knowledge and Confidence for Patients With Newly Diagnosed Cardiac Conditions: A Pre-Experimental Pilot Study. Heart Lung Circ 2019; 28:761-770. [DOI: 10.1016/j.hlc.2018.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 03/10/2018] [Accepted: 03/12/2018] [Indexed: 11/28/2022]
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12
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McGrath-Cadell L, Holloway CJ. Early Aftermath of Spontaneous Coronary Artery Dissection. Circ Cardiovasc Interv 2018; 11:e007237. [PMID: 30354603 DOI: 10.1161/circinterventions.118.007237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lucy McGrath-Cadell
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia (L.M.-C., C.J.H.).,St Vincent's Clinical School, Medicine, University of New South Wales, Sydney, Australia (L.M.-C., C.J.H)
| | - Cameron J Holloway
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia (L.M.-C., C.J.H.).,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (C.J.H.).,St Vincent's Clinical School, Medicine, University of New South Wales, Sydney, Australia (L.M.-C., C.J.H)
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13
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Abstract
Although people living with HIV (PLHIV) are approaching normal life expectancy, a limitation to achieving this goal is managing the higher prevalence of co-morbidities, including cardiovascular disease. Whilst ischaemic heart disease likely contributes to a large proportion of cardiac disease in the modern era of treatment, cardio-metabolic disease, including cardiac steatosis, akin to obesity-related heart disease, is also a possible mechanism of increased cardiac morbidity and mortality. HIV and other metabolic and inflammatory diseases affecting the heart, including obesity, share many cardio-metabolic abnormalities, with increased pericardial and myocardial fat content, in association with chronic systemic inflammatory changes and alterations in cardiac metabolism. Understanding the mechanisms of HIV-associated cardiac steatosis remains an important challenge, as managing the untreated metabolic and inflammatory precipitants may substantially improve cardiac outcomes for PLHIV.
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Affiliation(s)
- Morgan Jacob
- St. Vincent's Hospital, Darlinghurst, NSW, Australia
- University of Notre Dame, Darlinghurst, NSW, Australia
| | - Cameron J. Holloway
- St. Vincent's Hospital, Darlinghurst, NSW, Australia
- University of Notre Dame, Darlinghurst, NSW, Australia
- St.Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- *Correspondence: Cameron J. Holloway
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14
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O'Dwyer EJ, Bhamra-Ariza P, Rao S, Emmanuel S, Carr A, Holloway CJ. Lower coronary plaque burden in patients with HIV presenting with acute coronary syndrome. Open Heart 2016; 3:e000511. [PMID: 28123757 PMCID: PMC5237750 DOI: 10.1136/openhrt-2016-000511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/20/2016] [Accepted: 11/17/2016] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Treated HIV infection is associated with a higher incidence of coronary artery disease and myocardial infarction, although the mechanisms remain unclear. We sought to characterise the burden of coronary artery disease in men with HIV using retrospective data from invasive coronary angiograms in patients presenting with acute coronary syndrome (ACS). METHODS Demographic and coronary angiographic data were obtained from 160 men with ST elevation myocardial infarction, non-STEMI or high-risk chest pain; 73 HIV-infected cases and 87 age-matched controls. The burden of coronary disease was calculated using the Gensini Angiographic Scoring System by 2 independent cardiologists blinded to HIV status. RESULTS The 2 groups were matched for age, sex and cardiac event subtype and there was no difference in rates of smoking or cholesterol levels. Compared with control participants, patients with HIV had higher usage of antihypertensives (46 (63%) vs 30 (35%), p<0.001) and statins (47 (64%) vs 29 (33%), p<0.001). There was no difference in plaque distribution between both groups; however, the Gensini score was 42% lower in cases with HIV than in controls (p<0.03). C reactive protein was higher in cases with HIV (13.4±15.4 vs 3.7±3.6). CONCLUSIONS Men with HIV presenting with ACS paradoxically had a lower burden of coronary plaque than matched controls, despite more aggressive risk factor management, suggesting that plaque vulnerability, rather than total burden of atherosclerosis, may be important in the pathophysiology of coronary artery disease in men with HIV.
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Affiliation(s)
- E J O'Dwyer
- St. Vincent's Hospital Darlinghurst and the University of New South Wales, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
| | - P Bhamra-Ariza
- St. Vincent's Hospital Darlinghurst and the University of New South Wales, Sydney, New South Wales, Australia; Frimley Health NHS Foundation, Surrey, UK
| | - S Rao
- St. Vincent's Hospital Darlinghurst and the University of New South Wales, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
| | - S Emmanuel
- St. Vincent's Hospital Darlinghurst and the University of New South Wales, Sydney, New South Wales, Australia; University of Notre Dame, Sydney, New South Wales, Australia
| | - A Carr
- St. Vincent's Hospital Darlinghurst and the University of New South Wales, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - C J Holloway
- St. Vincent's Hospital Darlinghurst and the University of New South Wales, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; Frimley Health NHS Foundation, Surrey, UK
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15
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Levelt E, Rodgers CT, Clarke WT, Mahmod M, Ariga R, Francis JM, Liu A, Wijesurendra RS, Dass S, Sabharwal N, Robson MD, Holloway CJ, Rider OJ, Clarke K, Karamitsos TD, Neubauer S. Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus. Eur Heart J 2016; 37:3461-3469. [PMID: 26392437 PMCID: PMC5201143 DOI: 10.1093/eurheartj/ehv442] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/27/2015] [Accepted: 08/12/2015] [Indexed: 12/12/2022] Open
Abstract
AIMS Patients with type 2 diabetes mellitus (T2DM) are known to have impaired resting myocardial energetics and impaired myocardial perfusion reserve, even in the absence of obstructive epicardial coronary artery disease (CAD). Whether or not the pre-existing energetic deficit is exacerbated by exercise, and whether the impaired myocardial perfusion causes deoxygenation and further energetic derangement during exercise stress, is uncertain. METHODS AND RESULTS Thirty-one T2DM patients, on oral antidiabetic therapies with a mean HBA1c of 7.4 ± 1.3%, and 17 matched controls underwent adenosine stress cardiovascular magnetic resonance for assessment of perfusion [myocardial perfusion reserve index (MPRI)] and oxygenation [blood-oxygen level-dependent (BOLD) signal intensity change (SIΔ)]. Cardiac phosphorus-MR spectroscopy was performed at rest and during leg exercise. Significant CAD (>50% coronary stenosis) was excluded in all patients by coronary computed tomographic angiography. Resting phosphocreatine to ATP (PCr/ATP) was reduced by 17% in patients (1.74 ± 0.26, P = 0.001), compared with controls (2.07 ± 0.35); during exercise, there was a further 12% reduction in PCr/ATP (P = 0.005) in T2DM patients, but no change in controls. Myocardial perfusion and oxygenation were decreased in T2DM (MPRI 1.61 ± 0.43 vs. 2.11 ± 0.68 in controls, P = 0.002; BOLD SIΔ 7.3 ± 7.8 vs. 17.1 ± 7.2% in controls, P < 0.001). Exercise PCr/ATP correlated with MPRI (r = 0.50, P = 0.001) and BOLD SIΔ (r = 0.32, P = 0.025), but there were no correlations between rest PCr/ATP and MPRI or BOLD SIΔ. CONCLUSION The pre-existing energetic deficit in diabetic cardiomyopathy is exacerbated by exercise; stress PCr/ATP correlates with impaired perfusion and oxygenation. Our findings suggest that, in diabetes, coronary microvascular dysfunction exacerbates derangement of cardiac energetics under conditions of increased workload.
