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Baker RR, Muthurangu V, Rega M, Walsh SB, Steeden JA. Rapid 2D 23Na MRI of the calf using a denoising convolutional neural network. Magn Reson Imaging 2024; 110:184-194. [PMID: 38642779 DOI: 10.1016/j.mri.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE 23Na MRI can be used to quantify in-vivo tissue sodium concentration (TSC), but the inherently low 23Na signal leads to long scan times and/or noisy or low-resolution images. Reconstruction algorithms such as compressed sensing (CS) have been proposed to mitigate low signal-to-noise ratio (SNR); although, these can result in unnatural images, suboptimal denoising and long processing times. Recently, machine learning has been increasingly used to denoise 1H MRI acquisitions; however, this approach typically requires large volumes of high-quality training data, which is not readily available for 23Na MRI. Here, we propose using 1H data to train a denoising convolutional neural network (CNN), which we subsequently demonstrate on prospective 23Na images of the calf. METHODS 1893 1H fat-saturated transverse slices of the knee from the open-source fastMRI dataset were used to train denoising CNNs for different levels of noise. Synthetic low SNR images were generated by adding gaussian noise to the high-quality 1H k-space data before reconstruction to create paired training data. For prospective testing, 23Na images of the calf were acquired in 10 healthy volunteers with a total of 150 averages over ten minutes, which were used as a reference throughout the study. From this data, images with fewer averages were retrospectively reconstructed using a non-uniform fast Fourier transform (NUFFT) as well as CS, with the NUFFT images subsequently denoised using the trained CNN. RESULTS CNNs were successfully applied to 23Na images reconstructed with 50, 40 and 30 averages. Muscle and skin apparent TSC quantification from CNN-denoised images were equivalent to those from CS images, with <0.9 mM bias compared to reference values. Estimated SNR was significantly higher in CNN-denoised images compared to NUFFT, CS and reference images. Quantitative edge sharpness was equivalent for all images. For subjective image quality ranking, CNN-denoised images ranked equally best with reference images and significantly better than NUFFT and CS images. CONCLUSION Denoising CNNs trained on 1H data can be successfully applied to 23Na images of the calf; thus, allowing scan time to be reduced from ten minutes to two minutes with little impact on image quality or apparent TSC quantification accuracy.
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Affiliation(s)
- Rebecca R Baker
- UCL Centre for Medical Imaging, University College London, London, UK; UCL Centre for Translational Cardiovascular Imaging, University College London, London, UK.
| | - Vivek Muthurangu
- UCL Centre for Translational Cardiovascular Imaging, University College London, London, UK.
| | - Marilena Rega
- Institute of Nuclear Medicine, University College Hospital, London, UK.
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London, UK.
| | - Jennifer A Steeden
- UCL Centre for Translational Cardiovascular Imaging, University College London, London, UK.
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2
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Knight DS, Virsinskaite R, Karia N, Cole AR, Maclean RH, Brown JT, Patel RK, Razvi Y, Venneri L, Kotecha T, Martinez-Naharro A, Kellman P, Scott-Russell AM, Schreiber BE, Ong VH, Denton CP, Fontana M, Coghlan JG, Muthurangu V. Native myocardial T1 and right ventricular size by CMR predict outcome in systemic sclerosis-associated pulmonary hypertension. Rheumatology (Oxford) 2024:keae141. [PMID: 38759116 DOI: 10.1093/rheumatology/keae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/10/2024] [Accepted: 02/07/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES Measures of right heart size and function are prognostic in systemic sclerosis-associated pulmonary hypertension (SSc-PH), but the importance of myocardial tissue characterisation remains unclear. We aimed to investigate the predictive potential and interaction of cardiovascular magnetic resonance (CMR) myocardial tissue characterisation and right heart size and function in SSc-PH. METHODS A retrospective, single-centre, observational study of 148 SSc-PH patients confirmed by right heart catheterization who underwent clinically-indicated CMR including native myocardial T1 and T2 mapping from 2016 to 2023 was performed. RESULTS Sixty-six (45%) patients died during follow-up (median 3.5 years, range 0.1-7.3). Patients who died were older (65 vs 60 years, p= 0.035) with more dilated (RVEDVi and RVESVi, p< 0.001), hypertrophied (RVMi, p= 0.013) and impaired (RVEF, p< 0.001) right ventricles, more dilated right atria (RAi, p= 0.043) and higher native myocardial T1 (p< 0.001).After adjustment for age, RVESVi (p = 0.0023) and native T1 (p = 0.0024) were independent predictors of all-cause mortality. Both RVESVi and native T1 remained independently predictive after adjusting for age and PH subtype (RVESVi p < 0.001, T1 p = 0.0056). Optimal prognostic thresholds for RVESVi and native T1 were ≤38 mL/m2 and ≤1119 ms, respectively (p < 0.001). Patients with RVESVi ≤ 38 mL/m2 and native T1 ≤ 1119 ms had significantly better outcomes than all other combinations (p < 0.001). Furthermore, patients with RVESVi > 38mL/m2 and native T1 ≤ 1119 ms had significantly better survival than patients with RVESVi > 38mL/m2 and native T1 > 1119ms (p = 0.017). CONCLUSION We identified prognostically relevant CMR metrics and thresholds for patients with SSc-PH. Assessing myocardial tissue characterisation alongside RV function confers added value in SSc-PH and may represent an additional treatment target.
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Affiliation(s)
- Daniel S Knight
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, London, UK
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ruta Virsinskaite
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, London, UK
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Nina Karia
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Alice R Cole
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School (Royal Free Campus), London, UK
| | - Rory H Maclean
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School (Royal Free Campus), London, UK
| | - James T Brown
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, London, UK
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Rishi K Patel
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | - Yousuf Razvi
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | - Lucia Venneri
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, London, UK
| | - Tushar Kotecha
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, London, UK
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD, USA
| | | | - Benjamin E Schreiber
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, London, UK
| | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School (Royal Free Campus), London, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School (Royal Free Campus), London, UK
| | - Marianna Fontana
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | - J Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, London, UK
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London, UK
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Issitt RW, Cudworth E, Cortina-Borja M, Gupta A, Kallon D, Crook R, Shaw M, Robertson A, Tsang VT, Henwood S, Muthurangu V, Sebire NJ, Burch M, Fenton M. Rapid desensitization through immunoadsorption during cardiopulmonary bypass. A novel method to facilitate human leukocyte antigen incompatible heart transplantation. Perfusion 2024; 39:543-554. [PMID: 36625378 PMCID: PMC10943618 DOI: 10.1177/02676591221151035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Anti-human leukocyte antigen (HLA)-antibody production represents a major barrier to heart transplantation, limiting recipient compatibility with potential donors and increasing the risk of complications with poor waiting-list outcomes. Currently there is no consensus to when desensitization should take place, and through what mechanism, meaning that sensitized patients must wait for a compatible donor for many months, if not years. We aimed to determine if intraoperative immunoadsorption could provide a potential desensitization methodology. METHODS Anti-HLA antibody-containing whole blood was added to a Cardiopulmonary bypass (CPB) circuit set up to mimic a 20 kg patient undergoing heart transplantation. Plasma was separated and diverted to a standalone, secondary immunoadsorption system, with antibody-depleted plasma returned to the CPB circuit. Samples for anti-HLA antibody definition were taken at baseline, when combined with the CPB prime (on bypass), and then every 20 min for the duration of treatment (total 180 min). RESULTS A reduction in individual allele median fluorescence intensity (MFI) to below clinically relevant levels (<1000 MFI), and in the majority of cases below the lower positive detection limit (<500 MFI), even in alleles with a baseline MFI >4000 was demonstrated. Reduction occurred in all cases within 120 min, demonstrating efficacy in a time period usual for heart transplantation. Flowcytometric crossmatching of suitable pseudo-donor lymphocytes demonstrated a change from T cell and B cell positive channel shifts to negative, demonstrating a reduction in binding capacity. CONCLUSIONS Intraoperative immunoadsorption in an ex vivo setting demonstrates clinically relevant reductions in anti-HLA antibodies within the normal timeframe for heart transplantation. This method represents a potential desensitization technique that could enable sensitized children to accept a donor organ earlier, even in the presence of donor-specific anti-HLA antibodies.
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Affiliation(s)
- Richard W Issitt
- Perfusion Department, Great Ormond Street Hospital for Children, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Biomedical Research Centre, London, UK
| | - Eamonn Cudworth
- Clinical Transplantation Laboratory, Barts Health NHS Trust, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Arun Gupta
- Clinical Transplantation Laboratory, Barts Health NHS Trust, London, UK
| | - Delordson Kallon
- Clinical Transplantation Laboratory, Barts Health NHS Trust, London, UK
| | - Richard Crook
- Perfusion Department, Great Ormond Street Hospital for Children, London, UK
| | - Michael Shaw
- Perfusion Department, Great Ormond Street Hospital for Children, London, UK
| | - Alex Robertson
- Perfusion Department, Great Ormond Street Hospital for Children, London, UK
| | - Victor T Tsang
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Sophie Henwood
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children, London, UK
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London, UK
| | - Neil J Sebire
- Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Biomedical Research Centre, London, UK
| | - Michael Burch
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children, London, UK
- Department of Paediatric Cardiology, Institute of Child Health, University College London, London, UK
| | - Matthew Fenton
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children, London, UK
- Department of Paediatric Cardiology, Institute of Child Health, University College London, London, UK
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Patel RK, Bandera F, Venneri L, Porcari A, Razvi Y, Ioannou A, Chacko L, Martinez-Naharro A, Rauf MU, Knight D, Brown J, Petrie A, Wechalekar A, Whelan C, Lachmann H, Muthurangu V, Guazzi M, Hawkins PN, Gillmore JD, Fontana M. Cardiopulmonary Exercise Testing in Evaluating Transthyretin Amyloidosis. JAMA Cardiol 2024; 9:367-376. [PMID: 38446436 PMCID: PMC10918582 DOI: 10.1001/jamacardio.2024.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/26/2023] [Indexed: 03/07/2024]
Abstract
Importance Cardiopulmonary exercise testing (CPET) has an established role in the assessment of patients with heart failure. However, data are lacking in patients with transthyretin (ATTR) amyloidosis. Objective To use CPET to characterize the spectrum of functional phenotypes in patients with ATTR amyloidosis and assess their association with the cardiac amyloid burden as well as the association between CPET parameters and prognosis. Design, Setting and Participants This single-center study evaluated patients diagnosed with ATTR amyloidosis from May 2019 to September 2022 who underwent CPET at the National Amyloidosis Centre. Of 1045 patients approached, 506 were included and completed the study. Patients were excluded if they had an absolute contraindication to CPET or declined participation. The mean (SD) follow-up period was 22.4 (11.6) months. Main Outcomes and Measures Comparison of CPET parameters across disease phenotypes (ATTR with cardiomyopathy [ATTR-CM], polyneuropathy, or both [ATTR-mixed]), differences in CPET parameters based on degree of amyloid infiltration (as measured by cardiovascular magnetic resonance [CMR] with extracellular volume mapping), and association between CPET parameters and prognosis. Results Among the 506 patients with ATTR amyloidosis included in this study, the mean (SD) age was 73.5 (10.2) years, and 457 participants (90.3%) were male. Impairment in functional capacity was highly prevalent. Functional impairment in ATTR-CM and ATTR-mixed phenotypes (peak mean [SD] oxygen consumption [VO2], 14.5 [4.3] mL/kg/min and 15.7 [6.2] mL/kg/min, respectively) was observed alongside impairment in the oxygen pulse, with ventilatory efficiency highest in ATTR-CM (mean [SD] ventilatory efficiency/volume of carbon dioxide expired slope, 38.1 [8.6]). Chronotropic incompetence and exercise oscillatory ventilation (EOV) were highly prevalent across all phenotypes, with both the prevalence and severity being higher than in heart failure from different etiologies. Worsening of amyloid burden on CMR was associated with decline in multiple CPET parameters, although chronotropic response and EOV remained abnormal irrespective of amyloid burden. On multivariable Cox regression analysis, peak VO2 and peak systolic blood pressure (SBP) were independently associated with prognosis (peak VO2: hazard ratio, 0.89 [95% CI, 0.81-0.99; P = .03]; peak SBP: hazard ratio, 0.98 [95% CI, 0.97-0.99; P < .001]). Conclusions and Relevance In this study, ATTR amyloidosis was characterized by distinct patterns of functional impairment between all disease phenotypes. A high prevalence of chronotropic incompetence, EOV, and ventilatory inefficiency were characteristic of this population. CPET parameters were associated with amyloid burden by CMR and with peak VO2, and SBP, which have been shown to be independent predictors of mortality. These findings suggest that CPET may be useful in characterizing distinct patterns of functional impairment across the spectrum of amyloid infiltration and predicting outcomes, and potentially offers a more comprehensive method of evaluating functional capacity for future prospective studies.
