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Assadi H, Matthews G, Zhao X, Li R, Alabed S, Grafton-Clarke C, Mehmood Z, Kasmai B, Limbachia V, Gosling R, Yashoda GK, Halliday I, Swoboda P, Ripley DP, Zhong L, Vassiliou VS, Swift AJ, Geest RJVD, Garg P. Cardiac MR modelling of systolic and diastolic blood pressure. Open Heart 2023; 10:e002484. [PMID: 38114194 DOI: 10.1136/openhrt-2023-002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
AIMS Blood pressure (BP) is a crucial factor in cardiovascular health and can affect cardiac imaging assessments. However, standard outpatient cardiovascular MR (CMR) imaging procedures do not typically include BP measurements prior to image acquisition. This study proposes that brachial systolic BP (SBP) and diastolic BP (DBP) can be modelled using patient characteristics and CMR data. METHODS In this multicentre study, 57 patients from the PREFER-CMR registry and 163 patients from other registries were used as the derivation cohort. All subjects had their brachial SBP and DBP measured using a sphygmomanometer. Multivariate linear regression analysis was applied to predict brachial BP. The model was subsequently validated in a cohort of 169 healthy individuals. RESULTS Age and left ventricular ejection fraction were associated with SBP. Aortic forward flow, body surface area and left ventricular mass index were associated with DBP. When applied to the validation cohort, the correlation coefficient between CMR-derived SBP and brachial SBP was (r=0.16, 95% CI 0.011 to 0.305, p=0.03), and CMR-derived DBP and brachial DBP was (r=0.27, 95% CI 0.122 to 0.403, p=0.0004). The area under the curve (AUC) for CMR-derived SBP to predict SBP>120 mmHg was 0.59, p=0.038. Moreover, CMR-derived DBP to predict DBP>80 mmHg had an AUC of 0.64, p=0.002. CONCLUSION CMR-derived SBP and DBP models can estimate brachial SBP and DBP. Such models may allow efficient prospective collection, as well as retrospective estimation of BP, which should be incorporated into assessments due to its critical effect on load-dependent parameters.
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Affiliation(s)
- Hosamadin Assadi
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Gareth Matthews
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Xiaodan Zhao
- National Heart Research Institute, National Heart Centre, Singapore
| | - Rui Li
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Samer Alabed
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ciaran Grafton-Clarke
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Zia Mehmood
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Bahman Kasmai
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Vaishali Limbachia
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Rebecca Gosling
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Ian Halliday
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - David Paul Ripley
- Department of Cardiology, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - Liang Zhong
- National Heart Research Institute, National Heart Centre, Singapore
- Cardiovascular Science Academic Program, Duke-NUS Medical School, Singapore
| | - Vassilios S Vassiliou
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pankaj Garg
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Li R, Assadi H, Matthews G, Mehmood Z, Grafton-Clarke C, Kasmai B, Hewson D, Greenwood R, Spohr H, Zhong L, Zhao X, Sawh C, Duehmke R, Vassiliou VS, Nelthorpe F, Ashman D, Curtin J, Yashoda GK, Van der Geest RJ, Alabed S, Swift AJ, Hughes M, Garg P. The Importance of Mitral Valve Prolapse Doming Volume in the Assessment of Left Ventricular Stroke Volume with Cardiac MRI. Med Sci (Basel) 2023; 11:medsci11010013. [PMID: 36810480 PMCID: PMC9945133 DOI: 10.3390/medsci11010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
There remains a debate whether the ventricular volume within prolapsing mitral valve (MV) leaflets should be included in the left ventricular (LV) end-systolic volume, and therefore factored in LV stroke volume (SV), in cardiac magnetic resonance (CMR) assessments. This study aims to compare LV volumes during end-systolic phases, with and without the inclusion of the volume of blood on the left atrial aspect of the atrioventricular groove but still within the MV prolapsing leaflets, against the reference LV SV by four-dimensional flow (4DF). A total of 15 patients with MV prolapse (MVP) were retrospectively enrolled in this study. We compared LV SV with (LV SVMVP) and without (LV SVstandard) MVP left ventricular doming volume, using 4D flow (LV SV4DF) as the reference value. Significant differences were observed when comparing LV SVstandard and LV SVMVP (p < 0.001), and between LV SVstandard and LV SV4DF (p = 0.02). The Intraclass Correlation Coefficient (ICC) test demonstrated good repeatability between LV SVMVP and LV SV4DF (ICC = 0.86, p < 0.001) but only moderate repeatability between LV SVstandard and LV SV4DF (ICC = 0.75, p < 0.01). Calculating LV SV by including the MVP left ventricular doming volume has a higher consistency with LV SV derived from the 4DF assessment. In conclusion, LV SV short-axis cine assessment incorporating MVP dooming volume can significantly improve the precision of LV SV assessment compared to the reference 4DF method. Hence, in cases with bi-leaflet MVP, we recommend factoring in MVP dooming into the left ventricular end-systolic volume to improve the accuracy and precision of quantifying mitral regurgitation.
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Affiliation(s)
- Rui Li
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Hosamadin Assadi
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Gareth Matthews
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Zia Mehmood
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | | | - Bahman Kasmai
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - David Hewson
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Richard Greenwood
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Hilmar Spohr
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Cardiovascular Sciences Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore 169856, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Chris Sawh
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Rudolf Duehmke
- Cardiology Department, Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, King’s Lynn PE30 4ET, UK
| | - Vassilios S. Vassiliou
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Faye Nelthorpe
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - David Ashman
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - John Curtin
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Gurung-Koney Yashoda
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Rob J. Van der Geest
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Marina Hughes
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
- Correspondence: ; Tel.: +44-016-0359-2534
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