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Affiliation(s)
- Eylem Levelt
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Christopher T Rodgers
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - William T Clarke
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Rina Ariga
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Jane M Francis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Alexander Liu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Saira Dass
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | | | - Matthew D Robson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Cameron J Holloway
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
- St. Vincent's Hospital, Sydney, Australia
| | - Oliver J Rider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Kieran Clarke
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Theodoros D Karamitsos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University, Thessaloniki, Greece
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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16
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McGrath-Cadell L, McKenzie P, Emmanuel S, Muller DWM, Graham RM, Holloway CJ. Outcomes of patients with spontaneous coronary artery dissection. Open Heart 2016; 3:e000491. [PMID: 27621835 PMCID: PMC5013459 DOI: 10.1136/openhrt-2016-000491] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/26/2016] [Accepted: 08/02/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an uncommon but serious condition presenting as an acute coronary syndrome (ACS) or cardiac arrest. The pathophysiology and outcomes are poorly understood. We investigated the characteristics and outcomes of patients presenting with SCAD. METHODS In a retrospective study of a large cohort of patients with SCAD, data were collected regarding clinical presentation, patient characteristics, vascular screening, coronary artery involvement and clinical outcomes. RESULTS 40 patients with SCAD (95% women, mean age 45±10 years) were included. At least 1 traditional cardiovascular risk factor was present in 40% of patients. Migraine was reported in 43% of patients. Events preceding SCAD included parturition (8%), physical stress (13%), emotional stress (10%) and vasoconstrictor substance-use (8%). 65% of patients had a non-ST elevation ACS (NSTEACS) at presentation, 30% had an ST elevation myocardial infarction (STEMI) and 13% had a cardiac arrest. The left anterior descending artery was most frequently involved (68% of patients), and 13% had involvement of multiple coronary territories. Fibromuscular dysplasia (FMD) was identified in 7 (37%) of 19 patients screened. 68% of patients were managed medically, 30% had percutaneous coronary intervention and 5% had coronary artery bypass grafting. Over a median 16-month follow-up period, 8% of patients had at least 1 recurrent SCAD event. There were no deaths. CONCLUSIONS Patients with SCAD in this study often had multiple coronary territories involved (13%) and extracardiac vascular abnormalities, suggesting a systemic vascular process, which may explain the high incidence of migraine. All patients with SCAD should be screened for FMD and followed closely due to the possibility of recurrence.
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Affiliation(s)
| | | | - Sam Emmanuel
- St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | | | - Robert M Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Cameron J Holloway
- St Vincent's Hospital, Darlinghurst, New South Wales, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Kensington, New South Wales, Australia
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17
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Abstract
HIV infection is now considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). Increased risk of CAD in HIV-infected patients has been associated with the inflammatory sequelae of the infection as well as the greater prevalence of cardiac risk factors in HIV-positive populations and the side effects of life-prolonging antiretroviral therapies. Patients with HIV infection now have a 1.5 to 2-fold greater risk of developing CAD compared with noninfected individuals, raising the independent risk of CAD in HIV infection to levels similar to those in diabetes. Despite this increased risk, screening and other adjuvant assessment tools are lacking. In this paper we explore the current climate of CAD in the contemporary HIV-infected population and look at the tools used in the assessment and management of patients as well as the limitations of these approaches for this at-risk population group.
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Affiliation(s)
- J Nadel
- University of Notre Dame, Sydney, NSW, Australia.,St Vincent's Hospital, Sydney, NSW, Australia
| | - C J Holloway
- St Vincent's Hospital, Sydney, NSW, Australia.,Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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18
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Rider OJ, Ntusi N, Bull SC, Nethononda R, Ferreira V, Holloway CJ, Holdsworth D, Mahmod M, Rayner JJ, Banerjee R, Myerson S, Watkins H, Neubauer S. Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity. Heart 2016; 102:1566-72. [PMID: 27486142 PMCID: PMC5037604 DOI: 10.1136/heartjnl-2015-309201] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/25/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The electrocardiogram (ECG) is the most commonly used tool to screen for left ventricular hypertrophy (LVH), and yet current diagnostic criteria are insensitive in modern increasingly overweight society. We propose a simple adjustment to improve diagnostic accuracy in different body weights and improve the sensitivity of this universally available technique. METHODS Overall, 1295 participants were included-821 with a wide range of body mass index (BMI 17.1-53.3 kg/m(2)) initially underwent cardiac magnetic resonance evaluation of anatomical left ventricular (LV) axis, LV mass and 12-lead surface ECG in order to generate an adjustment factor applied to the Sokolow-Lyon criteria. This factor was then validated in a second cohort (n=520, BMI 15.9-63.2 kg/m(2)). RESULTS When matched for LV mass, the combination of leftward anatomical axis deviation and increased BMI resulted in a reduction of the Sokolow-Lyon index, by 4 mm in overweight and 8 mm in obesity. After adjusting for this in the initial cohort, the sensitivity of the Sokolow-Lyon index increased (overweight: 12.8% to 30.8%, obese: 3.1% to 27.2%) approaching that seen in normal weight (37.8%). Similar results were achieved in the validation cohort (specificity increased in overweight: 8.3% to 39.1%, obese: 9.4% to 25.0%) again approaching normal weight (39.0%). Importantly, specificity remained excellent (>93.1%). CONCLUSIONS Adjusting the Sokolow-Lyon index for BMI (overweight +4 mm, obesity +8 mm) improves the diagnostic accuracy for detecting LVH. As the ECG, worldwide, remains the most widely used screening tool for LVH, implementing these findings should translate into significant clinical benefit.
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Affiliation(s)
- Oliver J Rider
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Ntobeko Ntusi
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK Division of Cardiology, Department of Medicine Research, University of Capetown, South Africa
| | - Sacha C Bull
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Richard Nethononda
- Chris Hani Baragwanath Hospital, Soweto & University of Witwatersrand, Johannesburg, South Africa
| | - Vanessa Ferreira
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | | | - David Holdsworth
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Masliza Mahmod
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Jennifer J Rayner
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Rajarshi Banerjee
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Saul Myerson
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
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19
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Nadel J, O'Dwyer E, Emmanuel S, Huang J, Cheruvu S, Sammel N, Brew B, Otton J, Holloway CJ. High-risk coronary plaque, invasive coronary procedures, and cardiac events among HIV-positive individuals and matched controls. J Cardiovasc Comput Tomogr 2016; 10:391-7. [PMID: 27519655 DOI: 10.1016/j.jcct.2016.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/28/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection is considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). We analyzed the utility of coronary CTA in the assessment of CAD among HIV patients and explored whether HIV patients are at greater risk of associated morbidity and mortality compared to HIV-negative controls. METHODS In a retrospective, single center cohort study 97 males without history of previous coronary artery disease who had undergone coronary CTA between 2011 and 2014 was analyzed, including 32 HIV positive patients and 65 matched HIV negative controls. Presence and composition of coronary plaque was determined by coronary CTA. Data on subsequent coronary events and coronary intervention was collected. RESULTS Patients with HIV had higher rates of non-calcified plaque (0.8 ± 1.5 versus 0.3 ± 0.7, p = 0.03) compared to negative controls. At a median follow-up of 38 months, patients with HIV were at greater risk of non-ST elevation acute coronary syndrome (16% versus 3%, p < 0.04), although there was no difference in the combined endpoint of all acute coronary syndromes (19% versus 6%, p = 0.08). Following baseline coronary TCA, there was a higher rate of coronary intervention in patients without HIV (mean time to event 9.9 ± 3.3 versus 20.6 ± 4.9 months, p < 0.04). CONCLUSION Patients with HIV more pronounces coronary atherosclerosis on coronary CTA and higher rates of non-ST elevation acute coronary syndromes compared to negative controls.