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Affiliation(s)
- Rishi K. Patel
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Francesco Bandera
- Cardiac Rehabilitation and Heart Failure Unit, Cardiology University Department, Scientific Institute for Research, Hospitalization and Healthcare MultiMedica, Sesto San Giovanni, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Lucia Venneri
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Aldostefano Porcari
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Italy, Trieste, Italy
| | - Yousuf Razvi
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Adam Ioannou
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Liza Chacko
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Muhammad U. Rauf
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Daniel Knight
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - James Brown
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Aviva Petrie
- Eastman Dental Institute, University College London, University Street, London, United Kingdom
| | - Ashutosh Wechalekar
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Carol Whelan
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Helen Lachmann
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Marco Guazzi
- Cardiac Rehabilitation and Heart Failure Unit, Cardiology University Department, Scientific Institute for Research, Hospitalization and Healthcare MultiMedica, Sesto San Giovanni, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Philip N. Hawkins
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Julian D. Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, United Kingdom
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DiLorenzo MP, Lee S, Rathod RH, Raimondi F, Farooqi KM, Jain SS, Samyn MM, Johnson TR, Olivieri LJ, Fogel MA, Lai WW, Renella P, Powell AJ, Buddhe S, Stafford C, Johnson JN, Helbing WA, Pushparajah K, Voges I, Muthurangu V, Miles KG, Greil G, McMahon CJ, Slesnick TC, Fonseca BM, Morris SA, Soslow JH, Grosse-Wortmann L, Beroukhim RS, Grotenhuis HB. Design and implementation of multicenter pediatric and congenital studies with cardiovascular magnetic resonance: Big data in smaller bodies. J Cardiovasc Magn Reson 2024; 26:101041. [PMID: 38527706 PMCID: PMC10990896 DOI: 10.1016/j.jocmr.2024.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) has become the reference standard for quantitative and qualitative assessment of ventricular function, blood flow, and myocardial tissue characterization. There is a preponderance of large CMR studies and registries in adults; However, similarly powered studies are lacking for the pediatric and congenital heart disease (PCHD) population. To date, most CMR studies in children are limited to small single or multicenter studies, thereby limiting the conclusions that can be drawn. Within the PCHD CMR community, a collaborative effort has been successfully employed to recognize knowledge gaps with the aim to embolden the development and initiation of high-quality, large-scale multicenter research. In this publication, we highlight the underlying challenges and provide a practical guide toward the development of larger, multicenter initiatives focusing on PCHD populations, which can serve as a model for future multicenter efforts.
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Affiliation(s)
- Michael P. DiLorenzo
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway, New York, NY 10032, USA
| | - Simon Lee
- Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | | | - Francesca Raimondi
- Children's Hospital Meyer, University of Florence, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy
| | - Kanwal M. Farooqi
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway, New York, NY 10032, USA
| | - Supriya S. Jain
- New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Margaret M. Samyn
- Medical College of Wisconsin/The Herma Heart Institute at Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI 53226, USA
| | - Tiffanie R. Johnson
- Indiana University School of Medicine, Riley Children’s Health, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
| | - Laura J. Olivieri
- Department of Pediatric Cardiology, Children's Hospital of Pittsburgh, Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA 15224, USA
| | - Mark A. Fogel
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Wyman W. Lai
- CHOC Children's Hospital, 1201 W La Veta Ave, Orange, CA 92868, USA
| | | | | | - Sujatha Buddhe
- Department of Pediatrics, Division of Pediatric Cardiology, Betty Irene Moore Heart Center, Lucile Packard Children’s Hospital, 725 Welch Rd Ste 325, Palo Alto, CA 94304, USA
| | | | - Jason N. Johnson
- Department of Pediatrics, University of Tennessee Health Sciences Center, 848 Adams Ave, Memphis, TN 38103, USA
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Sciences Center, 848 Adams Ave, Memphis, TN 38103, USA
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Sophia's Children's Hospital, Erasmus University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Rotterdam, the Netherlands
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Inga Voges
- German Centre for Cardiovascular Research, Ootsdamer Str. 58, 10785 Berlin, Germany
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Vivek Muthurangu
- UCL Center for Translational Cardiovascular Imaging, University College London, Gower Street, London WC1E 6BT, UK
| | - Kimberley G. Miles
- Heart Institute, Cincinnati Children's Hospital Medical Center, 333 Burnet Ave, Kimberley, Cincinnati, OH 45229, USA
| | - Gerald Greil
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Colin J. McMahon
- University College of Dublin, School of Medicine and Department of Paediatric Cardiology, Children's Health Ireland, Gate 5, Crumlin, Dublin 12, Ireland
| | - Timothy C. Slesnick
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, 738 Old Norcross Road, Lawrenceville, GA 30046, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, Division of Pediatric Cardiology, Emory University School of Medicine, 738 Old Norcross Road, Lawrenceville, GA 30046, USA
| | - Brian M. Fonseca
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave, Aurora, CO 80045, USA
| | - Shaine A. Morris
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine Texas Children's Hospital, 6651 Main Street, Houston, TX 77030, USA
| | - Jonathan H. Soslow
- Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, 700 SW Campus Dr, Portland, OR, USA 97239
| | | | - Heynric B. Grotenhuis
- Pediatric Cardiology, Wilhelmina Children’s Hospital, UMCU, Lundlaan 6, 3584 EA Utrecht, the Netherlands
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Dawes TJW, Woodham V, Sharkey E, McEwan A, Derrick G, Muthurangu V, Moledina S, Hepburn L. Predicting Peri-Operative Cardiorespiratory Adverse Events in Children with Idiopathic Pulmonary Arterial Hypertension Undergoing Cardiac Catheterization Using Echocardiography: A Cohort Study. Pediatr Cardiol 2024:10.1007/s00246-024-03447-3. [PMID: 38512488 DOI: 10.1007/s00246-024-03447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/07/2024] [Indexed: 03/23/2024]
Abstract
General anesthesia in children with idiopathic pulmonary arterial hypertension (PAH) carries an increased risk of peri-operative cardiorespiratory complications though risk stratifying individual children pre-operatively remains difficult. We report the incidence and echocardiographic risk factors for adverse events in children with PAH undergoing general anesthesia for cardiac catheterization. Echocardiographic, hemodynamic, and adverse event data from consecutive PAH patients are reported. A multivariable predictive model was developed from echocardiographic variables identified by Bayesian univariable logistic regression. Model performance was reported by area under the curve for receiver operating characteristics (AUCroc) and precision/recall (AUCpr) and a pre-operative scoring system derived (0-100). Ninety-three children underwent 158 cardiac catheterizations with mean age 8.8 ± 4.6 years. Adverse events (n = 42) occurred in 15 patients (16%) during 16 catheterizations (10%) including cardiopulmonary resuscitation (n = 5, 3%), electrocardiographic changes (n = 3, 2%), significant hypotension (n = 2, 1%), stridor (n = 1, 1%), and death (n = 2, 1%). A multivariable model (age, right ventricular dysfunction, and dilatation, pulmonary and tricuspid regurgitation severity, and maximal velocity) was highly predictive of adverse events (AUCroc 0.86, 95% CI 0.75 to 1.00; AUCpr 0.68, 95% CI 0.50 to 0.91; baseline AUCpr 0.10). Pre-operative risk scores were higher in those who had a subsequent adverse event (median 47, IQR 43 to 53) than in those who did not (median 23, IQR 15 to 33). Pre-operative echocardiography informs the risk of peri-operative adverse events and may therefore be useful both for consent and multi-disciplinary care planning.
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Affiliation(s)
- Timothy J W Dawes
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK.
- UCL Institute of Cardiovascular Science, University College London, London, UK.
| | - Valentine Woodham
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK
| | - Emma Sharkey
- Department of Anaesthesia, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Angus McEwan
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK
| | - Graham Derrick
- UCL Institute of Cardiovascular Science, University College London, London, UK
- Department of Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Shahin Moledina
- UCL Institute of Cardiovascular Science, University College London, London, UK
- National Paediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucy Hepburn
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK
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Baker RR, Muthurangu V, Rega M, Montalt‐Tordera J, Rot S, Solanky BS, Gandini Wheeler‐Kingshott CAM, Walsh SB, Steeden JA. 2D sodium MRI of the human calf using half-sinc excitation pulses and compressed sensing. Magn Reson Med 2024; 91:325-336. [PMID: 37799019 PMCID: PMC10962573 DOI: 10.1002/mrm.29841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Sodium MRI can be used to quantify tissue sodium concentration (TSC) in vivo; however, UTE sequences are required to capture the rapidly decaying signal. 2D MRI enables high in-plane resolution but typically has long TEs. Half-sinc excitation may enable UTE; however, twice as many readouts are necessary. Scan time can be minimized by reducing the number of signal averages (NSAs), but at a cost to SNR. We propose using compressed sensing (CS) to accelerate 2D half-sinc acquisitions while maintaining SNR and TSC. METHODS Ex vivo and in vivo TSC were compared between 2D spiral sequences with full-sinc (TE = 0.73 ms, scan time ≈ 5 min) and half-sinc excitation (TE = 0.23 ms, scan time ≈ 10 min), with 150 NSAs. Ex vivo, these were compared to a reference 3D sequence (TE = 0.22 ms, scan time ≈ 24 min). To investigate shortening 2D scan times, half-sinc data was retrospectively reconstructed with fewer NSAs, comparing a nonuniform fast Fourier transform to CS. Resultant TSC and image quality were compared to reference 150 NSAs nonuniform fast Fourier transform images. RESULTS TSC was significantly higher from half-sinc than from full-sinc acquisitions, ex vivo and in vivo. Ex vivo, half-sinc data more closely matched the reference 3D sequence, indicating improved accuracy. In silico modeling confirmed this was due to shorter TEs minimizing bias caused by relaxation differences between phantoms and tissue. CS was successfully applied to in vivo, half-sinc data, maintaining TSC and image quality (estimated SNR, edge sharpness, and qualitative metrics) with ≥50 NSAs. CONCLUSION 2D sodium MRI with half-sinc excitation and CS was validated, enabling TSC quantification with 2.25 × 2.25 mm2 resolution and scan times of ≤5 mins.
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Affiliation(s)
- Rebecca R. Baker
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUK
| | - Vivek Muthurangu
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUK
| | - Marilena Rega
- Institute of Nuclear MedicineUniversity College HospitalLondonUK
| | | | - Samuel Rot
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Bhavana S. Solanky
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Claudia A. M. Gandini Wheeler‐Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Digital Neuroscience Research UnitIRCCS Mondino FoundationPaviaItaly
| | | | - Jennifer A. Steeden
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUK
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Jaubert O, Montalt‐Tordera J, Knight D, Arridge S, Steeden J, Muthurangu V. HyperSLICE: HyperBand optimized spiral for low-latency interactive cardiac examination. Magn Reson Med 2024; 91:266-279. [PMID: 37799087 PMCID: PMC10953456 DOI: 10.1002/mrm.29855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Interactive cardiac MRI is used for fast scan planning and MR-guided interventions. However, the requirement for real-time acquisition and near-real-time visualization constrains the achievable spatio-temporal resolution. This study aims to improve interactive imaging resolution through optimization of undersampled spiral sampling and leveraging of deep learning for low-latency reconstruction (deep artifact suppression). METHODS A variable density spiral trajectory was parametrized and optimized via HyperBand to provide the best candidate trajectory for rapid deep artifact suppression. Training data consisted of 692 breath-held CINEs. The developed interactive sequence was tested in simulations and prospectively in 13 subjects (10 for image evaluation, 2 during catheterization, 1 during exercise). In the prospective study, the optimized framework-HyperSLICE- was compared with conventional Cartesian real-time and breath-hold CINE imaging in terms quantitative and qualitative image metrics. Statistical differences were tested using Friedman chi-squared tests with post hoc Nemenyi test (p < 0.05). RESULTS In simulations the normalized RMS error, peak SNR, structural similarity, and Laplacian energy were all statistically significantly higher using optimized spiral compared to radial and uniform spiral sampling, particularly after scan plan changes (structural similarity: 0.71 vs. 0.45 and 0.43). Prospectively, HyperSLICE enabled a higher spatial and temporal resolution than conventional Cartesian real-time imaging. The pipeline was demonstrated in patients during catheter pull back, showing sufficiently fast reconstruction for interactive imaging. CONCLUSION HyperSLICE enables high spatial and temporal resolution interactive imaging. Optimizing the spiral sampling enabled better overall image quality and superior handling of image transitions compared with radial and uniform spiral trajectories.
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Affiliation(s)
- Olivier Jaubert
- UCL Center for Translational Cardiovascular ImagingUniversity College LondonLondonUK
| | | | - Daniel Knight
- UCL Center for Translational Cardiovascular ImagingUniversity College LondonLondonUK
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUK
| | - Simon Arridge
- Department of Computer ScienceUniversity College LondonLondonUK
| | - Jennifer Steeden
- UCL Center for Translational Cardiovascular ImagingUniversity College LondonLondonUK
| | - Vivek Muthurangu
- UCL Center for Translational Cardiovascular ImagingUniversity College LondonLondonUK
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Yao T, St. Clair N, Miller GF, Dorfman AL, Fogel MA, Ghelani S, Krishnamurthy R, Lam CZ, Quail M, Robinson JD, Schidlow D, Slesnick TC, Weigand J, Steeden JA, Rathod RH, Muthurangu V. A Deep Learning Pipeline for Assessing Ventricular Volumes from a Cardiac MRI Registry of Patients with Single Ventricle Physiology. Radiol Artif Intell 2024; 6:e230132. [PMID: 38166332 PMCID: PMC10831511 DOI: 10.1148/ryai.230132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 01/04/2024]
Abstract
Purpose To develop an end-to-end deep learning (DL) pipeline for automated ventricular segmentation of cardiac MRI data from a multicenter registry of patients with Fontan circulation (Fontan Outcomes Registry Using CMR Examinations [FORCE]). Materials and Methods This retrospective study used 250 cardiac MRI examinations (November 2007-December 2022) from 13 institutions for training, validation, and testing. The pipeline contained three DL models: a classifier to identify short-axis cine stacks and two U-Net 3+ models for image cropping and segmentation. The automated segmentations were evaluated on the test set (n = 50) by using the Dice score. Volumetric and functional metrics derived from DL and ground truth manual segmentations were compared using Bland-Altman and intraclass correlation analysis. The pipeline was further qualitatively evaluated on 475 unseen examinations. Results There were acceptable limits of agreement (LOA) and minimal biases between the ground truth and DL end-diastolic volume (EDV) (bias: -0.6 mL/m2, LOA: -20.6 to 19.5 mL/m2) and end-systolic volume (ESV) (bias: -1.1 mL/m2, LOA: -18.1 to 15.9 mL/m2), with high intraclass correlation coefficients (ICCs > 0.97) and Dice scores (EDV, 0.91 and ESV, 0.86). There was moderate agreement for ventricular mass (bias: -1.9 g/m2, LOA: -17.3 to 13.5 g/m2) and an ICC of 0.94. There was also acceptable agreement for stroke volume (bias: 0.6 mL/m2, LOA: -17.2 to 18.3 mL/m2) and ejection fraction (bias: 0.6%, LOA: -12.2% to 13.4%), with high ICCs (>0.81). The pipeline achieved satisfactory segmentation in 68% of the 475 unseen examinations, while 26% needed minor adjustments, 5% needed major adjustments, and in 0.4%, the cropping model failed. Conclusion The DL pipeline can provide fast standardized segmentation for patients with single ventricle physiology across multiple centers. This pipeline can be applied to all cardiac MRI examinations in the FORCE registry. Keywords: Cardiac, Adults and Pediatrics, MR Imaging, Congenital, Volume Analysis, Segmentation, Quantification Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
| | | | - Gabriel F. Miller
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Adam L. Dorfman
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Mark A. Fogel
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Sunil Ghelani
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Rajesh Krishnamurthy
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Christopher Z. Lam
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Michael Quail
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Joshua D. Robinson
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - David Schidlow
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Timothy C. Slesnick
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Justin Weigand
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Jennifer A. Steeden
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Rahul H. Rathod
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
| | - Vivek Muthurangu
- From the Institutes of Health Informatics (T.Y.) and Cardiovascular Science (M.Q., J.A.S., V.M.), University College London, 20c Guilford Street, London WC1N 1DZ, England; Department of Cardiology, Boston Children's Hospital, Boston, Mass (N.S.C., G.F.M., S.G., D.S., R.H.R.); Department of Pediatrics, University of Michigan, Ann Arbor, Mich (A.L.D.); Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.F.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (R.K.); Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada (C.Z.L.); Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill (J.D.R.); Department of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Ga (T.C.S.); and Department of Cardiology, Texas Children's Hospital, Houston, Tex (J.W.)
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Hudson LD, Al-Khairulla H, Maicoo M, Borja MC, Rapala A, Viner R, Nicholls D, Taylor A, Muthurangu V, Hughes A. Pulse wave velocity during re-feeding and with weight gain in underweight female adolescents with anorexia nervosa. J Hum Hypertens 2023; 37:1126-1128. [PMID: 37468542 DOI: 10.1038/s41371-023-00848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
Anorexia Nervosa (AN) causes harmful underweight and important cardiovascular acute complications however less is known about longer-term cardiovascular risk. We measured carotid femoral pulse wave velocity (PWV) in a group of underweight young women with AN at baseline and weekly as they were refed and gained weight. PWV decreased over time and was negatively associated with increasing BMI and calorific meal content suggesting potential positive cardiovascular benefits for refeeding and weight gain in AN and supports current consensus for the importance of weight gain in underweight young women with AN.
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Affiliation(s)
| | | | | | | | | | | | - Dasha Nicholls
- Dept Brain Sciences, Imperial College London, London, UK
| | | | | | - Alun Hughes
- UCL Institute of Cardiovascular Science, London, UK
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Karia N, Howard L, Johnson M, Kiely DG, Lordan J, McCabe C, Pepke-Zaba J, Ong R, Preiss M, Knight D, Muthurangu V, Coghlan JG. Predictors of outcomes in mild pulmonary hypertension according to 2022 ESC/ERS Guidelines: the EVIDENCE-PAH UK study. Eur Heart J 2023; 44:4678-4691. [PMID: 37619574 PMCID: PMC10659956 DOI: 10.1093/eurheartj/ehad532] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND AIMS Interventional studies in pulmonary arterial hypertension completed to date have shown to be effective in symptomatic patients with significantly elevated mean pulmonary artery pressure (mPAP) (≥25 mmHg) and pulmonary vascular resistance (PVR) > 3 Wood Unit (WU). However, in health the mPAP does not exceed 20 mmHg and PVR is 2 WU or lower, at rest. The ESC/ERS guidelines have recently been updated to reflect this. There is limited published data on the nature of these newly defined populations (mPAP 21-24 mmHg and PVR >2-≤3 WU) and the role of comorbidity in determining their natural history. With the change in guidelines, there is a need to understand this population and the impact of the ESC/ERS guidelines in greater detail. METHODS A retrospective nationwide evaluation of the role of pulmonary haemodynamics and comorbidity in predicting survival among patients referred to the UK pulmonary hypertension (PH) centres between 2009 and 2017. In total, 2929 patients were included in the study. Patients were stratified by mPAP (<21 mmHg, 21-24 mmHg, and ≥25 mmHg) and PVR (≤2 WU, > 2-≤3 WU, and >3 WU), with 968 (33.0%) in the mPAP <21 mmHg group, 689 (23.5%) in the mPAP 21-24 mmHg group, and 1272 (43.4%) in the mPAP ≥25 mmHg group. RESULTS Survival was negatively correlated with mPAP and PVR in the population as a whole. Survival in patients with mildly elevated mPAP (21-24 mmHg) or PVR (>2-≤3WU) was lower than among those with normal pressures (mPAP <21 mmHg) and normal PVR (PVR ≤ 2WU) independent of comorbid lung and heart disease [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.14-1.61, P = .0004 for mPAP vs. HR 1.28, 95% CI 1.10-1.49, P = .0012 for PVR]. Among patients with mildly elevated mPAP, a mildly elevated PVR remained an independent predictor of survival when adjusted for comorbid lung and heart disease (HR 1.33, 95% CI 1.01-1.75, P = .042 vs. HR 1.4, 95% CI 1.06-1.86, P = .019). 68.2% of patients with a mPAP 21-24 mmHg had evidence of underlying heart or lung disease. Patients with mildly abnormal haemodynamics were not more symptomatic than patients with normal haemodynamics. Excluding patients with heart and lung disease, connective tissue disease was associated with a poorer survival among those with PH. In this subpopulation evaluating those with a mPAP of 21-24 mmHg, survival curves only diverged after 5 years. CONCLUSIONS This study supports the change in diagnostic category of the ESC/ERS guidelines in a PH population. The newly included patients have an increased mortality independent of significant lung or heart disease. The majority of patients in this new category have underlying heart or lung disease rather than an isolated pulmonary vasculopathy. Mortality is higher if comorbidity is present. Rigorous phenotyping will be pivotal to determine which patients are at risk of progressive vasculopathic disease and in whom surveillance and recruitment to studies may be of benefit. This study provides an insight into the population defined by the new guidelines.
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Affiliation(s)
- Nina Karia
- National Pulmonary Hypertension Service, Royal Free Hospital London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| | - Luke Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London W12 0HS, UK
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow G81 4DY, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - James Lordan
- Pulmonary Vascular Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK
| | - Rose Ong
- Actelion Pharmaceuticals Ltd, A Janssen Pharmaceutical Company of Johnson and Johnson, Global Epidemiology, Allschwil CH-4123, Switzerland
| | - Michael Preiss
- Actelion Pharmaceuticals Ltd, Janssen Pharmaceutical Company of Johnson & Johnson, Global Medical Affairs, Allschwil CH-4123, Switzerland
| | - Daniel Knight
- National Pulmonary Hypertension Service, Royal Free Hospital London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| | - J Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free Hospital London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
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Patel KP, Vandermolen S, Alharbi B, Hoare D, Mukhopadhyay S, Smith A, Bhattacharyya S, Muthurangu V, Mullen MJ. Identifying Characteristics of Short-Term Response to Transcatheter Edge-to-Edge Mitral Valve Repair. Am J Cardiol 2023; 204:183-184. [PMID: 37544142 DOI: 10.1016/j.amjcard.2023.07.079] [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: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Kush P Patel
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
| | - Sebastian Vandermolen
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Badr Alharbi
- Institute of Cardiovascular Science, Institute of Population Health Sciences, University College London, London, United Kingdom; Emergency medical service, King Khalid University, Abha, Saudi Arabia
| | - David Hoare
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, Institute of Population Health Sciences, University College London, London, United Kingdom
| | | | - Andrew Smith
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Sanjeev Bhattacharyya
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Vivek Muthurangu
- Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michael J Mullen
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
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13
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Stokes C, Ahmed D, Lind N, Haupt F, Becker D, Hamilton J, Muthurangu V, von Tengg-Kobligk H, Papadakis G, Balabani S, Díaz-Zuccarini V. Aneurysmal growth in type-B aortic dissection: assessing the impact of patient-specific inlet conditions on key haemodynamic indices. J R Soc Interface 2023; 20:20230281. [PMID: 37727072 PMCID: PMC10509589 DOI: 10.1098/rsif.2023.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
Type-B aortic dissection is a cardiovascular disease in which a tear develops in the intimal layer of the descending aorta, allowing pressurized blood to delaminate the layers of the vessel wall. In medically managed patients, long-term aneurysmal dilatation of the false lumen (FL) is considered virtually inevitable and is associated with poorer disease outcomes. While the pathophysiological mechanisms driving FL dilatation are not yet understood, haemodynamic factors are believed to play a key role. Computational fluid dynamics (CFD) and 4D-flow MRI (4DMR) analyses have revealed correlations between flow helicity, oscillatory wall shear stress and aneurysmal dilatation of the FL. In this study, we compare CFD simulations using a patient-specific, three-dimensional, three-component inlet velocity profile (4D IVP) extracted from 4DMR data against simulations with flow rate-matched uniform and axial velocity profiles that remain widely used in the absence of 4DMR. We also evaluate the influence of measurement errors in 4DMR data by scaling the 4D IVP to the degree of imaging error detected in prior studies. We observe that oscillatory shear and helicity are highly sensitive to inlet velocity distribution and flow volume throughout the FL and conclude that the choice of IVP may greatly affect the future clinical value of simulations.
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Affiliation(s)
- C. Stokes
- Department of Mechanical Engineering, University College London, London, UK
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, UK
| | - D. Ahmed
- Department of Aeronautics, Imperial College London, London, UK
| | - N. Lind
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - F. Haupt
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - D. Becker
- Clinic of Vascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - J. Hamilton
- Department of Mechanical Engineering, University College London, London, UK
| | - V. Muthurangu
- Centre for Translational Cardiovascular Imaging, University College London, London, UK
| | - H. von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - G. Papadakis
- Department of Aeronautics, Imperial College London, London, UK
| | - S. Balabani
- Department of Mechanical Engineering, University College London, London, UK
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, UK
| | - V. Díaz-Zuccarini
- Department of Mechanical Engineering, University College London, London, UK
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, UK
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14
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Hauser JA, Burden SJ, Karunakaran A, Muthurangu V, Taylor AM, Jones A. Whole-Body Magnetic Resonance Imaging Assessment of the Contributions of Adipose and Nonadipose Tissues to Cardiovascular Remodeling in Adolescents. J Am Heart Assoc 2023; 12:e030221. [PMID: 37489750 PMCID: PMC10492986 DOI: 10.1161/jaha.123.030221] [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: 03/16/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023]
Abstract
Background Greater body mass index is associated with cardiovascular remodeling in adolescents. However, body mass index cannot differentiate between adipose and nonadipose tissues. We examined how visceral and subcutaneous adipose tissue are linked with markers of early cardiovascular remodeling, independently from nonadipose tissue. Methods and Results Whole-body magnetic resonance imaging was done in 82 adolescents (39 overweight/obese; 36 female; median age, 16.3 [interquartile range, 14.4-18.1] years) to measure body composition and cardiovascular remodeling markers. Left ventricular diastolic function was assessed by echocardiography. Waist, waist:height ratio, and body mass index z scores were calculated. Residualized nonadipose tissue, subcutaneous adipose tissue, and visceral adipose tissue variables, uncorrelated with each other, were constructed using partial regression modeling to allow comparison of their individual contributions in a 3-compartment body composition model. Cardiovascular variables mostly related to nonadipose rather than adipose tissue. Nonadipose tissue was correlated positively with left ventricular mass (r=0.81), end-diastolic volume (r=0.70), stroke volume (r=0.64), left ventricular mass:end-diastolic volume (r=0.37), and systolic blood pressure (r=0.35), and negatively with heart rate (r=-0.33) (all P<0.01). Subcutaneous adipose tissue was associated with worse left ventricular diastolic function (r=-0.42 to -0.48, P=0.0007-0.02) and higher heart rates (r=0.34, P=0.007) but linked with better systemic vascular resistance (r=-0.35, P=0.006). There were no significant relationships with visceral adipose tissue and no associations of any compartment with pulse wave velocity. Conclusions Simple anthropometry does not reflect independent effects of nonadipose tissue and subcutaneous adipose tissue on the adolescent cardiovascular system. This could result in normal cardiovascular adaptations to growth being misinterpreted as pathological sequelae of excess adiposity in studies reliant on such measures.
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Affiliation(s)
- Jakob A. Hauser
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Samuel J. Burden
- Department of PaediatricsUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
- Department of Women and Children’s HealthKing’s College London, St Thomas’ HospitalLondonUnited Kingdom
| | - Ajanthiha Karunakaran
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Vivek Muthurangu
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Andrew M. Taylor
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUnited Kingdom
| | - Alexander Jones
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Department of PaediatricsUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
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15
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Wang Y, Muthurangu V, Wurdemann HA. Toward Autonomous Pulmonary Artery Catheterization: A Learning-based Robotic Navigation System. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-5. [PMID: 38082621 DOI: 10.1109/embc40787.2023.10340140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Providing imaging during interventional treatments of cardiovascular diseases is challenging. Magnetic Resonance Imaging (MRI) has gained popularity as it is radiation-free and returns high resolution of soft tissue. However, the clinician has limited access to the patient, e.g., to their femoral artery, within the MRI scanner to accurately guide and manipulate an MR-compatible catheter. At the same time, communication will need to be maintained with a clinician, located in a separate control room, to provide the most appropriate image to the screen inside the MRI room. Hence, there is scope to explore the feasibility of how autonomous catheterization robots could support the steering of catheters along trajectories inside complex vessel anatomies.In this paper, we present a Learning from Demonstration based Gaussian Mixture Model for a robot trajectory optimisation during pulmonary artery catheterization. The optimisation algorithm is integrated into a 2 Degree-of-Freedom MR-compatible interventional robot allowing for continuous and simultaneous translation and rotation. Our methodology achieves autonomous navigation of the catheter tip from the inferior vena cava, through the right atrium and the right ventricle into the pulmonary artery where an interventions is performed. Our results show that our MR-compatible robot can follow an advancement trajectory generated by our Learning from Demonstration algorithm. Looking at the overall duration of the intervention, it can be concluded that procedures performed by the robot (teleoperated or autonomously) required significantly less time compared to manual hand-held procedures.