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Affiliation(s)
- James Nadel
- University of Notre Dame, Sydney, Australia; St. Vincent's Hospital, Sydney, Australia.
| | | | - Sam Emmanuel
- University of Notre Dame, Sydney, Australia; St. Vincent's Hospital, Sydney, Australia
| | | | | | - Neville Sammel
- University of Notre Dame, Sydney, Australia; St. Vincent's Hospital, Sydney, Australia
| | - Bruce Brew
- St. Vincent's Hospital, Sydney, Australia; Peter Duncan Neurosciences Unit St Vincent's Centre for Applied Medical Research University of New South Wales, Sydney, Australia
| | - James Otton
- St. Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Cameron J Holloway
- University of Notre Dame, Sydney, Australia; St. Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
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20
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Holloway CJ, Murray AJ, Mitchell K, Martin DS, Johnson AW, Cochlin LE, Codreanu I, Dhillon S, Rodway GW, Ashmore T, Levett DZH, Neubauer S, Montgomery HE, Grocott MPW, Clarke K. Oral Coenzyme Q10 supplementation does not prevent cardiac alterations during a high altitude trek to everest base cAMP. High Alt Med Biol 2015; 15:459-67. [PMID: 24661196 DOI: 10.1089/ham.2013.1053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Exposure to high altitude is associated with sustained, but reversible, changes in cardiac mass, diastolic function, and high-energy phosphate metabolism. Whilst the underlying mechanisms remain elusive, tissue hypoxia increases generation of reactive oxygen species (ROS), which can stabilize hypoxia-inducible factor (HIF) transcription factors, bringing about transcriptional changes that suppress oxidative phosphorylation and activate autophagy. We therefore investigated whether oral supplementation with an antioxidant, Coenzyme Q10, prevented the cardiac perturbations associated with altitude exposure. Twenty-three volunteers (10 male, 13 female, 46±3 years) were recruited from the 2009 Caudwell Xtreme Everest Research Treks and studied before, and within 48 h of return from, a 17-day trek to Everest Base Camp, with subjects receiving either no intervention (controls) or 300 mg Coenzyme Q10 per day throughout altitude exposure. Cardiac magnetic resonance imaging and echocardiography were used to assess cardiac morphology and function. Following altitude exposure, body mass fell by 3 kg in all subjects (p<0.001), associated with a loss of body fat and a fall in BMI. Post-trek, left ventricular mass had decreased by 11% in controls (p<0.05) and by 16% in Coenzyme Q10-treated subjects (p<0.001), whereas mitral inflow E/A had decreased by 18% in controls (p<0.05) and by 21% in Coenzyme Q10-treated subjects (p<0.05). Coenzyme Q10 supplementation did not, therefore, prevent the loss of left ventricular mass or change in diastolic function that occurred following a trek to Everest Base Camp.
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Affiliation(s)
- Cameron J Holloway
- 1 Department of Physiology, Anatomy and Genetics, University of Oxford , United Kingdom
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21
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Dass S, Holloway CJ, Cochlin LE, Rider OJ, Mahmod M, Robson M, Sever E, Clarke K, Watkins H, Ashrafian H, Karamitsos TD, Neubauer S. No Evidence of Myocardial Oxygen Deprivation in Nonischemic Heart Failure. Circ Heart Fail 2015; 8:1088-93. [PMID: 26333351 PMCID: PMC4645953 DOI: 10.1161/circheartfailure.114.002169] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 08/05/2015] [Indexed: 12/26/2022]
Abstract
Whether the myocardium in nonischemic heart failure experiences oxygen limitation remains a long-standing controversy. We addressed this question in patients with dilated cardiomyopathy (DCM) using a dual approach. First, we tested the changes in myocardial oxygenation between rest and stress states, using oxygenation-sensitive cardiovascular magnetic resonance. Second, we sought to assess the functional consequences of oxygen limitation at rest by measuring myocardial energetics before and after short-term oxygen supplementation.
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Affiliation(s)
- Sairia Dass
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Cameron J Holloway
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Lowri E Cochlin
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Oliver J Rider
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Masliza Mahmod
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Matthew Robson
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Emily Sever
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Kieran Clarke
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Hugh Watkins
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Houman Ashrafian
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Theodoros D Karamitsos
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom
| | - Stefan Neubauer
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (S.D., O.J.R., M.M., M.R., E.S., H.W., H.A., T.D.K., S.N.) and Department of Physiology, Anatomy, and Genetics (C.J.H., L.E.C., K.C.), Oxford University, Oxford, United Kingdom.
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22
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Dass S, Cochlin LE, Suttie JJ, Holloway CJ, Rider OJ, Carden L, Tyler DJ, Karamitsos TD, Clarke K, Neubauer S, Watkins H. Exacerbation of cardiac energetic impairment during exercise in hypertrophic cardiomyopathy: a potential mechanism for diastolic dysfunction. Eur Heart J 2015; 36:1547-54. [PMID: 25990345 DOI: 10.1093/eurheartj/ehv120] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 03/24/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Hypertrophic cardiomyopathy (HCM) is the commonest cause of sudden cardiac death in the young, with an excess of exercise-related deaths. The HCM sarcomere mutations increase the energy cost of contraction and impaired resting cardiac energetics has been documented by measurement of phosphocreatine/ATP (PCr/ATP) using (31)Phosphorus MR Spectroscopy ((31)P MRS). We hypothesized that cardiac energetics are further impaired acutely during exercise in HCM and that this would have important functional consequences. METHODS AND RESULTS (31)P MRS was performed in 35 HCM patients and 20 age- and gender-matched normal volunteers at rest and during leg exercise with 2.5 kg ankle weights. Peak left-ventricular filling rates (PFRs) and myocardial perfusion reserve (MPRI) were calculated during adenosine stress. Resting PCr/ATP was significantly reduced in HCM (HCM: 1.71 ± 0.35, normal 2.14 ± 0.35 P < 0.0001). During exercise, there was a further reduction in PCr/ATP in HCM (1.56 ± 0.29, P = 0.02 compared with rest) but not in normals (2.16 ± 0.26, P = 0.98 compared with rest). There was no correlation between PCr/ATP reduction and cardiac mass, wall thickness, MPRI, or late-gadolinium enhancement. PFR and PCr/ATP were significantly correlated at rest (r = 0.48, P = 0.02) and stress (r = 0.53, P = 0.01). CONCLUSION During exercise, the pre-existing energetic deficit in HCM is further exacerbated independent of hypertrophy, perfusion reserve, or degree of fibrosis. This is in keeping with the change at the myofilament level. We offer a potential explanation for exercise-related diastolic dysfunction in HCM.
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Affiliation(s)
- Sairia Dass
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Lowri E Cochlin
- Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Joseph J Suttie
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Cameron J Holloway
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Oliver J Rider
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Leah Carden
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Damian J Tyler
- Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Theodoros D Karamitsos
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
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23
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Wang LW, He EYJ, Ghosh D, Day RO, Jones GRD, Subbiah RN, Holloway CJ. Severe carbon monoxide poisoning from waterpipe smoking: a public health concern. Med J Aust 2015; 202:446-7. [DOI: 10.5694/mja14.01264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 11/11/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Louis W Wang
- St Vincent's Hospital, Sydney, NSW
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW
- Victor Chang Cardiac Research Institute, Sydney, NSW
| | - Emily YJ He
- Lowy Cancer Research Centre, University of New South Wales, Sydney, NSW
| | | | - Richard O Day
- St Vincent's Hospital, Sydney, NSW
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW
| | - Graham RD Jones
- St Vincent's Hospital, Sydney, NSW
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW
| | - Rajesh N Subbiah
- St Vincent's Hospital, Sydney, NSW
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW
- Victor Chang Cardiac Research Institute, Sydney, NSW
| | - Cameron J Holloway
- St Vincent's Hospital, Sydney, NSW
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW
- Victor Chang Cardiac Research Institute, Sydney, NSW
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24
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Abstract
With widespread access to high-quality medical care as in Australia, human immunodeficiency virus (HIV) is now considered a chronic, treatable condition, with a good life expectancy. The use of combined highly active antiretroviral therapy has enabled effective suppression of the virus, but has also been associated with increased cardiac morbidity and mortality. Over representation of traditional cardiac risk factors, such as hyperlipidaemia and diabetes, as well as an increased incidence of ischaemic and non-ischaemic heart disease is now considered a major concern of treatment with antiretroviral therapy. Therefore, a contemporary management strategy for patients with HIV must include active prevention and treatment of cardiovascular risk. This review will outline the complex interplay between HIV infection, antiretroviral drug regimens and accelerated cardiovascular disease, with a particular focus on screening, prevention and treatment options in a contemporary Australian HIV population.