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16
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Stokes C, Haupt F, Becker D, Muthurangu V, von Tengg-Kobligk H, Balabani S, Díaz-Zuccarini V. The Influence of Minor Aortic Branches in Patient-Specific Flow Simulations of Type-B Aortic Dissection. Ann Biomed Eng 2023; 51:1627-1644. [PMID: 36967447 PMCID: PMC10264290 DOI: 10.1007/s10439-023-03175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/19/2023] [Indexed: 03/28/2023]
Abstract
Type-B aortic dissection (TBAD) is a disease in which a tear develops in the intimal layer of the descending aorta forming a true lumen and false lumen (FL). Because disease outcomes are thought to be influenced by haemodynamic quantities such as pressure and wall shear stress (WSS), their analysis via numerical simulations may provide valuable clinical insights. Major aortic branches are routinely included in simulations but minor branches are virtually always neglected, despite being implicated in TBAD progression and the development of complications. As minor branches are estimated to carry about 7-21% of cardiac output, neglecting them may affect simulation accuracy. We present the first simulation of TBAD with all pairs of intercostal, subcostal and lumbar arteries, using 4D-flow MRI (4DMR) to inform patient-specific boundary conditions. Compared to an equivalent case without minor branches, their inclusion improved agreement with 4DMR velocities, reduced time-averaged WSS (TAWSS) and transmural pressure and elevated oscillatory shear in regions where FL dilatation and calcification were observed in vivo. Minor branch inclusion resulted in differences of 60-75% in these metrics of potential clinical relevance, indicating a need to account for minor branch flow loss if simulation accuracy is sought.
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Affiliation(s)
- C Stokes
- Department of Mechanical Engineering, University College London, London, UK
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, University College London, London, UK
| | - F Haupt
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - D Becker
- Clinic of Vascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - V Muthurangu
- Centre for Translational Cardiovascular Imaging, University College London, London, UK
| | - H von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - S Balabani
- Department of Mechanical Engineering, University College London, London, UK
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, University College London, London, UK
| | - V Díaz-Zuccarini
- Department of Mechanical Engineering, University College London, London, UK.
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, University College London, London, UK.
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17
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Beroukhim RS, Merlocco A, Gerardin JF, Tham E, Patel JK, Siddiqui S, Goot B, Farooqi K, Soslow J, Grotenhuis H, Hor K, Muthurangu V, Raimondi F. Multicenter research priorities in pediatric CMR: results of a collaborative wiki survey. Sci Rep 2023; 13:9022. [PMID: 37270629 DOI: 10.1038/s41598-023-34720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/06/2023] [Indexed: 06/05/2023] Open
Abstract
Multicenter studies in pediatric cardiovascular magnetic resonance (CMR) improve statistical power and generalizability. However, a structured process for identifying important research topics has not been developed. We aimed to (1) develop a list of high priority knowledge gaps, and (2) pilot the use of a wiki survey to collect a large group of responses. Knowledge gaps were defined as areas that have been either unexplored or under-explored in the research literature. High priority goals were: (1) feasible and answerable from a multicenter research study, and (2) had potential for high impact on the field of pediatric CMR. Seed ideas were contributed by a working group and imported into a pairwise wiki survey format which allows for new ideas to be uploaded and voted upon ( https://allourideas.org ). Knowledge gaps were classified into 2 categories: 'Clinical CMR Practice' (16 ideas) and 'Disease Specific Research' (22 ideas). Over a 2-month period, 3,658 votes were cast by 96 users, and 2 new ideas were introduced. The 3 highest scoring sub-topics were myocardial disorders (9 ideas), translating new technology & techniques into clinical practice (7 ideas), and normal reference values (5 ideas). The highest priority gaps reflected strengths of CMR (e.g., myocardial tissue characterization; implementation of technologic advances into clinical practice), and deficiencies in pediatrics (e.g., data on normal reference values). The wiki survey format was effective and easy to implement, and could be used for future surveys.
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Affiliation(s)
- Rebecca S Beroukhim
- Department of Cardiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Anthony Merlocco
- Department of Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Jennifer F Gerardin
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Edythe Tham
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Jyoti K Patel
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Saira Siddiqui
- Division of Pediatric Cardiology, Atlantic Health System, Morristown, NJ, USA
| | - Benjamin Goot
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Kanwal Farooqi
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Jonathan Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - Heynric Grotenhuis
- Department of Pediatric Cardiology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Kan Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Vivek Muthurangu
- Department of Cardiology, UCL Center for Translational Cardiovascular Imaging, University College London, London, UK
| | - Francesca Raimondi
- Department of Cardiology, Meyer Children's Hospital, University of Florence, Florence, Italy
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18
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Pajaziti E, Montalt-Tordera J, Capelli C, Sivera R, Sauvage E, Quail M, Schievano S, Muthurangu V. Shape-driven deep neural networks for fast acquisition of aortic 3D pressure and velocity flow fields. PLoS Comput Biol 2023; 19:e1011055. [PMID: 37093855 PMCID: PMC10159343 DOI: 10.1371/journal.pcbi.1011055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/04/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
Computational fluid dynamics (CFD) can be used to simulate vascular haemodynamics and analyse potential treatment options. CFD has shown to be beneficial in improving patient outcomes. However, the implementation of CFD for routine clinical use is yet to be realised. Barriers for CFD include high computational resources, specialist experience needed for designing simulation set-ups, and long processing times. The aim of this study was to explore the use of machine learning (ML) to replicate conventional aortic CFD with automatic and fast regression models. Data used to train/test the model consisted of 3,000 CFD simulations performed on synthetically generated 3D aortic shapes. These subjects were generated from a statistical shape model (SSM) built on real patient-specific aortas (N = 67). Inference performed on 200 test shapes resulted in average errors of 6.01% ±3.12 SD and 3.99% ±0.93 SD for pressure and velocity, respectively. Our ML-based models performed CFD in ∼0.075 seconds (4,000x faster than the solver). This proof-of-concept study shows that results from conventional vascular CFD can be reproduced using ML at a much faster rate, in an automatic process, and with reasonable accuracy.
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Affiliation(s)
- Endrit Pajaziti
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Javier Montalt-Tordera
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Claudio Capelli
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Raphaël Sivera
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Emilie Sauvage
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Michael Quail
- Great Ormond Street Hospital, Cardiac Unit, London, United Kingdom
| | - Silvia Schievano
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Vivek Muthurangu
- University College London, Institution of Cardiovascular Science, London, United Kingdom
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19
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Knight DS, Karia N, Cole AR, Maclean RH, Brown JT, Masi A, Patel RK, Razvi Y, Chacko L, Venneri L, Kotecha T, Martinez-Naharro A, Kellman P, Scott-Russell AM, Schreiber BE, Ong VH, Denton CP, Fontana M, Coghlan JG, Muthurangu V. Distinct cardiovascular phenotypes are associated with prognosis in systemic sclerosis: a cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging 2023; 24:463-471. [PMID: 35775814 PMCID: PMC10029850 DOI: 10.1093/ehjci/jeac120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/16/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Cardiovascular involvement in systemic sclerosis (SSc) is heterogeneous and ill-defined. This study aimed to: (i) discover cardiac phenotypes in SSc by cardiovascular magnetic resonance (CMR); (ii) provide a CMR-based algorithm for phenotypic classification; and (iii) examine for associations between phenotypes and mortality. METHODS AND RESULTS A retrospective, single-centre, observational study of 260 SSc patients who underwent clinically indicated CMR including native myocardial T1 and T2 mapping from 2016 to 2019 was performed. Agglomerative hierarchical clustering using only CMR variables revealed five clusters of SSc patients with shared CMR characteristics: dilated right hearts with right ventricular failure (RVF); biventricular failure dilatation and dysfunction (BVF); and normal function with average cavity (NF-AC), normal function with small cavity (NF-SC), and normal function with large cavity (NF-LC) sizes. Phenotypes did not co-segregate with clinical or antibody classifications. A CMR-based decision tree for phenotype classification was created. Sixty-three (24%) patients died during a median follow-up period of 3.4 years. After adjustment for age and presence of pulmonary hypertension (PH), independent CMR predictors of all-cause mortality were native T1 (P < 0.001) and right ventricular ejection fraction (RVEF) (P = 0.0032). NF-SC and NF-AC groups had more favourable prognoses (P≤0.036) than the other three groups which had no differences in prognoses between them (P > 0.14). Hazard ratios (HR) were statistically significant for RVF (HR = 8.9, P < 0.001), BVF (HR = 5.2, P = 0.006), and NF-LC (HR = 4.9, P = 0.002) groups. The NF-LC group remained significantly predictive of mortality after adjusting for RVEF, native T1, and PH diagnosis (P = 0.0046). CONCLUSION We identified five CMR-defined cardiac SSc phenotypes that did not co-segregate with clinical data and had distinct outcomes, offering opportunities for a more precision-medicine based management approach.
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Affiliation(s)
- Daniel S Knight
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Nina Karia
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Alice R Cole
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Rory H Maclean
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - James T Brown
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Ambra Masi
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Rishi K Patel
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- National Amyloidosis Centre, Division of Medicine, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Yousuf Razvi
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- National Amyloidosis Centre, Division of Medicine, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Liza Chacko
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- National Amyloidosis Centre, Division of Medicine, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Lucia Venneri
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Tushar Kotecha
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Ana Martinez-Naharro
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- National Amyloidosis Centre, Division of Medicine, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institute of Health, 31 Center Dr, Bethesda, MD 20892, USA
| | - Ann M Scott-Russell
- Department of Rheumatology, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY, UK
| | - Benjamin E Schreiber
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Marianna Fontana
- UCL Department of Cardiac MRI, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
- National Amyloidosis Centre, Division of Medicine, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - J Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
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20
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Montalt-Tordera J, Steeden JA, Muthurangu V. Editorial for "Automatic Time-Resolved Cardiovascular Segmentation of 4D Flow MRI Using Deep Learning". J Magn Reson Imaging 2023; 57:204-205. [PMID: 35510802 DOI: 10.1002/jmri.28220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - Jennifer A Steeden
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, University College London, London, UK
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21
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Montalt-Tordera J, Pajaziti E, Jones R, Sauvage E, Puranik R, Singh AAV, Capelli C, Steeden J, Schievano S, Muthurangu V. Automatic segmentation of the great arteries for computational hemodynamic assessment. J Cardiovasc Magn Reson 2022; 24:57. [PMID: 36336682 PMCID: PMC9639271 DOI: 10.1186/s12968-022-00891-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 10/03/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Computational fluid dynamics (CFD) is increasingly used for the assessment of blood flow conditions in patients with congenital heart disease (CHD). This requires patient-specific anatomy, typically obtained from segmented 3D cardiovascular magnetic resonance (CMR) images. However, segmentation is time-consuming and requires expert input. This study aims to develop and validate a machine learning (ML) method for segmentation of the aorta and pulmonary arteries for CFD studies. METHODS 90 CHD patients were retrospectively selected for this study. 3D CMR images were manually segmented to obtain ground-truth (GT) background, aorta and pulmonary artery labels. These were used to train and optimize a U-Net model, using a 70-10-10 train-validation-test split. Segmentation performance was primarily evaluated using Dice score. CFD simulations were set up from GT and ML segmentations using a semi-automatic meshing and simulation pipeline. Mean pressure and velocity fields across 99 planes along the vessel centrelines were extracted, and a mean average percentage error (MAPE) was calculated for each vessel pair (ML vs GT). A second observer (SO) segmented the test dataset for assessment of inter-observer variability. Friedman tests were used to compare ML vs GT, SO vs GT and ML vs SO metrics, and pressure/velocity field errors. RESULTS The network's Dice score (ML vs GT) was 0.945 (interquartile range: 0.929-0.955) for the aorta and 0.885 (0.851-0.899) for the pulmonary arteries. Differences with the inter-observer Dice score (SO vs GT) and ML vs SO Dice scores were not statistically significant for either aorta or pulmonary arteries (p = 0.741, p = 0.061). The ML vs GT MAPEs for pressure and velocity in the aorta were 10.1% (8.5-15.7%) and 4.1% (3.1-6.9%), respectively, and for the pulmonary arteries 14.6% (11.5-23.2%) and 6.3% (4.3-7.9%), respectively. Inter-observer (SO vs GT) and ML vs SO pressure and velocity MAPEs were of a similar magnitude to ML vs GT (p > 0.2). CONCLUSIONS ML can successfully segment the great vessels for CFD, with errors similar to inter-observer variability. This fast, automatic method reduces the time and effort needed for CFD analysis, making it more attractive for routine clinical use.