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Affiliation(s)
- S Cheruvu
- St Vincent's Hospital, Sydney, New South Wales, Australia
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25
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Rider OJ, Asaad M, Ntusi N, Wainwright E, Clutton G, Hancock G, Banerjee R, Pitcher A, Samaras K, Clarke K, Neubauer S, Dorrell L, Holloway CJ. HIV is an independent predictor of aortic stiffness. J Cardiovasc Magn Reson 2014; 16:57. [PMID: 25187084 PMCID: PMC4422254 DOI: 10.1186/s12968-014-0057-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 03/28/2014] [Accepted: 07/16/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients with treated Human Immunodeficiency Virus-1 (HIV) infection are at increased risk of cardiovascular events. Traditionally much of this risk has been attributed to metabolic and anthropometric abnormalities associated with HIV, which are similar to the metabolic syndrome (MS), an established risk factor for cardiovascular mortality. It remains unclear whether treated HIV infection is itself associated with increased risk, via increase vascular stiffness. METHODS 226 subjects (90 with HIV) were divided into 4 groups based on HIV and MS status: 1) HIV-ve/MS-ve, 2) HIV-ve/MS + ve, 3) HIV + ve/MS-ve and 4)HIV + ve/MS + ve. CMR was used to determine aortic pulse wave velocity (PWV) and regional aortic distensibility (AD). RESULTS PWV was 11% higher and regional AD up to 14% lower in the HIV + ve/MS-ve group when compared to HIV-ve/MS-ve (p < 0.01 all analyses). PWV and AD in the HIV + ve/MS-ve group was similar to that observed in the HIV-ve/MS + ve group (p > 0.99 all analyses). The HIV + ve/MS + ve group had 32% higher PWV and 30-34% lower AD than the HIV-ve/MS-ve group (all p < 0.001), and 19% higher PWV and up to 31% lower AD than HIV + ve/MS-ve subjects (all p < 0.05). On multivariable regression, age, systolic blood pressure and treated HIV infection were all independent predictors of both PWV and regional AD. CONCLUSION Across multiple measures, treated HIV infection is associated with increased aortic stiffness and is also an independent predictor of both PWV and regional AD. The magnitude of the effect of treated HIV and MS are similar, with additive detrimental effects on central vascular elasticity.
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Affiliation(s)
- Oliver J Rider
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, OX1 3PT, UK.
- Department of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, (OCMR), John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Mina Asaad
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, OX1 3PT, UK.
- Department of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, (OCMR), John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Ntobeko Ntusi
- Department of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, (OCMR), John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Emma Wainwright
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - Genevieve Clutton
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - Gemma Hancock
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - Rajarshi Banerjee
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, OX1 3PT, UK.
| | - Alex Pitcher
- Department of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, (OCMR), John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | | | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, OX1 3PT, UK.
| | - Stefan Neubauer
- Department of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, (OCMR), John Radcliffe Hospital, Oxford, OX3 9DU, UK.
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - Lucy Dorrell
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - Cameron J Holloway
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, OX1 3PT, UK.
- Department of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, (OCMR), John Radcliffe Hospital, Oxford, OX3 9DU, UK.
- St Vincent's Hospital, Sydney, Australia.
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Codreanu I, Robson MD, Rider OJ, Pegg TJ, Dasanu CA, Jung BA, Rotaru N, Clarke K, Holloway CJ. Details of left ventricular radial wall motion supporting the ventricular theory of the third heart sound obtained by cardiac MR. Br J Radiol 2014; 87:20130780. [PMID: 24641347 DOI: 10.1259/bjr.20130780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Obtaining new details of radial motion of left ventricular (LV) segments using velocity-encoding cardiac MRI. METHODS Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Cine images for navigator-gated phase contrast velocity mapping were acquired using a black blood segmented κ-space spoiled gradient echo sequence with a temporal resolution of 13.8 ms. Peak systolic and diastolic radial velocities as well as radial velocity curves were obtained for 16 ventricular segments. RESULTS Significant differences among peak radial velocities of basal and mid-ventricular segments have been recorded. Particular patterns of segmental radial velocity curves were also noted. An additional wave of outward radial movement during the phase of rapid ventricular filling, corresponding to the expected timing of the third heart sound, appeared of particular interest. CONCLUSION The technique has allowed visualization of new details of LV radial wall motion. In particular, higher peak systolic radial velocities of anterior and inferior segments are suggestive of a relatively higher dynamics of anteroposterior vs lateral radial motion in systole. Specific patterns of radial motion of other LV segments may provide additional insights into LV mechanics. ADVANCES IN KNOWLEDGE The outward radial movement of LV segments impacted by the blood flow during rapid ventricular filling provides a potential substrate for the third heart sound. A biphasic radial expansion of the basal anteroseptal segment in early diastole is likely to be related to the simultaneous longitudinal LV displacement by the stretched great vessels following repolarization and their close apposition to this segment.
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Affiliation(s)
- I Codreanu
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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Codreanu I, Robson MD, Rider OJ, Pegg TJ, Dasanu CA, Jung BA, Clarke K, Holloway CJ. Effects of ventricular insertion sites on rotational motion of left ventricular segments studied by cardiac MR. Br J Radiol 2014; 86:20130326. [PMID: 24133098 DOI: 10.1259/bjr.20130326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Obtaining new details for rotational motion of left ventricular (LV) segments using velocity encoding cardiac MR and correlating the regional motion patterns to LV insertion sites. METHODS Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Peak rotational velocities and circumferential velocity curves were obtained for 16 ventricular segments. RESULTS Reduced peak clockwise velocities of anteroseptal segments (i.e. Segments 2 and 8) and peak counterclockwise velocities of inferoseptal segments (i.e. Segments 3 and 9) were the most prominent findings. The observations can be attributed to the LV insertion sites into the right ventricle, limiting the clockwise rotation of anteroseptal LV segments and the counterclockwise rotation of inferoseptal segments as viewed from the apex. Relatively lower clockwise velocities of Segment 5 and counterclockwise velocities of Segment 6 were also noted, suggesting a cardiac fixation point between these two segments, which is in close proximity to the lateral LV wall. CONCLUSION Apart from showing different rotational patterns of LV base, mid ventricle and apex, the study showed significant differences in the rotational velocities of individual LV segments. Correlating regional wall motion with known orientation of myocardial aggregates has also provided new insights into the mechanisms of LV rotational motions during a cardiac cycle. ADVANCES IN KNOWLEDGE LV insertion into the right ventricle limits the clockwise rotation of anteroseptal LV segments and the counterclockwise rotation of inferoseptal segments adjacent to the ventricular insertion sites. The pattern should be differentiated from wall motion abnormalities in cardiac pathology.
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Affiliation(s)
- I Codreanu
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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Codreanu I, Pegg TJ, Selvanayagam JB, Robson MD, Rider OJ, Dasanu CA, Jung BA, Taggart DP, Golding SJ, Clarke K, Holloway CJ. Normal values of regional and global myocardial wall motion in young and elderly individuals using navigator gated tissue phase mapping. Age (Dordr) 2014; 36:231-241. [PMID: 23604860 PMCID: PMC3889897 DOI: 10.1007/s11357-013-9535-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 04/05/2013] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to evaluate normal values for regional and global myocardial wall motion parameters in young and elderly individuals, as detected by navigator gated high temporal resolution tissue phase mapping. Radial, longitudinal and circumferential ventricular wall motion, as well as ventricular torsion and longitudinal strain rates, were assessed in two age groups of volunteers, 23 ± 3 (n = 14) and 66 ± 7 years old (n = 9), respectively. All subjects were healthy, non-smokers without known cardiac disease. An increased global left ventricular (LV) torsion rate (peak systolic torsion rate 20.6 ± 2.0 versus 14.5 ± 1.0°/s/cm, peak diastolic torsion rate -25.2 ± 1.8 versus -14.1 ± 1.3°/s/cm) and a decrease in longitudinal LV motion (peak systolic values at mid-ventricle 5.9 ± 0.5 versus 8.5 ± 0.8 cm/s, peak diastolic values -10.7 ± 0.7 versus -15.2 ± 0.9 cm/s) in the older age group were the most prominent findings. Lower peak diastolic radial velocities with a longer time-to-peak values, most pronounced at the apex, are consistent with reduced diastolic function with ageing. Lower peak clockwise and counter-clockwise velocities at all LV levels revealed limitations in resting LV rotational motions in the older group. Significant changes in the undulating pattern of the rotational motions of the left ventricle were also observed. The results demonstrate distinct changes in regional and global myocardial wall motion in elderly individuals. Increased LV torsion rate and reduced LV longitudinal motion were particularly prominent in the older group. These parameters may have a role in the assessment of global LV contractility and help differentiate age-related changes from cardiac disease.
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Affiliation(s)
- Ion Codreanu
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK,
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Davis AE, Lewandowski AJ, Holloway CJ, Ntusi NAB, Banerjee R, Nethononda R, Pitcher A, Francis JM, Myerson SG, Leeson P, Donovan T, Neubauer S, Rider OJ. Observational study of regional aortic size referenced to body size: production of a cardiovascular magnetic resonance nomogram. J Cardiovasc Magn Reson 2014; 16:9. [PMID: 24447690 PMCID: PMC3899403 DOI: 10.1186/1532-429x-16-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/14/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is regarded as the gold standard for clinical assessment of the aorta, but normal dimensions are usually referenced to echocardiographic and computed tomography data and no large CMR normal reference range exists. As a result we aimed to 1) produce a normal CMR reference range of aortic diameters and 2) investigate the relationship between regional aortic size and body surface area (BSA) in a large group of healthy subjects with no vascular risk factors. METHODS 447 subjects (208 male, aged 19-70 years) without identifiable cardiac risk factors (BMI range 15.7-52.6 kg/m2) underwent CMR at 1.5 T to determine aortic diameter at three levels: the ascending aorta (Ao) and proximal descending aorta (PDA) at the level of the pulmonary artery, and the abdominal aorta (DDA), at a level 12 cm distal to the PDA. In addition, 201 of these subjects had aortic root imaging, allowing for measurements at the level of the aortic valve annulus (AV), aortic sinuses and sinotubular junction (STJ). RESULTS Normal diameters (mean ±2 SD) were; AV annulus male(♂) 24.4 ± 5.4, female (♀) 21.0 ± 3.6 mm, aortic sinus♂ 32.4 ± 7.7, ♀27.6 ± 5.8 mm, ST-junction ♂25.0 ± 7.4, ♀21.8 ± 5.4 mm, Ao ♂26.7 ± 7.7, ♀25.5 ± 7.4 mm, PDA ♂20.6 ± 5.6, +18.9 ± 4.0 mm, DDA ♂17.6 ± 5.1, ♀16.4 ± 4.0 mm. Aortic root and thoracic aortic diameters increased at all levels measured with BSA. No gender difference was seen in the degree of dilatation with increasing BSA (p>0.5 for all analyses). CONCLUSION Across both genders, increasing body size is characterized by a modest degree of aortic dilatation, even in the absence of traditional cardiovascular risk factors.
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Affiliation(s)
- Anne E Davis
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Adam J Lewandowski
- Oxford Clinical Cardiovascular Research Facility, University of Oxford, Oxford, UK
| | - Cameron J Holloway
- St. Vincent’s Hospital and the Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Ntobeko AB Ntusi
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Rajarshi Banerjee
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Richard Nethononda
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Alex Pitcher
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Jane M Francis
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Saul G Myerson
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Paul Leeson
- Oxford Clinical Cardiovascular Research Facility, University of Oxford, Oxford, UK
| | - Tim Donovan
- University of Cumbria Health and Medical Sciences, Lancaster, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Oliver J Rider
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Holloway CJ, Ntusi N, Suttie J, Mahmod M, Wainwright E, Clutton G, Hancock G, Beak P, Tajar A, Piechnik SK, Schneider JE, Angus B, Clarke K, Dorrell L, Neubauer S. Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients. Circulation 2013; 128:814-22. [PMID: 23817574 DOI: 10.1161/circulationaha.113.001719] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND HIV infection continues to be endemic worldwide. Although treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional, or biochemical cardiac abnormalities that may underlie their increased cardiac morbidity and mortality. The purpose of this study was to characterize myocardial abnormalities in a contemporary group of HIV-infected individuals undergoing combination antiretroviral therapy. METHODS AND RESULTS Volunteers with HIV who were undergoing combination antiretroviral therapy and age-matched control subjects without a history of cardiovascular disease underwent cardiac magnetic resonance imaging and spectroscopy for the determination of cardiac function, myocardial fibrosis, and myocardial lipid content. A total of 129 participants were included in this analysis. Compared with age-matched control subjects (n=39; 30.23%), HIV-infected subjects undergoing combination antiretroviral therapy (n=90; 69.77%) had 47% higher median myocardial lipid levels (P <0.003) and 74% higher median plasma triglyceride levels (both P<0.001). Myocardial fibrosis, predominantly in the basal inferolateral wall of the left ventricle, was observed in 76% of HIV-infected subjects compared with 13% of control subjects (P<0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals than in control subjects and remained statistically significant after adjustment for available confounders. CONCLUSIONS Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function, and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects undergoing combination antiretroviral therapy. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.
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Affiliation(s)
- Cameron J Holloway
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom.
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Affiliation(s)
- Vanessa M Ferreira
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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32
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Dass S, Suttie JJ, Piechnik SK, Ferreira VM, Holloway CJ, Banerjee R, Mahmod M, Cochlin L, Karamitsos TD, Robson MD, Watkins H, Neubauer S. Response to letter regarding article, "myocardial tissue characterization using magnetic resonance noncontrast t1 mapping in hypertrophic and dilated cardiomyopathy". Circ Cardiovasc Imaging 2013; 6:e2. [PMID: 23512784 DOI: 10.1161/circimaging.113.000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wilson MH, Davagnanam I, Holland G, Dattani RS, Tamm A, Hirani SP, Kolfschoten N, Strycharczuk L, Green C, Thornton JS, Wright A, Edsell M, Kitchen ND, Sharp DJ, Ham TE, Murray A, Holloway CJ, Clarke K, Grocott MP, Montgomery H, Imray C. Cerebral venous system and anatomical predisposition to high-altitude headache. Ann Neurol 2013; 73:381-9. [DOI: 10.1002/ana.23796] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 09/12/2012] [Accepted: 10/29/2012] [Indexed: 01/03/2023]
Affiliation(s)
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology; National Hospital for Neurology and Neurosurgery; London
| | - Graeme Holland
- Centre for Altitude, Space, and Extreme Environment Medicine; University College London; London
| | - Raj S. Dattani
- Centre for Altitude, Space, and Extreme Environment Medicine; University College London; London
| | - Alexander Tamm
- Centre for Altitude, Space, and Extreme Environment Medicine; University College London; London
| | | | - Nicky Kolfschoten
- Centre for Altitude, Space, and Extreme Environment Medicine; University College London; London
| | - Lisa Strycharczuk
- Lysholm Department of Neuroradiology; National Hospital for Neurology and Neurosurgery; London
| | - Cathy Green
- Lysholm Department of Neuroradiology; National Hospital for Neurology and Neurosurgery; London
| | - John S. Thornton
- Lysholm Department of Neuroradiology; National Hospital for Neurology and Neurosurgery; London
| | | | | | - Neil D. Kitchen
- Department of Neurosurgery; National Hospital for Neurology and Neurosurgery; London
| | - David J. Sharp
- The Traumatic Brain Injury Centre; St Mary's Hospital; Imperial College; London; W1 2NY
| | - Timothy E. Ham
- The Traumatic Brain Injury Centre; St Mary's Hospital; Imperial College; London; W1 2NY
| | - Andrew Murray
- Department of Physiology, Development, and Neuroscience; University of Cambridge; Cambridge
| | | | - Kieran Clarke
- Department of Physiology; University of Oxford; Oxford
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Dass S, Suttie JJ, Piechnik SK, Ferreira VM, Holloway CJ, Banerjee R, Mahmod M, Cochlin L, Karamitsos TD, Robson MD, Watkins H, Neubauer S. Myocardial tissue characterization using magnetic resonance noncontrast t1 mapping in hypertrophic and dilated cardiomyopathy. Circ Cardiovasc Imaging 2012; 5:726-33. [PMID: 23071146 DOI: 10.1161/circimaging.112.976738] [Citation(s) in RCA: 257] [Impact Index Per Article: 21.4] [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: 12/18/2022]
Abstract
BACKGROUND Noncontrast magnetic resonance T1 mapping reflects a composite of both intra- and extracellular signal. We hypothesized that noncontrast T1 mapping can characterize the myocardium beyond that achieved by the well-established late gadolinium enhancement (LGE) technique (which detects focal fibrosis) in both hypertrophic (HCM) and dilated (DCM) cardiomyopathy, by detecting both diffuse and focal fibrosis. METHODS AND RESULTS Subjects underwent Cardiovascular Magnetic Resonance imaging at 3T (28 HCM, 18 DCM, and 12 normals). Matching short-axis slices were acquired for cine, T1 mapping, and LGE imaging (0.1 mmol/kg). Circumferential strain was measured in the midventricular slice, and (31)P magnetic resonance spectroscopy was acquired for the septum of the midventricular slice. Mean T1 relaxation time was increased in HCM and DCM (HCM 1209±28 ms, DCM 1225±42 ms, normal 1178±13 ms, P<0.05). There was a weak correlation between mean T1 and LGE (r=0.32, P<0.001). T1 values were higher in segments with LGE than in those without (HCM with LGE 1228±41 ms versus no LGE 1192±79 ms, P<0.01; DCM with LGE 1254±73 ms versus no LGE 1217±52 ms, P<0.01). However, in both HCM and DCM, even in segments unaffected by LGE, T1 values were significantly higher than normal (P<0.01). T1 values correlated with disease severity, being increased as wall thickness increased in HCM; conversely, in DCM, T1 values were highest in the thinnest myocardial segments. T1 values also correlated significantly with circumferential strain (r=0.42, P<0.01). Interestingly, this correlation remained statistically significant even for the slices without LGE (r=0.56, P=0.04). Finally, there was also a statistically significant negative correlation between T1 values and phosphocreatine/adenosine triphosphate ratios (r=-0.59, P<0.0001). CONCLUSIONS In HCM and DCM, noncontrast T1 mapping detects underlying disease processes beyond those assessed by LGE in relatively low-risk individuals.