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Affiliation(s)
| | | | - Rod Jones
- Great Ormond Street Hospital, London, UK
| | - Emilie Sauvage
- UCL Institute of Cardiovascular Science, UCL, London, UK
| | - Rajesh Puranik
- Children’s Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Aakansha Ajay Vir Singh
- Children’s Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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22
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Jaubert O, Montalt‐Tordera J, Brown J, Knight D, Arridge S, Steeden J, Muthurangu V. FReSCO: Flow Reconstruction and Segmentation for low-latency Cardiac Output monitoring using deep artifact suppression and segmentation. Magn Reson Med 2022; 88:2179-2189. [PMID: 35781891 PMCID: PMC9545927 DOI: 10.1002/mrm.29374] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/19/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Real-time monitoring of cardiac output (CO) requires low-latency reconstruction and segmentation of real-time phase-contrast MR, which has previously been difficult to perform. Here we propose a deep learning framework for "FReSCO" (Flow Reconstruction and Segmentation for low latency Cardiac Output monitoring). METHODS Deep artifact suppression and segmentation U-Nets were independently trained. Breath-hold spiral phase-contrast MR data (N = 516) were synthetically undersampled using a variable-density spiral sampling pattern and gridded to create aliased data for training of the artifact suppression U-net. A subset of the data (N = 96) was segmented and used to train the segmentation U-net. Real-time spiral phase-contrast MR was prospectively acquired and then reconstructed and segmented using the trained models (FReSCO) at low latency at the scanner in 10 healthy subjects during rest, exercise, and recovery periods. Cardiac output obtained via FReSCO was compared with a reference rest CO and rest and exercise compressed-sensing CO. RESULTS The FReSCO framework was demonstrated prospectively at the scanner. Beat-to-beat heartrate, stroke volume, and CO could be visualized with a mean latency of 622 ms. No significant differences were noted when compared with reference at rest (bias = -0.21 ± 0.50 L/min, p = 0.246) or compressed sensing at peak exercise (bias = 0.12 ± 0.48 L/min, p = 0.458). CONCLUSIONS The FReSCO framework was successfully demonstrated for real-time monitoring of CO during exercise and could provide a convenient tool for assessment of the hemodynamic response to a range of stressors.
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Affiliation(s)
- Olivier Jaubert
- UCL Center for Translational Cardiovascular ImagingUniversity College London
LondonUK
- Department of Computer ScienceUniversity College LondonLondonUK
| | | | - James Brown
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUK
| | - Daniel Knight
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUK
| | - Simon Arridge
- Department of Computer ScienceUniversity College LondonLondonUK
| | - Jennifer Steeden
- UCL Center for Translational Cardiovascular ImagingUniversity College London
LondonUK
| | - Vivek Muthurangu
- UCL Center for Translational Cardiovascular ImagingUniversity College London
LondonUK
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUK
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23
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Karia N, Howard L, Johnson M, Kiely D, Lordan J, McCabe C, Ong R, Pepke-Zaba J, Preiss M, Muthurangu V, Coghlan G. Mortality rates and cause of mortality in patients with mildly elevated pulmonary pressures versus PH: insights from the retrospective EVIDENCE-PAH study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Normal mean pulmonary artery pressure (mPAP) does not exceed 20 mmHg and normal pulmonary vascular resistance (PVR) does not exceed 2 Wood Units (WU). The thresholds used to define pre-capillary pulmonary hypertension (PH) – mPAP ≥25 mmHg and PVR >3 WU – are being evaluated. It is unclear if treatment would benefit patients with mildly elevated mPAP (≥21–<25 mmHg).
Purpose
The EVIDENCE-PAH study aims to describe mortality and hospitalisation outcomes, clinical characteristics, therapies, and quality of life during long-term follow-up of a national cohort of patients with different levels of mPAP and PVR. We report preliminary analyses focusing on mortality and its cause in patients stratified by their baseline (BL) mPAP.
Methods
This retrospective analysis included PAH-treatment-naïve patients with suspected PH who received a first right heart catheterisation (RHC) between 2009 and 2017 at any of the 7 UK tertiary PH centres, which assess all PH patients in the UK. A sample of patients with BL mPAP ≥25 mmHg (stratified by PVR and treatable versus non-treatable PH) was used as a control in this analysis. Baseline characteristics, mortality and cause of mortality were stratified by mPAP (<21, ≥21–<25, ≥25 mmHg) at BL (first RHC). Mortality was also stratified by BL PVR (<1, 1–<2, 2–<3, 3–<6, ≥6 WU). Mortality analysis was done without matching cohorts. Mortality data were obtained from the Office for National Statistics, NHS Digital.
Results
In total, 2926 patients were analysed (968, 689 and 1269 with mPAP <21, ≥21–<25, ≥25 mmHg, respectively). Mean observation was 6.1 years. BL characteristics are in Table. Survival worsened with increasing mPAP (p<0.0001) and increasing PVR (p<0.01) (Figure). After 5 years of follow-up, 187 (27.1%) patients with mPAP ≥21–<25 mmHg had died, compared with 162 (16.7%) and 595 (46.9%) patients in the lower and higher mPAP groups, respectively. In patients with mPAP ≥21–<25 mmHg, the most common main cause of death was respiratory disease (36.4%) – with scleroderma lung disease and interstitial lung disease accounting for 69.1% of these deaths – followed by cardiac disease (16.6%) and malignancy (15.0%) (Table). PH was the main cause of death for only 1.6% of patients with mildly elevated mPAP and it was a contributor to death in 6.8% (BL mPAP <21 mmHg), 10.2% (≥21–<25 mmHg), and 40.2% (≥25 mmHg) of cases.
Conclusion
Long-term survival in patients with mPAP ≥21–<25 mmHg was worse than in those with normal mPAP, and better than in those with the current definition of PH. While the main cause of death was mostly unrelated to PH and further analysis is needed to understand the impact of underlying disease, mildly elevated mPAP appears to confer a worse prognosis and should be closely monitored. These data show the relevant disease burden in patients with mPAP ≥21–<25 mmHg and the need to understand if they could benefit from treatment. PVR may be key in determining patients who might benefit.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Actelion Pharmaceuticals Ltd., a Janssen pharmaceutical company of Johnson & Johnson.
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Affiliation(s)
- N Karia
- Royal Free Hospital , London , United Kingdom
| | - L Howard
- Hammersmith Hospital, National Pulmonary Hypertension Service , London , United Kingdom
| | - M Johnson
- Golden Jubilee National Hospital, Scottish Pulmonary Vascular Unit , Glasgow , United Kingdom
| | - D Kiely
- Sheffield Teaching Hospitals NHS Trust, Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital , Sheffield , United Kingdom
| | - J Lordan
- Freeman Hospital , Newcastle upon Tyne , United Kingdom
| | - C McCabe
- Royal Brompton Hospital , London , United Kingdom
| | - R Ong
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | - J Pepke-Zaba
- Royal Papworth Hospital NHS Foundation Trust, Pulmonary Vascular Disease Unit , Cambridge , United Kingdom
| | - M Preiss
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | - V Muthurangu
- University College London, Institute of Cardiovascular Science , London , United Kingdom
| | - G Coghlan
- Royal Free Hospital , London , United Kingdom
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24
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Constantine A, Dimopoulos K, Condliffe R, Clift P, Jansen K, Dhillon R, Chaplin G, Muthurangu V, Moledina S. Paediatric pulmonary arterial hypertension following congenital heart defect repair: enhanced risk stratification and outcomes in a national cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD). PAH following CHD repair (repaired PAH-CHD) is an emerging population with increased morbidity and mortality [1–3]. Risk scores that are widely used in the adult PAH population have not been validated and may not be applicable in young children with repaired PAH-CHD.
Purpose
To characterize the 20-year cohort of the UK National Paediatric PH Service, focusing on peri-operative characteristics and outcomes of children with repaired PAH-CHD, and develop a tailored risk stratification tool.
Methods
We included consecutive children presenting to our specialist service between 2001 and 2021 with a diagnosis of repaired PAH-CHD. Patients with univentricular physiology, segmental pulmonary hypertension (PH), and PH primarily due to abnormal development of the pulmonary vasculature were excluded. Univariable Cox regression analysis was performed in children with PAH present ≥3 months after CHD repair, with an outcome of death or transplantation. Time-dependent ROC analysis was used to evaluate the risk model.
Results
Overall, 178 patients were included (age 3.2 [1.3–7.9] years, 58.4% female). Most children (73.0%) were referred following CHD repair. Complex CHD was present in 61.2%, and 48.9% had combined pre- and post-tricuspid shunts. Down syndrome was present in 33.1%. At the first post-operative PH assessment, 53.1% of patients had symptoms, mainly breathlessness. On echocardiographic evaluation, 30.9% had moderate-severe right ventricular dilatation and 23.7% had right ventricular systolic impairment. Over a median follow-up of 6.0 [2.4–11.0] years, 30 (19.2%) patients died and 5 (3.2%) patients underwent lung transplantation. Transpant-free survival at 1, 5, and 10 years was 94.7% (95% CI: 91.2–98.3%), 85.9% (95% CI: 80.3–91.9%), and 80.1% (95% CI: 73.1–87.7%), respectively. Cox analysis identified several clinical variables associated with death or transplantation, of which the following variables assessed post-repair were used to develop the risk score: absence of pre-operative PH, breathlessness, right ventricular dysfunction, and pulmonary vascular resistance index >14 WU m2 or lesion at high risk of causing PH (Figure 1). This novel, simple risk score performed well (AUC >80% at 1, 3, 5 and 10 years) and was well-calibrated in our cohort (Figure 2, D'Agostino-Nam p=0.76).
Conclusions
In this national cohort of children with repaired PAH-CHD, mortality is significant. This novel, simple risk score performed well in our population and could be used in clinical practice at the time of post-operative assessment to predict outcome and direct management but requires further validation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - K Dimopoulos
- Royal Brompton Hospital , London , United Kingdom
| | - R Condliffe
- Sheffield Teaching Hospitals NHS Trust, Pulmonary Vascular Disease Unit , Sheffield , United Kingdom
| | - P Clift
- Queen Elizabeth Hospital Birmingham, Department of Cardiology , Birmingham , United Kingdom
| | - K Jansen
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit , Newcastle-Upon-Tyne , United Kingdom
| | - R Dhillon
- Birmingham Children's Hospital, Heart Unit , Birmingham , United Kingdom
| | - G Chaplin
- University College London, UCL Institute of Cardiovascular Science , London , United Kingdom
| | - V Muthurangu
- University College London, UCL Institute of Cardiovascular Science , London , United Kingdom
| | - S Moledina
- Great Ormond Street Hospital for Children, National Paediatric Pulmonary Hypertension Service UK , London , United Kingdom
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25
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Constantine A, Dimopoulos K, Haworth SG, Muthurangu V, Moledina S. Twenty-Year Experience and Outcomes in a National Pediatric Pulmonary Hypertension Service. Am J Respir Crit Care Med 2022; 206:758-766. [PMID: 35579610 PMCID: PMC9799107 DOI: 10.1164/rccm.202110-2428oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rationale: Pediatric pulmonary hypertension is an important cause of childhood morbidity and mortality, but there are limited data on the range of associated diseases, contributions of different pulmonary hypertension subtypes, therapeutic strategies, and clinical outcomes in children. Objectives: To report the 20-year experience of a large UK National Pediatric Pulmonary Hypertension Service focusing on epidemiology and clinical outcomes. Methods: Consecutive patients presenting between 2001 and 2021 were included, and survival analysis was performed for incident patients. Measurements and Main Results: Of 1,353 patients assessed, a pulmonary hypertension diagnosis was made in 1,101 (81.4%) patients (51% female, median age, 2.6 [interquartile range, 0.8-8.2] years). The most common form was pulmonary arterial hypertension in 48%, followed by 32.3% with pulmonary hypertension due to lung disease. Multiple contributory causes of pulmonary hypertension were common, with 16.9% displaying features of more than one diagnostic group. The annual incidence of childhood pulmonary hypertension was 3.5 (95% confidence interval [CI], 3.3-3.8) per 1 million children, and the prevalence was 18.1 (95% CI, 15.8-20.4) per 1 million. The incidence was highest for pulmonary hypertension due to lung disease in infancy (15.0 [95% CI, 12.7-17.2] per 1 million per year). Overall, 82.4% patients received pulmonary arterial hypertension therapy, and escalation to triple therapy during follow-up was required in 13.1%. In 970 (88.1%) incident patients, transplant-free survival was 86.7% (95% CI, 84.5-89%) at 1 and 68.6% (95% CI, 64.7-72.6%) at 10 years. Pulmonary hypertension due to left heart disease had the lowest survival (hazard ratio, 2.0; 95% CI, 1.36-2.94; P < 0.001). Conclusions: Clinical phenotypes of pediatric pulmonary hypertension are heterogeneous and overlapping, with clinical phenotypes that evolve throughout childhood. Despite widespread use of pulmonary arterial hypertension therapy, the prognosis remains poor.