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Affiliation(s)
- Sairia Dass
- University of Oxford Centre for Clinical Magnetic Resonance Research, UK
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Rider OJ, Lewandowski A, Nethononda R, Petersen SE, Francis JM, Pitcher A, Holloway CJ, Dass S, Banerjee R, Byrne JP, Leeson P, Neubauer S. Gender-specific differences in left ventricular remodelling in obesity: insights from cardiovascular magnetic resonance imaging. Eur Heart J 2012; 34:292-9. [PMID: 23053174 DOI: 10.1093/eurheartj/ehs341] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [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: 01/19/2023] Open
Abstract
AIMS As obesity-related cardiovascular mortality, although elevated when compared with normal weight, is lower in females than in males at every body mass index (BMI) level, we aimed to investigate gender-specific differences in left ventricular (LV) hypertrophy in obesity, which themselves have been shown to have varying prognostic value. METHOD AND RESULTS In total, 741 subjects (female, n = 399) without identifiable cardiovascular risk factors (BMI 15.7-59.2 kg/m(2)) underwent cardiovascular magnetic resonance (1.5 T) to determine LV mass, end-diastolic volume (EDV, mL), and LV mass/volume ratio (LVM/VR). Across both sexes, there was a strong positive correlation between BMI and LV mass (male r = 0.44, female r = 0.57, both P < 0.001), with males showing a greater LV hypertrophic response (male +2.3 vs. female +1.6 g per BMI point increase, P = 0.001). Concentric hypertrophy was present in both sexes and LVM/VR positively correlated to BMI (male r = 0.45, female r = 0.29, both P < 0.001) on linear regression analysis. However, the degree of concentric hypertrophy was greater in males (male +0.13 vs. female +0.06 LVM/VR increase per BMI point increase, P = 0.001). On the other hand, females showed a greater LV cavity dilatory response (female +1.1 vs. male +0.3 mL per BMI point increase, P < 0.001). Indeed, in contrast to females, where BMI and LV-EDV were positively correlated (r = 0.38, P < 0.001), BMI did not correlate with EDV in men (r = 0.03, P = 0.62). CONCLUSION In the absence of traditional cardiovascular risk factors, obese men show predominantly concentric hypertrophy, whereas obese women exhibit both eccentric and concentric hypertrophy. As concentric hypertrophy is more strongly related to cardiovascular mortality than eccentric hypertrophy, our observations may explain the observed gender difference in obesity-related mortality.
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Affiliation(s)
- Oliver J Rider
- Department of Cardiovascular Medicine, University of Oxford, UK.
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Holloway CJ, Dass S, Suttie JJ, Rider OJ, Cox P, Cochlin LE, Jackson H, Fast AM, Johnson AW, Karamitsos TD, Neubauer S, Clarke K. Exercise training in dilated cardiomyopathy improves rest and stress cardiac function without changes in cardiac high energy phosphate metabolism. Heart 2012; 98:1083-90. [DOI: 10.1136/heartjnl-2012-302145] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Edwards LM, Tyler DJ, Kemp GJ, Dwyer RM, Johnson A, Holloway CJ, Nevill AM, Clarke K. The reproducibility of 31-phosphorus MRS measures of muscle energetics at 3 Tesla in trained men. PLoS One 2012; 7:e37237. [PMID: 22701564 PMCID: PMC3372482 DOI: 10.1371/journal.pone.0037237] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 08/08/2011] [Accepted: 04/18/2012] [Indexed: 01/21/2023] Open
Abstract
Objective Magnetic resonance spectroscopy (MRS) provides an exceptional opportunity for the study of in vivo metabolism. MRS is widely used to measure phosphorus metabolites in trained muscle, although there are no published data regarding its reproducibility in this specialized cohort. Thus, the aim of this study was to assess the reproducibility of 31P-MRS in trained skeletal muscle. Methods We recruited fifteen trained men (VO2peak = 4.7±0.8 L min−1/58±8 mL kg−1 min−1) and performed duplicate MR experiments during plantar flexion exercise, three weeks apart. Results Measures of resting phosphorus metabolites were reproducible, with 1.7 mM the smallest detectable difference in phosphocreatine (PCr). Measures of metabolites during exercise were less reliable: exercising PCr had a coefficient of variation (CV) of 27% during exercise, compared with 8% at rest. Estimates of mitochondrial function were variable, but experimentally useful. The CV of PCr1/2t was 40%, yet much of this variance was inter-subject such that differences of <20% were detectable with n = 15, given a significance threshold of p<0.05. Conclusions 31-phosphorus MRS provides reproducible and experimentally useful measures of phosphorus metabolites and mitochondrial function in trained human skeletal muscle.
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Affiliation(s)
- Lindsay M Edwards
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.
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Rider OJ, Holloway CJ, Emmanuel Y, Bloch E, Clarke K, Neubauer S. Increasing plasma free fatty acids in healthy subjects induces aortic distensibility changes seen in obesity. Circ Cardiovasc Imaging 2012; 5:367-75. [PMID: 22492484 DOI: 10.1161/circimaging.111.971804] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [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: 12/24/2022]
Abstract
BACKGROUND Elevated free fatty acid (FFA) levels are known to impair aortic elastic function. In obesity, FFA levels are elevated and aortic distensibility (AD) reduced in a pattern that predominantly affects the distal aorta. Despite this, the role of FFAs in obesity-related aortic stiffness remains unclear. METHODS AND RESULTS Using vascular MRI, we aimed to determine if (1) FFA level correlated with AD in obesity; and (2) whether elevating FFA acutely and subacutely in normal-weight subjects reproduced the distal pattern of AD change in obesity. To do this, regional AD was recorded in 35 normal-weight and 70 obese subjects and then correlated with FFA levels. When compared with normal weight, obesity was associated with reduced AD in a pattern predominantly affecting the distal aorta (ascending aorta by -22%, proximal descending aorta by -25%, and abdominal aorta by -35%; P<0.001). After controlling for age, blood pressure, and body mass index, FFA levels remained negatively correlated with abdominal AD (r=-0.43, P<0.01). In 2 further normal-weight groups, AD was recorded before and after elevation of FFA levels with intralipid infusion (by +535%, n=9) and a 5-day high-fat, low-carbohydrate diet (by +48%, n=14). CONCLUSIONS Both intralipid infusion and a low-carbohydrate diet resulted in reduced abdominal AD (infusion -22%, diet -28%; both P<0.05), reproducing the distal pattern AD reduction seen in obesity. These findings suggest that elevated FFA impair AD in obesity and provide a potential therapeutic target to improve aortic elastic function in obesity.
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Affiliation(s)
- Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research and the Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
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Abstract
Cardiac magnetic resonance spectroscopy (MRS) is a noninvasive tool for the assessment of myocardial metabolism, without the use of radiation or intravenous contrast agents. Using the intrinsic magnetic resonance signals from nuclei, including (31)Phosphorus, (1)Hydrogen, (23)Sodium, and (13)Carbon and, more recently, hyperpolarization techniques, MRS provides a comprehensive metabolic assessment of cardiac muscle. This highly versatile technique has provided insights into the pathophysiology of cardiac metabolism in a wide range of conditions, including ischemic heart disease, heart failure, genetic cardiomyopathies, heart transplantation, hypertensive heart disease, valvular heart disease, and diabetes. In addition, MRS has value in the assessment of prognosis and for monitoring therapeutic strategies in heart failure. However, because of the low temporal and spatial resolution of the technique, MRS has so far been limited to research applications. With higher field strength magnets and novel hyperpolarization techniques, the promise of using MRS for clinical applications may eventually be fulfilled.
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Affiliation(s)
- Cameron J Holloway
- Department of Cardiovascular Medicine, The University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK.
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Karamitsos TD, Ntusi NBA, Francis JM, Holloway CJ, Myerson SG, Neubauer S. Feasibility and safety of high-dose adenosine perfusion cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106844 DOI: 10.1186/1532-429x-13-s1-p105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Holloway CJ, Suttie J, Dass S, Cox P, Jackson H, Johnson AW, Francis JM, Karamitsos T, Neubauer S, Clarke K. Exercise training improves cardiac function, quality of life and exercise capacity in patients with dilated cardiomyopathy. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106563 DOI: 10.1186/1532-429x-13-s1-p349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Myerson SG, Holloway CJ, Francis JM, Neubauer S. Cardiovascular magnetic resonance (CMR)--an update and review. Prog Nucl Magn Reson Spectrosc 2011; 59:213-222. [PMID: 21920218 DOI: 10.1016/j.pnmrs.2010.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/11/2010] [Indexed: 05/31/2023]
Affiliation(s)
- Saul G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.
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Codreanu I, Pegg TJ, Selvanayagam JB, Robson MD, Rider OJ, Dasanu CA, Jung BA, Taggart DP, Clarke K, Holloway CJ. Details of left ventricular remodeling and the mechanism of paradoxical ventricular septal motion after coronary artery bypass graft surgery. J Invasive Cardiol 2011; 23:276-282. [PMID: 21725122] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The purpose of this study was to obtain new details of three-dimensional left ventricular wall motion related to ventricular remodeling in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS Cardiac-gated, phase-contrast measurements using navigator-gated, high temporal resolution, tissue phase mapping were obtained on 19 patients (66 ± 7 years old) before and after CABG. Left ventricular motion patterns and myocardial velocities were recorded for radial, circumferential and longitudinal motion. Radial, circumferential and longitudinal velocity curves were obtained separately for 16 ventricular segments. Ventricular torsion rate and longitudinal strain rate were also derived pre- and post-surgery. RESULTS After CABG, there was a significant improvement in apical contraction, with an apparent paradoxical decrease in the radial inward motion of the septal segments at the left ventricular base. Despite improved ventricular contractility during systole, peak longitudinal and rotational velocities decreased or showed no significant changes. An altered pattern of rotational motion with decreased initial counter-clockwise rotation at the beginning of systole and subsequent lower amplitude of reversed motions in diastole was also noted in most left ventricular segments. Lower peak clockwise rotational velocities were recorded in the basal anteroseptal segment with relatively higher values in the rest of the basal segments. CONCLUSION Our results suggest that post-operative changes after CABG are limiting ventricular rotational and longitudinal motions, despite an increase in ventricular contractility due to revascularization. At the ventricular base, the restrained rotational motion of basal anteroseptal segment, located proximally to the right ventricular insertion, and higher rotational velocities of the rest of the segments are pushing the septum toward the right ventricle during ventricular twisting. At the ventricular apex, the restrain in rotational motion caused by post-operative adhesions is affecting all apical segments due to a much smaller left ventricular diameter at this level. The rotating apex and the apical septum are similarly displaced toward the right ventricle during ventricular twisting.
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Affiliation(s)
- Ion Codreanu
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, United Kingdom.
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Codreanu I, Robson MD, Rider OJ, Pegg TJ, Jung BA, Dasanu CA, Clarke K, Holloway CJ. Chasing the reflected wave back into the heart: a new hypothesis while the jury is still out. Vasc Health Risk Manag 2011; 7:365-73. [PMID: 21731888 PMCID: PMC3119594 DOI: 10.2147/vhrm.s20845] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Indexed: 11/23/2022] Open
Abstract
Background: Arterial stiffness directly influences cardiac function and is independently associated with cardiovascular risk. However, the influence of the aortic reflected pulse pressure wave on left ventricular function has not been well characterized. The aim of this study was to obtain detailed information on regional ventricular wall motion patterns corresponding to the propagation of the reflected aortic wave on ventricular segments. Methods: Left ventricular wall motion was investigated in a group of healthy volunteers (n = 14, age 23 ± 3 years), using cardiac magnetic resonance navigator-gated tissue phase mapping. The left ventricle was divided into 16 segments and regional wall motion was studied in high temporal detail. Results: Corresponding to the expected timing of the reflected aortic wave reaching the left ventricle, a characteristic “notch” of regional myocardial motion was seen in all radial, circumferential, and longitudinal velocity graphs. This notch was particularly prominent in septal segments adjacent to the left ventricular outflow tract on radial velocity graphs and in anterior and posterior left ventricular segments on circumferential velocity graphs. Similarly, longitudinal velocity graphs demonstrated a brief deceleration in the upward recoil motion of the entire ventricle at the beginning of diastole. Conclusion: These results provide new insights into the possible influence of the reflected aortic waves on ventricular segments. Although the association with the reflected wave appears to us to be unambiguous, it represents a novel research concept, and further studies enabling the actual recording of the pulse wave are required.
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Affiliation(s)
- Ion Codreanu
- Department of Physiology, Anatomy, and Genetics, University of Oxford, UK.
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Edwards LM, Holloway CJ, Murray AJ, Knight NS, Carter EE, Kemp GJ, Thompson CH, Tyler DJ, Neubauer S, Robbins PA, Clarke K. Endurance exercise training blunts the deleterious effect of high-fat feeding on whole body efficiency. Am J Physiol Regul Integr Comp Physiol 2011; 301:R320-6. [PMID: 21632846 DOI: 10.1152/ajpregu.00850.2010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We recently showed that a week-long, high-fat diet reduced whole body exercise efficiency in sedentary men by >10% (Edwards LM, Murray AJ, Holloway CJ, Carter EE, Kemp GJ, Codreanu I, Brooker H, Tyler DJ, Robbins PA, Clarke K. FASEB J 25: 1088-1096, 2011). To test if a similar dietary regime would blunt whole body efficiency in endurance-trained men and, as a consequence, hinder aerobic exercise performance, 16 endurance-trained men were given a short-term, high-fat (70% kcal from fat) and a moderate carbohydrate (50% kcal from carbohydrate) diet, in random order. Efficiency was assessed during a standardized exercise task on a cycle ergometer, with aerobic performance assessed during a 1-h time trial and mitochondrial function later measured using (31)P-magnetic resonance spectroscopy. The subjects then underwent a 2-wk wash-out period, before the study was repeated with the diets crossed over. Muscle biopsies, for mitochondrial protein analysis, were taken at the start of the study and on the 5th day of each diet. Plasma fatty acids were 60% higher on the high-fat diet compared with moderate carbohydrate diet (P < 0.05). However, there was no change in whole body efficiency and no change in mitochondrial function. Endurance exercise performance was significantly reduced (P < 0.01), most probably due to glycogen depletion. Neither diet led to changes in citrate synthase, ATP synthase, or mitochondrial uncoupling protein 3. We conclude that prior exercise training blunts the deleterious effect of short-term, high-fat feeding on whole body efficiency.
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Affiliation(s)
- Lindsay M Edwards
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.