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Affiliation(s)
- Andrew Constantine
- National Pediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom; and
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom; and
| | - Sheila G. Haworth
- National Pediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
- University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Vivek Muthurangu
- University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Shahin Moledina
- National Pediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
- University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
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Affiliation(s)
- Anna Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK
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27
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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28
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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29
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Brown JT, Saigal A, Karia N, Patel RK, Razvi Y, Constantinou N, Steeden JA, Mandal S, Kotecha T, Fontana M, Goldring J, Muthurangu V, Knight DS. Ongoing Exercise Intolerance Following COVID-19: A Magnetic Resonance-Augmented Cardiopulmonary Exercise Test Study. J Am Heart Assoc 2022; 11:e024207. [PMID: 35470679 PMCID: PMC9238618 DOI: 10.1161/jaha.121.024207] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Ongoing exercise intolerance of unclear cause following COVID-19 infection is well recognized but poorly understood. We investigated exercise capacity in patients previously hospitalized with COVID-19 with and without self-reported exercise intolerance using magnetic resonance-augmented cardiopulmonary exercise testing. Methods and Results Sixty subjects were enrolled in this single-center prospective observational case-control study, split into 3 equally sized groups: 2 groups of age-, sex-, and comorbidity-matched previously hospitalized patients following COVID-19 without clearly identifiable postviral complications and with either self-reported reduced (COVIDreduced) or fully recovered (COVIDnormal) exercise capacity; a group of age- and sex-matched healthy controls. The COVIDreducedgroup had the lowest peak workload (79W [Interquartile range (IQR), 65-100] versus controls 104W [IQR, 86-148]; P=0.01) and shortest exercise duration (13.3±2.8 minutes versus controls 16.6±3.5 minutes; P=0.008), with no differences in these parameters between COVIDnormal patients and controls. The COVIDreduced group had: (1) the lowest peak indexed oxygen uptake (14.9 mL/minper kg [IQR, 13.1-16.2]) versus controls (22.3 mL/min per kg [IQR, 16.9-27.6]; P=0.003) and COVIDnormal patients (19.1 mL/min per kg [IQR, 15.4-23.7]; P=0.04); (2) the lowest peak indexed cardiac output (4.7±1.2 L/min per m2) versus controls (6.0±1.2 L/min per m2; P=0.004) and COVIDnormal patients (5.7±1.5 L/min per m2; P=0.02), associated with lower indexed stroke volume (SVi:COVIDreduced 39±10 mL/min per m2 versus COVIDnormal 43±7 mL/min per m2 versus controls 48±10 mL/min per m2; P=0.02). There were no differences in peak tissue oxygen extraction or biventricular ejection fractions between groups. There were no associations between COVID-19 illness severity and peak magnetic resonance-augmented cardiopulmonary exercise testing metrics. Peak indexed oxygen uptake, indexed cardiac output, and indexed stroke volume all correlated with duration from discharge to magnetic resonance-augmented cardiopulmonary exercise testing (P<0.05). Conclusions Magnetic resonance-augmented cardiopulmonary exercise testing suggests failure to augment stroke volume as a potential mechanism of exercise intolerance in previously hospitalized patients with COVID-19. This is unrelated to disease severity and, reassuringly, improves with time from acute illness.
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Affiliation(s)
- James T. Brown
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Anita Saigal
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Nina Karia
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Rishi K. Patel
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - Yousuf Razvi
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - Natalie Constantinou
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | | | - Swapna Mandal
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Tushar Kotecha
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Marianna Fontana
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - James Goldring
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Vivek Muthurangu
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Daniel S. Knight
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
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Chiesa ST, Charakida M, Georgiopoulos G, Roberts JD, Stafford SJ, Park C, Mykkänen J, Kähönen M, Lehtimäki T, Ala-Korpela M, Raitakari O, Pietiäinen M, Pussinen P, Muthurangu V, Hughes AD, Sattar N, Timpson NJ, Deanfield JE. Glycoprotein Acetyls: A Novel Inflammatory Biomarker of Early Cardiovascular Risk in the Young. J Am Heart Assoc 2022; 11:e024380. [PMID: 35156387 PMCID: PMC9245818 DOI: 10.1161/jaha.121.024380] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/03/2022] [Indexed: 02/06/2023]
Abstract
Background Low-grade inflammation in the young may contribute to the early development of cardiovascular disease. We assessed whether circulating levels of glycoprotein acetyls (GlycA) were better able to predict the development of adverse cardiovascular disease risk profiles compared with the more commonly used biomarker high-sensitivity CRP (C-reactive protein). Methods and Results A total of 3306 adolescents and young adults from the Avon Longitudinal Study of Parents and Children (mean age, 15.4±0.3; n=1750) and Cardiovascular Risk in Young Finns Study (mean age, 32.1±5.0; n=1556) were included. Baseline associations between inflammatory biomarkers, body composition, cardiovascular risk factors, and subclinical measures of vascular dysfunction were assessed cross-sectionally in both cohorts. Prospective risk of developing hypertension and metabolic syndrome during 9-to-10-year follow-up were also assessed as surrogate markers for future cardiovascular risk. GlycA showed greater within-subject correlation over 9-to-10-year follow-up in both cohorts compared with CRP, particularly in the younger adolescent group (r=0.36 versus 0.07). In multivariable analyses, GlycA was found to associate with multiple lifestyle-related cardiovascular disease risk factors, cardiometabolic risk factor burden, and vascular dysfunction (eg, mean difference in flow-mediated dilation=-1.2 [-1.8, -0.7]% per z-score increase). In contrast, CRP levels appeared predominantly driven by body mass index and showed little relationship to any measured cardiovascular risk factors or phenotypes. In both cohorts, only GlycA predicted future risk of both hypertension (risk ratio [RR], ≈1.1 per z-score increase for both cohorts) and metabolic syndrome (RR, ≈1.2-1.3 per z-score increase for both cohorts) in 9-to-10-year follow-up. Conclusions Low-grade inflammation captured by the novel biomarker GlycA is associated with adverse cardiovascular risk profiles from as early as adolescence and predicts future risk of hypertension and metabolic syndrome in up to 10-year follow-up. GlycA is a stable inflammatory biomarker which may capture distinct sources of inflammation in the young and may provide a more sensitive measure than CRP for detecting early cardiovascular risk.
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Affiliation(s)
- Scott T Chiesa
- Institute of Cardiovascular Science University College London UK
| | - Marietta Charakida
- Department of Imaging Science and Biomedical Engineering King's College London UK
| | | | - Justin D Roberts
- Cambridge Centre for Sport and Exercise Sciences Anglia Ruskin University Cambridge UK
| | - Simon J Stafford
- Molecular Diagnostics Unit Medical Technology Research Centre Faculty of Health, Education, Medicine & Social Care Anglia Ruskin University Chelmsford UK
| | - Chloe Park
- Cardiometabolic Phenotyping Group Institute of Cardiovascular Science University College London UK
| | - Juha Mykkänen
- Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland
- Centre for Population Health Research University of Turku and Turku University Hospital Finland
| | - Mika Kähönen
- Department of Clinical Physiology Tampere University Hospital Tampere Finland
- Finnish Cardiovascular Research Center Tampere Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Terho Lehtimäki
- Finnish Cardiovascular Research Center Tampere Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Department of Clinical Chemistry Fimlab Laboratories Tampere Finland
| | - Mika Ala-Korpela
- Computational Medicine Faculty of Medicine University of Oulu and Biocenter Oulu Finland
- Center for Life Course Health Research University of Oulu Finland
- NMR Metabolomics Laboratory School of Pharmacy University of Eastern Finland Kuopio Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland
- Centre for Population Health Research University of Turku and Turku University Hospital Finland
- Department of Clinical Physiology and Nuclear Medicine Turku University Hospital Turku Finland
| | - Milla Pietiäinen
- Oral and Maxillofacial Diseases University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Pirkko Pussinen
- Oral and Maxillofacial Diseases University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging UCL Institute of Cardiovascular Science London United Kingdom
| | - Alun D Hughes
- Cardiometabolic Phenotyping Group Institute of Cardiovascular Science University College London UK
- MRC Unit for Lifelong Health and AgeingUniversity College London UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences British Heart Foundation (BHF) Glasgow Cardiovascular Research CentreUniversity of Glasgow UK
| | - Nicholas J Timpson
- Population Health Sciences Bristol Medical School Faculty of Health Sciences University of Bristol UK
- Medical Research Council Integrative Epidemiology Unit University of Bristol UK
| | - John E Deanfield
- Institute of Cardiovascular Science University College London UK
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Brown JT, Kotecha T, Steeden JA, Fontana M, Denton CP, Coghlan JG, Knight DS, Muthurangu V. Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study. J Cardiovasc Magn Reson 2021; 23:118. [PMID: 34706740 PMCID: PMC8554852 DOI: 10.1186/s12968-021-00817-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Exercise intolerance in systemic sclerosis (SSc) is typically attributed to cardiopulmonary limitations. However, problems with skeletal muscle oxygen extraction have not been fully investigated. This study used cardiovascular magnetic resonance (CMR)-augmented cardiopulmonary exercise testing (CMR-CPET) to simultaneously measure oxygen consumption and cardiac output. This allowed calculation of arteriovenous oxygen content gradient, a recognized marker of oxygen extraction. We performed CMR-CPET in 4 groups: systemic sclerosis (SSc); systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH); non-connective tissue disease pulmonary hypertension (NC-PAH); and healthy controls. METHODS We performed CMR-CPET in 60 subjects (15 in each group) using a supine ergometer following a ramped exercise protocol until exhaustion. Values for oxygen consumption, cardiac output and oxygen content gradient, as well as ventricular volumes, were obtained at rest and peak-exercise for all subjects. In addition, T1 and T2 maps were acquired at rest, and the most recent clinical measures (hemoglobin, lung function, 6-min walk, cardiac and catheterization) were collected. RESULTS All patient groups had reduced peak oxygen consumption compared to healthy controls (p < 0.022). The SSc and SSc-PAH groups had reduced peak oxygen content gradient compared to healthy controls (p < 0.03). Conversely, the SSc-PAH and NC-PH patients had reduced peak cardiac output compared to healthy controls and SSc patients (p < 0.006). Higher hemoglobin was associated with higher peak oxygen content gradient (p = 0.025) and higher myocardial T1 was associated with lower peak stroke volume (p = 0.011). CONCLUSIONS Reduced peak oxygen consumption in SSc patients is predominantly driven by reduced oxygen content gradient and in SSc-PAH patients this was amplified by reduced peak cardiac output. Trial registration The study is registered with ClinicalTrials.gov Protocol Registration and Results System (ClinicalTrials.gov ID: 100358).
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Affiliation(s)
- James T Brown
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Tushar Kotecha
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Jennifer A Steeden
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marianna Fontana
- Royal Free Hospital, London, UK
- Division of Medicine, University College London, London, UK
| | - Christopher P Denton
- Royal Free Hospital, London, UK
- Division of Medicine, University College London, London, UK
| | | | - Daniel S Knight
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London, UK.
- Centre for Cardiovascular Imaging, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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Constantine A, Dimopoulos K, Condliffe R, Clift P, Chaplin G, Muthurangu V, Haworth SG, Moledina S. Pulmonary arterial hypertension associated with congenital heart disease in children: clinical characterisation, outcomes and changes in demographics over time. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD) in children and is associated with significant morbidity and mortality. The impact of different phenotypes on management and survival remains unclear.
Purpose
To examine the clinical features, management and outcomes of paediatric PAH-CHD patients based on the 20-year experience of the UK National Paediatric Pulmonary Hypertension (PH) Service.
Methods
Consecutive PAH-CHD patients entering the service between January 2001 and January 2021 were included and classified into: Eisenmenger syndrome (ES, group A), PAH related to a significant systemic-pulmonary shunt (group B), PAH with small or co-incidental CHD (group C) and PAH following defect repair (group D). Incident patients (without pre-existing PAH) were included in survival analysis.
Results
Of the overall PH paediatric cohort of 1104 patients, 819 (74.2%) had co-existing CHD and 354 (32.1%) patients received a diagnosis of PAH-CHD: 57.1% female, median [IQR] 4.6 [1.7–10.9] years. Group D PAH-CHD was the commonest subgroup, accounting for 36%, while the least frequent subtype was group C (14%). Group A and group B PAH-CHD represented 26% and 24%, respectively. Down syndrome was present in over one third (122, 34.5%) of PAH-CHD patients and was more commonly associated with ES (p=0.02). PAH therapy was started in 79.9% of PAH-CHD patients. At the end of follow-up, patients with group C PAH-CHD were more likely to be on combination therapy than any other group (64.6% vs. 28.4%, p<0.0001). Prostanoid therapy was used in a minority (11%) of patients.
The subgroup distribution of PAH-CHD at diagnosis changed from the early (2000–2005) to late (2015–2020) period (Figure 1). The proportion of ES patients decreased from 43.4% to 14.6% of PAH-CHD (p<0.0001). The proportion of group B PAH-CHD patients increased (9.4% vs. 33.3%, p<0.0001), with the majority (59.3%) deemed “operable” on specialist assessment. There was a trend for an increase in repaired PAH-CHD patients between the early and late era (31.1% vs. 43.8%, p=0.09).
Transplant-free survival in PAH-CHD was 90.9% (95% CI: 87.8–94%) at 1 year, 77.9% (95% CI: 73.1–83.1%) at 5 years, and 74.9% (95% CI: 69.6–80.7%) at 10 years (Figure 2). Group C PAH-CHD had a lower transplant-free survival than the other 3 groups (HR 2.54, 95% CI: 1.51–4.28, p=0.0005). There was no difference in outcome between group A and group D PAH-CHD (HR 1.19, 95% CI: 0.62–2.28, p=0.6).
Conclusions
Repaired PAH-CHD, not ES, was the most common subtype in this large paediatric cohort. Over time, there were fewer ES patients and more “operable” patients with left-right shunts, suggesting an improvement in early diagnosis and management. Despite widespread use of PAH therapy, PAH-CHD remains a life-limiting disease with the poorest outcomes in PAH with co-incidental CHD.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Constantine received a personal PhD fellowship grant (CHAMPION PhD Fellowship) Figure 1Figure 2
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Affiliation(s)
| | | | - R Condliffe
- Sheffield Teaching Hospitals NHS Trust, Pulmonary Vascular Disease Unit, Sheffield, United Kingdom
| | - P Clift
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - G Chaplin
- University College of London, Institute of Cardiovascular Science, London, United Kingdom
| | - V Muthurangu
- Great Ormond Street Hospital for Children, National Paediatric Pulmonary Hypertension Service UK, London, United Kingdom
| | - S G Haworth
- Great Ormond Street Hospital for Children, National Paediatric Pulmonary Hypertension Service UK, London, United Kingdom
| | - S Moledina
- Great Ormond Street Hospital for Children, National Paediatric Pulmonary Hypertension Service UK, London, United Kingdom
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Abstract
Abstract
Background/Introduction
Paediatric pulmonary hypertension (PH) is an important cause of childhood morbidity and mortality, but there are limited data on the range of associated diseases (including several paediatric-specific aetiologies), contributions of different PH subtypes, therapeutic strategies and clinical outcomes in paediatric patients.