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Holloway CJ, Cochlin LE, Emmanuel Y, Murray A, Codreanu I, Edwards LM, Szmigielski C, Tyler DJ, Knight NS, Saxby BK, Lambert B, Thompson C, Neubauer S, Clarke K. A high-fat diet impairs cardiac high-energy phosphate metabolism and cognitive function in healthy human subjects. Am J Clin Nutr 2011; 93:748-55. [PMID: 21270386 DOI: 10.3945/ajcn.110.002758] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High-fat, low-carbohydrate diets are widely used for weight reduction, but they may also have detrimental effects via increased circulating free fatty acid concentrations. OBJECTIVE We tested whether raising plasma free fatty acids by using a high-fat, low-carbohydrate diet results in alterations in heart and brain in healthy subjects. DESIGN Men (n = 16) aged 22 ± 1 y (mean ± SE) were randomly assigned to 5 d of a high-fat, low-carbohydrate diet containing 75 ± 1% of calorie intake through fat consumption or to an isocaloric standard diet providing 23 ± 1% of calorie intake as fat. In a crossover design, subjects undertook the alternate diet after a 2-wk washout period, with results compared after the diet periods. Cardiac (31)P magnetic resonance (MR) spectroscopy and MR imaging, echocardiography, and computerized cognitive tests were used to assess cardiac phosphocreatine (PCr)/ATP, cardiac function, and cognitive function, respectively. RESULTS Compared with the standard diet, subjects who consumed the high-fat, low-carbohydrate diet had 44% higher plasma free fatty acids (P < 0.05), 9% lower cardiac PCr/ATP (P < 0.01), and no change in cardiac function. Cognitive tests showed impaired attention (P < 0.01), speed (P < 0.001), and mood (P < 0.01) after the high-fat, low-carbohydrate diet. CONCLUSION Raising plasma free fatty acids decreased myocardial PCr/ATP and reduced cognition, which suggests that a high-fat diet is detrimental to heart and brain in healthy subjects.
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Affiliation(s)
- Cameron J Holloway
- Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom.
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Edwards LM, Murray AJ, Holloway CJ, Carter EE, Kemp GJ, Codreanu I, Brooker H, Tyler DJ, Robbins PA, Clarke K. Short‐term consumption of a high‐fat diet impairs whole‐body efficiency and cognitive function in sedentary men. FASEB J 2010; 25:1088-96. [DOI: 10.1096/fj.10-171983] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lindsay M. Edwards
- Department of Physiology Anatomy, and Genetics, University of Oxford Oxford UK
- The Oxford Centre for Clinical Magnetic Resonance Research John Radcliffe Hospital Oxford UK
| | - Andrew J. Murray
- Department of Physiology Development, and Neuroscience University of Cambridge Cambridge UK
| | - Cameron J. Holloway
- The Oxford Centre for Clinical Magnetic Resonance Research John Radcliffe Hospital Oxford UK
| | - Emma E. Carter
- Department of Physiology Anatomy, and Genetics, University of Oxford Oxford UK
| | - Graham J. Kemp
- Institute of Ageing and Chronic Disease Faculty of Health and Life Sciences University of Liverpool Liverpool UK
| | - Ion Codreanu
- The Oxford Centre for Clinical Magnetic Resonance Research John Radcliffe Hospital Oxford UK
| | | | - Damian J. Tyler
- Department of Physiology Anatomy, and Genetics, University of Oxford Oxford UK
| | - Peter A. Robbins
- Department of Physiology Anatomy, and Genetics, University of Oxford Oxford UK
| | - Kieran Clarke
- Department of Physiology Anatomy, and Genetics, University of Oxford Oxford UK
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Karamitsos TD, Ntusi NAB, Francis JM, Holloway CJ, Myerson SG, Neubauer S. Feasibility and safety of high-dose adenosine perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:66. [PMID: 21080924 PMCID: PMC2996376 DOI: 10.1186/1532-429x-12-66] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [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: 07/02/2010] [Accepted: 11/16/2010] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Adenosine is the most widely used vasodilator stress agent for cardiovascular magnetic resonance (CMR) perfusion studies. With the standard dose of 140 mcg/kg/min some patients fail to demonstrate characteristic haemodynamic changes: a significant increase in heart rate (HR) and mild decrease in systolic blood pressure (SBP). Whether an increase in the rate of adenosine infusion would improve peripheral and, likely, coronary vasodilatation in those patients is unknown. The aim of the present study was to assess the tolerance and safety of a high-dose adenosine protocol in patients with inadequate haemodynamic response to the standard adenosine protocol when undergoing CMR perfusion imaging. METHODS 98 consecutive patients with known or suspected coronary artery disease (CAD) underwent CMR perfusion imaging at 1.5 Tesla. Subjects were screened for contraindications to adenosine, and an electrocardiogram was performed prior to the scan. All patients initially received the standard adenosine protocol (140 mcg/kg/min for at least 3 minutes). If the haemodynamic response was inadequate (HR increase < 10 bpm or SBP decrease < 10 mmHg) then the infusion rate was increased up to a maximum of 210 mcg/kg/min (maximal infusion duration 7 minutes). RESULTS All patients successfully completed the CMR scan. Of a total of 98 patients, 18 (18%) did not demonstrate evidence of a significant increase in HR or decrease in SBP under the standard adenosine infusion rate. Following the increase in the rate of infusion, 16 out of those 18 patients showed an adequate haemodynamic response. One patient of the standard infusion group and two patients of the high-dose group developed transient advanced AV block. Significantly more patients complained of chest pain in the high-dose group (61% vs. 29%, p = 0.009). On multivariate analysis, age > 65 years and ejection fraction < 57% were the only independent predictors of blunted haemodynamic responsiveness to adenosine. CONCLUSIONS A substantial number of patients do not show adequate peripheral haemodynamic response to standard-dose adenosine stress during perfusion CMR imaging. Age and reduced ejection fraction are predictors of inadequate response to standard dose adenosine. A high-dose adenosine protocol (up to 210 mcg/kg/min) is well tolerated and results in adequate haemodynamic response in nearly all patients.
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Affiliation(s)
- Theodoros D Karamitsos
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Ntobeko AB Ntusi
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Jane M Francis
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Cameron J Holloway
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Saul G Myerson
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Stefan Neubauer
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
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Holloway CJ, Betts TR, Neubauer S, Myerson SG. Hypertrophic Cardiomyopathy Complicated by Large Apical Aneurysm and Thrombus, Presenting as Ventricular Tachycardia. J Am Coll Cardiol 2010; 56:1961. [DOI: 10.1016/j.jacc.2010.01.078] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 01/12/2010] [Accepted: 01/18/2010] [Indexed: 10/18/2022]
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Holloway CJ, Montgomery HE, Murray AJ, Cochlin LE, Codreanu I, Hopwood N, Johnson AW, Rider OJ, Levett DZH, Tyler DJ, Francis JM, Neubauer S, Grocott MPW, Clarke K. Cardiac response to hypobaric hypoxia: persistent changes in cardiac mass, function, and energy metabolism after a trek to Mt. Everest Base Camp. FASEB J 2010; 25:792-6. [PMID: 20978235 DOI: 10.1096/fj.10-172999] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We postulated that changes in cardiac high-energy phosphate metabolism may underlie the myocardial dysfunction caused by hypobaric hypoxia. Healthy volunteers (n=14) were studied immediately before, and within 4 d of return from, a 17-d trek to Mt. Everest Base Camp (5300 m). (31)P magnetic resonance (MR) spectroscopy was used to measure cardiac phosphocreatine (PCr)/ATP, and MR imaging and echocardiography were used to assess cardiac volumes, mass, and function. Immediately after returning from Mt. Everest, total body weight had fallen by 3% (P<0.05), but left ventricular mass, adjusted for changes in body surface area, had disproportionately decreased by 11% (P<0.05). Alterations in diastolic function were also observed, with a reduction in peak left ventricular filling rates and mitral inflow E/A, by 17% (P<0.05) and 24% (P<0.01), respectively, with no change in hydration status. Compared with pretrek, cardiac PCr/ATP ratio had decreased by 18% (P<0.01). Whether the abnormalities were even greater at altitude is unknown, but all had returned to pretrek levels after 6 mo. The alterations in cardiac morphology, function, and energetics are similar to findings in patients with chronic hypoxia. Thus, a decrease in cardiac PCr/ATP may be a universal response to periods of sustained low oxygen availability, underlying hypoxia-induced cardiac dysfunction in healthy human heart and in patients with cardiopulmonary diseases.
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Affiliation(s)
- Cameron J Holloway
- 1 Department of Physiology, Anatomy, and Genetics, Sherrington Bldg., University of Oxford, Oxford OX1 3PT, UK.
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