Purpose
In this study, we report the 20-year experience of a UK National Paediatric Pulmonary Hypertension Service focusing on the aetiology, management and outcomes of children with PH.
Methods
Consecutive patients presenting to the service between January 2001 and January 2021 were included in this retrospective study. Other inclusion criteria were: age ≤18 years at diagnosis and diagnosis of PH following specialist assessment. Only incident patients (without pre-existing PH) were entered in the survival analysis.
Results
A total of 1104 (81.5%) PH patients were included during the study period: 51% female, median age 2.6 [0.8–8.2] years. The most common PH diagnosis was group 1 (pulmonary arterial hypertension, PAH) in 532 (48.2%) patients, followed by group 3 PH (due to lung disease) in 358 (32.4%), group 2 (101, 9.1%), group 5 (93, 8.4%), and group 4 disease (20, 1.8%). The most common PAH subgroup was PAH associated with congenital heart disease (CHD, 63.3%), followed by idiopathic PAH (22.4%). One quarter of patients (23.6%) had multiple contributory factors for PH, fitting more than one diagnostic group.
Resolution of PH, defined as normalisation of pulmonary artery pressures following cessation of PAH therapy, occurred in 172 (15.6%) patients at a median age of 3.7 [2.1–5.7] years and was more common in group 3 than other PH groups (33.5% vs. 9.1% at 5 years post-diagnosis, p<0.0001).
Overall, 909 (82.3%) patients received PAH therapy. Patients with group 3 PH were as likely to receive PAH therapy as an initial treatment strategy as group 1 patients (86.6% vs. 82.3%, p=0.11), but were more likely to receive sildenafil monotherapy (p=0.002) and less likely to be offered triple therapy (p<0.0001). During follow-up, maintenance or escalation to triple therapy was required in 103 (9.3%) patients and was far more common in idiopathic compared to other PAH subgroups (37.7% vs. 7.8%, p<0.0001).
Transplant-free survival was 86.7% (95% CI: 84.5–88.9%) at 1 year, 74.2% (95% CI: 71.1–77.5%) at 5 years, and 68.9% (95% CI: 65.1–73%) at 10 years (Figure 1). PAH related to CHD had the highest transplant-free survival (HR 0.62, 95% CI: 0.46–0.84, p=0.002). Group 2 had the lowest transplant-free survival (HR 2.09, 95% CI: 1.42–3.09, p=0.0002) whereas groups 3,4 and 5 did not differ significantly from PAH (Figure 2).
Conclusions
In this large, national cohort of paediatric PH patients, the most common type of PH was PAH, followed by group 3 PH. Multiple contributory causes for PH are common and PH resolution was not uncommon, especially in group 3 patients. Despite widespread use of PAH therapy, the prognosis remains guarded.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Constantine has received a PhD grant from Janssen-Cilag Ltd. as the CHAMPION PhD Fellow. Figure 1Figure 2
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Affiliation(s)
| | | | - V Muthurangu
- Great Ormond Street Hospital for Children, National Paediatric Pulmonary Hypertension Service UK, London, United Kingdom
| | - S Haworth
- Great Ormond Street Hospital for Children, National Paediatric Pulmonary Hypertension Service UK, London, United Kingdom
| | - S Moledina
- Great Ormond Street Hospital for Children, National Paediatric Pulmonary Hypertension Service UK, London, United Kingdom
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Jaubert O, Montalt‐Tordera J, Knight D, Coghlan GJ, Arridge S, Steeden JA, Muthurangu V. Real-time deep artifact suppression using recurrent U-Nets for low-latency cardiac MRI. Magn Reson Med 2021; 86:1904-1916. [PMID: 34032308 PMCID: PMC8613539 DOI: 10.1002/mrm.28834] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/22/2021] [Accepted: 04/17/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Real-time low latency MRI is performed to guide various cardiac interventions. Real-time acquisitions often require iterative image reconstruction strategies, which lead to long reconstruction times. In this study, we aim to reconstruct highly undersampled radial real-time data with low latency using deep learning. METHODS A 2D U-Net with convolutional long short-term memory layers is proposed to exploit spatial and preceding temporal information to reconstruct highly accelerated tiny golden radial data with low latency. The network was trained using a dataset of breath-hold CINE data (including 770 time series from 7 different orientations). Synthetic paired data were created by retrospectively undersampling the magnitude images, and the network was trained to recover the target images. In the spirit of interventional imaging, the network was trained and tested for varying acceleration rates and orientations. Data were prospectively acquired and reconstructed in real time in 1 healthy subject interactively and in 3 patients who underwent catheterization. Images were visually compared to sliding window and compressed sensing reconstructions and a conventional Cartesian real-time sequence. RESULTS The proposed network generalized well to different acceleration rates and unseen orientations for all considered metrics in simulated data (less than 4% reduction in structural similarity index compared to similar acceleration and orientation-specific networks). The proposed reconstruction was demonstrated interactively, successfully depicting catheters in vivo with low latency (39 ms, including 19 ms for deep artifact suppression) and an image quality comparing favorably to other reconstructions. CONCLUSION Deep artifact suppression was successfully demonstrated in the time-critical application of non-Cartesian real-time interventional cardiac MR.
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Affiliation(s)
- Olivier Jaubert
- Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Javier Montalt‐Tordera
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Dan Knight
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Gerry J. Coghlan
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Simon Arridge
- Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Jennifer A. Steeden
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Vivek Muthurangu
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
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Jaubert O, Steeden J, Montalt-Tordera J, Arridge S, Kowalik GT, Muthurangu V. Deep artifact suppression for spiral real-time phase contrast cardiac magnetic resonance imaging in congenital heart disease. Magn Reson Imaging 2021; 83:125-132. [PMID: 34419611 DOI: 10.1016/j.mri.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Real-time spiral phase contrast MR (PCMR) enables rapid free-breathing assessment of flow. Target spatial and temporal resolutions require high acceleration rates often leading to long reconstruction times. Here we propose a deep artifact suppression framework for fast and accurate flow quantification. METHODS U-Nets were trained for deep artifact suppression using 520 breath-hold gated spiral PCMR aortic datasets collected in congenital heart disease patients. Two spiral trajectories (uniform and perturbed) and two losses (Mean Absolute Error -MAE- and average structural similarity index measurement -SSIM-) were compared in synthetic data in terms of MAE, peak SNR (PSNR) and SSIM. Perturbed spiral PCMR was prospectively acquired in 20 patients. Stroke Volume (SV), peak mean velocity and edge sharpness measurements were compared to Compressed Sensing (CS) and Cartesian reference. RESULTS In synthetic data, perturbed spiral consistently outperformed uniform spiral for the different image metrics. U-Net MAE showed better MAE and PSNR while U-Net SSIM showed higher SSIM based metrics. In-vivo, there were no significant differences in SV between any of the real-time reconstructions and the reference standard Cartesian data. However, U-Net SSIM had better image sharpness and lower biases for peak velocity when compared to U-Net MAE. Reconstruction of 96 frames took ~59 s for CS and 3.9 s for U-Nets. CONCLUSION Deep artifact suppression of complex valued images using an SSIM based loss was successfully demonstrated in a cohort of congenital heart disease patients for fast and accurate flow quantification.
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Affiliation(s)
- Olivier Jaubert
- Department of Computer Science, University College London, London WC1E 6BT, United Kingdom; Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London WC1N 1EH, United Kingdom.
| | - Jennifer Steeden
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London WC1N 1EH, United Kingdom
| | - Javier Montalt-Tordera
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London WC1N 1EH, United Kingdom
| | - Simon Arridge
- Department of Computer Science, University College London, London WC1E 6BT, United Kingdom
| | - Grzegorz Tomasz Kowalik
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London WC1N 1EH, United Kingdom
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London WC1N 1EH, United Kingdom
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Wan S, Steeden J, Rega M, Hoy L, Walls D, Endozo R, Hoath J, Shortman R, Agu O, Menezes L, Muthurangu V, Groves AM. Comprehensive mechanical & metabolic imaging of abdominal aortic aneurysm with 4D flow/ FDG PET on an integrated PETMRI: a feasibility study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): NIHR Biomedical Research Centre, University College London Hospitals.
Background
A number of non-invasive imaging derived parameters have been implicated in the development and progression of abdominal aortic aneurysm, although the mechanism, and relationships of many of these are yet to be precisely determined. Mechanical parameters can now be studied using 4D phase contrast magnetic resonance (PCMR), and inflammatory cellular activity can be detected with FDG PET.
Purpose
It may be postulated that inflammation of the aortic wall may be the intermediary at the tissue level linking mechanical wall shear stress (WSS) to aneurysm progression. It may be feasible to study 4D PCMR and FDG PET at the same patient visit on a PETMRI platform, with the potential to enhance temporal and spatial co-registration and improving the understanding of any relationship between these two parameters. Our study aims to assess feasibility of studying these on an integrated PETMRI system.
Methods
7 patients with known aortic aneurysm were recruited in a vascular ultrasound screening follow up clinic. During a single visit following 6 hours fasting, all patients underwent FDG injection and 60 minutes uptake period. With quiet breathing, list mode PET acquisition and concurrent 4D PCMR was acquired using stacks of spiral acquisition, with ECG trace information for retrospective gating. Images from the 4D PCMR and FDG PET were assessed qualitatively for image quality and visual matching.
Results
All 7 patients completed the study. Overall image quality was adequate to good. There is qualitatively a good concordance with impression of positive correlation between wall shear stress and inflammatory signal (see attached image).
Conclusion
We have demonstrated feasibility of combined assessment of mechanical and metabolic imaging parameters using an integrated PETMRI system. Initial findings show there to be a broad concordance of wall shear stress and inflammatory signal in the abdominal aneurysm.
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Affiliation(s)
- S Wan
- University College London Hospitals, Institute of Nuclear Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - J Steeden
- University College London, Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science , London, United Kingdom of Great Britain & Northern Ireland
| | - M Rega
- University College London Hospitals, Institute of Nuclear Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - L Hoy
- University College London Hospitals, Institute of Nuclear Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - D Walls
- University College London Hospitals, Institute of Nuclear Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - R Endozo
- University College London Hospitals, Institute of Nuclear Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - J Hoath
- University College London Hospitals, Institute of Nuclear Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - R Shortman
- University College London Hospitals, Institute of Nuclear Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - O Agu
- University College London Hospitals, Vascular Services, London, United Kingdom of Great Britain & Northern Ireland
| | - L Menezes
- University College London Hospitals, Institute of Nuclear Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - V Muthurangu
- University College London, Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science , London, United Kingdom of Great Britain & Northern Ireland
| | - AM Groves
- University College London, Centre for Translational Cardiovascular Imaging, Institute of Cardiovascular Science , London, United Kingdom of Great Britain & Northern Ireland
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Annio G, Torii R, Ducci A, Muthurangu V, Tsang V, Burriesci G. Experimental Validation of Enhanced Magnetic Resonance Imaging (EMRI) Using Particle Image Velocimetry (PIV). Ann Biomed Eng 2021; 49:3481-3493. [PMID: 34181130 DOI: 10.1007/s10439-021-02811-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
Flow-sensitive four-dimensional Cardiovascular Magnetic Resonance Imaging (4D Flow CMR) has increasingly been utilised to characterise patients' blood flow, in association with patiens' state of health and disease, even though spatial and temporal resolutions still constitute a limit. Computational fluid dynamics (CFD) is a powerful tool that could expand these information and, if integrated with experimentally-obtained velocity fields, would enable to derive a large variety of the flow descriptors of interest. However, the accuracy of the flow parameters is highly influenced by the quality of the input data such as the anatomical model and boundary conditions typically derived from medical images including 4D Flow CMR. We previously proposed a novel approach in which 4D Flow CMR and CFD velocity fields are integrated to obtain an Enhanced 4D Flow CMR (EMRI), allowing to overcome the spatial-resolution limitation of 4D Flow CMR, and enable an accurate quantification of flow. In this paper, the proposed approach is validated in a U bend channel, an idealised model of the human aortic arch. The flow patterns were studied with 4D Flow CMR, CFD and EMRI, and compared with high resolution 2D PIV experiments obtained in pulsatile conditions. The main strengths and limitations of 4D Flow CMR and CFD were illustrated by exploiting the accuracy of PIV by comparing against PIV velocity fields. EMRI flow patterns showed a better qualitative and quantitative agreement with PIV results than the other techniques. EMRI enables to overcome the experimental limitations of MRI-based velocity measurements and the modelling simplifications of CFD, allowing an accurate prediction of complex flow patterns observed experimentally, while satisfying mass and momentum balance equations.
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Affiliation(s)
- Giacomo Annio
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK.
| | - Andrea Ducci
- Department of Mechanical Engineering, University College London, London, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging and Physics, University College London, London, UK
| | - Victor Tsang
- Cardiothoracic Surgery Unit, Great Ormond Street Hospital, London, UK
| | - Gaetano Burriesci
- Department of Mechanical Engineering, University College London, London, UK.
- Ri.MED Foundation, Palermo, Italy.
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Issitt R, Booth J, Crook R, Robertson A, Molyneux V, Richardson R, Cross N, Shaw M, Tsang V, Muthurangu V, Sebire NJ, Burch M, Fenton M. Intraoperative anti-A/B immunoadsorption is associated with significantly reduced blood product utilization with similar outcomes in pediatric ABO-incompatible heart transplantation. J Heart Lung Transplant 2021; 40:1433-1442. [PMID: 34187714 PMCID: PMC8579753 DOI: 10.1016/j.healun.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background Intraoperative anti-A/B immunoadsorption (ABO-IA) was recently introduced for ABO-incompatible heart transplantation. Here we report the first case series of patients transplanted with ABO-IA, and compare outcomes with those undergoing plasma exchange facilitated ABO-incompatible heart transplantation (ABO-PE). Methods Data were retrospectively analysed on all ABO-incompatible heart transplants undertaken at a single centre between January 1, 2000 and June 1, 2020. Data included all routine laboratory tests, demographics and pre-operative characteristics, intraoperative details and post-operative outcomes. Primary outcome measures were volume of blood product transfusions, maximum post-transplant isohaemagglutinin titres, occurrence of rejection and graft survival. Secondary outcome measures were length of intensive care and hospital stay. Demographic and survival data were also obtained for ABO-compatible transplants during the same time period for comparison. Results Thirty-seven patients underwent ABO-incompatible heart transplantation, with 27 (73%) using ABO-PE and 10 (27%) using ABO-IA. ABO-IA patients were significantly older than ABO-PE patients (p < 0.001) and the total volume of blood products transfused during the hospital admission was significantly lower (164 [126-212] ml/kg vs 323 [268-379] ml/kg, p < 0.001). No significant differences were noted between methods in either pre or post-transplant maximum isohaemagglutinin titres, incidence of rejection, length of intensive care or total hospital stay. Survival comparison showed no significant difference between antibody reduction methods, or indeed ABO-compatible transplants (p = 0.6). Conclusions This novel technique appears to allow a significantly older population than typical to undergo ABO-incompatible heart transplantation, as well as significantly reducing blood product utilization. Furthermore, intraoperative anti-A/B immunoadsorption does not demonstrate increased early post-transplant isohaemagglutinin accumulation or rates of rejection compared to ABO-PE. Early survival is equivalent between ABO-IA, ABO-PE and ABO-compatible heart transplantation.
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Affiliation(s)
- Richard Issitt
- Perfusion Department, Great Ormond Street Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK; Digital Research Informatics and Virtual Environment Unit, NIHR Great Ormond Street Hospital BRC, London, UK.
| | - John Booth
- Digital Research Informatics and Virtual Environment Unit, NIHR Great Ormond Street Hospital BRC, London, UK
| | - Richard Crook
- Perfusion Department, Great Ormond Street Hospital, London, UK
| | - Alex Robertson
- Perfusion Department, Great Ormond Street Hospital, London, UK
| | | | | | - Nigel Cross
- Perfusion Department, Great Ormond Street Hospital, London, UK
| | - Michael Shaw
- Perfusion Department, Great Ormond Street Hospital, London, UK
| | - Victor Tsang
- Institute of Cardiovascular Science, University College London, London, UK; Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London, UK
| | - Neil J Sebire
- Digital Research Informatics and Virtual Environment Unit, NIHR Great Ormond Street Hospital BRC, London, UK
| | - Michael Burch
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital, London, UK; Department of Paediatric Cardiology, Institute of Child Health, University College London, London, UK
| | - Matthew Fenton
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital, London, UK; Department of Paediatric Cardiology, Institute of Child Health, University College London, London, UK
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Hauser JA, Muthurangu V, Pandya B, Michel-Behnke I, Taylor AM, Demyanets S. Postprandial variability of novel heart failure biomarkers in Fontan patients compared to healthy volunteers. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Secinaro S, Calandra D, Secinaro A, Muthurangu V, Biancone P. The role of artificial intelligence in healthcare: a structured literature review. BMC Med Inform Decis Mak 2021; 21:125. [PMID: 33836752 PMCID: PMC8035061 DOI: 10.1186/s12911-021-01488-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/INTRODUCTION Artificial intelligence (AI) in the healthcare sector is receiving attention from researchers and health professionals. Few previous studies have investigated this topic from a multi-disciplinary perspective, including accounting, business and management, decision sciences and health professions. METHODS The structured literature review with its reliable and replicable research protocol allowed the researchers to extract 288 peer-reviewed papers from Scopus. The authors used qualitative and quantitative variables to analyse authors, journals, keywords, and collaboration networks among researchers. Additionally, the paper benefited from the Bibliometrix R software package. RESULTS The investigation showed that the literature in this field is emerging. It focuses on health services management, predictive medicine, patient data and diagnostics, and clinical decision-making. The United States, China, and the United Kingdom contributed the highest number of studies. Keyword analysis revealed that AI can support physicians in making a diagnosis, predicting the spread of diseases and customising treatment paths. CONCLUSIONS The literature reveals several AI applications for health services and a stream of research that has not fully been covered. For instance, AI projects require skills and data quality awareness for data-intensive analysis and knowledge-based management. Insights can help researchers and health professionals understand and address future research on AI in the healthcare field.
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Affiliation(s)
| | - Davide Calandra
- Department of Management, University of Turin, Turin, Italy.
| | | | - Vivek Muthurangu
- Institute of Child Health, University College London, London, UK
| | - Paolo Biancone
- Department of Management, University of Turin, Turin, Italy
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Quail MA, Chan I, Sarna S, Hughes M, Muthurangu V. A preoperative estimate of central venous pressure is associated with early Fontan failure. J Thorac Cardiovasc Surg 2021; 161:1426-1434. [PMID: 32747130 DOI: 10.1016/j.jtcvs.2020.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Early Fontan failure is a serious complication after total cavopulmonary connection, characterized by high central venous pressure, low cardiac output, and resistance to medical therapy. This study aimed to estimate postoperative central venous pressure in patients with total cavopulmonary connection using data routinely collected during preoperative assessment. We sought to determine if this metric correlated with measured postoperative central venous pressure and if it was associated with early Fontan failure. METHODS In this retrospective study, central venous pressure in total cavopulmonary connection was estimated in 131 patients undergoing pre-total cavopulmonary connection assessment by cardiac magnetic resonance imaging and central venous pressure measurement under general anesthesia. Postoperative central venous pressure during the first 24 hours in the intensive care unit was collected from electronic patient records in a subset of patients. Early Fontan failure was defined as death, transplantation, total cavopulmonary connection takedown, or emergency fenestration within the first 30 days. RESULTS Estimated central venous pressure in total cavopulmonary connection correlated significantly with central venous pressure during the first 24 hours in the intensive care unit (r = 0.26, P = .03), particularly in patients without a fenestration (r = 0.45, P = .01). Central venous pressure in total cavopulmonary connection was significantly associated with early Fontan failure (odds ratio, 1.1; 95% confidence interval, 1.01-1.21; P = .03). A threshold of central venous pressure in total cavopulmonary connection 33 mm Hg or greater was found to have the highest specificity (90%) and sensitivity (58%) for identifying early Fontan failure (area under receiver operating curve = 0.73; odds ratio, 12.4; 95% confidence interval, 2.5-62.3; P = .002). This association was stronger in patients with single superior vena cava. CONCLUSIONS Estimated central venous pressure in total cavopulmonary connection is an easily calculated metric combining preoperative pressure and flow data. Higher central venous pressure in total cavopulmonary connection is associated with an increased risk of early Fontan failure and is correlated with directly measured post-total cavopulmonary connection pressure. Identification of patients at risk of early Fontan failure has the potential to guide risk-mitigation strategies.
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Affiliation(s)
- Michael A Quail
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom.
| | - Ignatius Chan
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
| | - Shiv Sarna
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
| | - Marina Hughes
- Adult Congenital Heart Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
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Montalt-Tordera J, Muthurangu V, Hauptmann A, Steeden JA. Machine learning in Magnetic Resonance Imaging: Image reconstruction. Phys Med 2021; 83:79-87. [DOI: 10.1016/j.ejmp.2021.02.020] [Citation(s) in RCA: 8] [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] [Received: 11/30/2020] [Accepted: 02/23/2021] [Indexed: 12/27/2022] Open
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Montalt-Tordera J, Quail M, Steeden JA, Muthurangu V. Reducing Contrast Agent Dose in Cardiovascular MR Angiography with Deep Learning. J Magn Reson Imaging 2021; 54:795-805. [PMID: 33619859 PMCID: PMC9681557 DOI: 10.1002/jmri.27573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022] Open
Abstract
Background Contrast‐enhanced magnetic resonance angiography (MRA) is used to assess various cardiovascular conditions. However, gadolinium‐based contrast agents (GBCAs) carry a risk of dose‐related adverse effects. Purpose To develop a deep learning method to reduce GBCA dose by 80%. Study Type Retrospective and prospective. Population A total of 1157 retrospective and 40 prospective congenital heart disease patients for training/validation and testing, respectively. Field Strength/Sequence A 1.5 T, T1‐weighted three‐dimensional (3D) gradient echo. Assessment A neural network was trained to enhance low‐dose (LD) 3D MRA using retrospective synthetic data and tested with prospective LD data. Image quality for LD (LD‐MRA), enhanced LD (ELD‐MRA), and high‐dose (HD‐MRA) was assessed in terms of signal‐to‐noise ratio (SNR), contrast‐to‐noise ratio (CNR), and a quantitative measure of edge sharpness and scored for perceptual sharpness and contrast on a 1–5 scale. Diagnostic confidence was assessed on a 1–3 scale. LD‐ and ELD‐MRA were assessed against HD‐MRA for sensitivity/specificity and agreement of vessel diameter measurements (aorta and pulmonary arteries). Statistical Tests SNR, CNR, edge sharpness, and vessel diameters were compared between LD‐, ELD‐, and HD‐MRA using one‐way repeated measures analysis of variance with post‐hoc t‐tests. Perceptual quality and diagnostic confidence were compared using Friedman's test with post‐hoc Wilcoxon signed‐rank tests. Sensitivity/specificity was compared using McNemar's test. Agreement of vessel diameters was assessed using Bland–Altman analysis. Results SNR, CNR, edge sharpness, perceptual sharpness, and perceptual contrast were lower (P < 0.05) for LD‐MRA compared to ELD‐MRA and HD‐MRA. SNR, CNR, edge sharpness, and perceptual contrast were comparable between ELD and HD‐MRA, but perceptual sharpness was significantly lower. Sensitivity/specificity was 0.824/0.921 for LD‐MRA and 0.882/0.960 for ELD‐MRA. Diagnostic confidence was 2.72, 2.85, and 2.92 for LD, ELD, and HD‐MRA, respectively (PLD‐ELD, PLD‐HD < 0.05). Vessel diameter measurements were comparable, with biases of 0.238 (LD‐MRA) and 0.278 mm (ELD‐MRA). Data Conclusion Deep learning can improve contrast in LD cardiovascular MRA. Level of Evidence Level 2 Technical Efficacy Stage 2
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Affiliation(s)
- Javier Montalt-Tordera
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, London, WC1N 1EH, UK
| | - Michael Quail
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, London, WC1N 1EH, UK.,Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, London, WC1N 1EH, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, London, WC1N 1EH, UK
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Abstract
Over the past decade, cardiovascular magnetic resonance (CMR) has become a mainstream noninvasive imaging tool for assessment of adult and pediatric patients with congenital heart disease. It provides comprehensive anatomic and hemodynamic information that echocardiography and catheterization alone do not provide. Extracardiac anatomy can be delineated with high spatial resolution, intracardiac anatomy can be imaged in multiple planes, and functional assessment can be made accurately and with high reproducibility. In patients with heart failure, CMR provides not only reference standard evaluation of ventricular volumes and function but also information about the possible causes of dysfunction.
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Affiliation(s)
- Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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Kotecha T, Chacko L, Chehab O, O’Reilly N, Martinez-Naharro A, Lazari J, Knott KD, Brown J, Knight D, Muthurangu V, Hawkins P, Plein S, Moon JC, Xue H, Kellman P, Rakhit R, Patel N, Fontana M. Assessment of Multivessel Coronary Artery Disease Using Cardiovascular Magnetic Resonance Pixelwise Quantitative Perfusion Mapping. JACC Cardiovasc Imaging 2020; 13:2546-2557. [DOI: 10.1016/j.jcmg.2020.06.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 06/04/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023]
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Leiner T, Bogaert J, Friedrich MG, Mohiaddin R, Muthurangu V, Myerson S, Powell AJ, Raman SV, Pennell DJ. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:76. [PMID: 33161900 PMCID: PMC7649060 DOI: 10.1186/s12968-020-00682-4] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [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: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.
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Affiliation(s)
- Tim Leiner
- Department of Radiology, E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Raad Mohiaddin
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, UCL Institute of Cardiovascular, Great Ormond Street, London, WC1N 3JH, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Dudley J Pennell
- Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- Imperial College, South Kensington Campus, London, SW7 2AZ, UK
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Hauser JA, Jones A, Pandya B, Taylor AM, Muthurangu V. Comprehensive MRI assessment of the cardiovascular responses to food ingestion in Fontan physiology. Am J Physiol Heart Circ Physiol 2020; 319:H808-H813. [PMID: 32857602 PMCID: PMC7654659 DOI: 10.1152/ajpheart.00500.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 07/23/2020] [Accepted: 08/25/2020] [Indexed: 11/22/2022]
Abstract
In univentricular (Fontan) physiology, peripheral and splanchnic vascular tone may be raised to counteract reduced cardiac output (CO) and elevated central venous pressure and thus maintain vital organ perfusion. This could negatively affect the normal cardiovascular response to food ingestion, where mesenteric vasodilation and a concurrent rise in CO are central. We sought to elucidate this using rapid cardiovascular MRI. Thirty fasting subjects (50% controls, 40% women and 60% men) ingested a standardized meal. Responses over ~50 min in mean arterial pressure (MAP), CO, and blood flow in all major aortic branches were measured, and regional vascular impedance (Z0) was calculated. Differences from baseline and between groups were assessed by repeated-measures mixed models. Compared with the control group, the Fontan patient group had greater fasting Z0 of the legs and kidneys, resulting in greater systemic Z0 and similar MAP. They further had similar blood flow to the digestive organs at baseline, despite larger variation in mesenteric resistance. Postprandially, blood flow to the legs decreased in the control group but not in the Fontan patient group. Increases in CO and superior mesenteric blood flow were similar in both groups, but the celiac response was blunted in the Fontan patient group. No significant differences in MAP responses were observed. In conclusion, alterations in vascular tone to counteract adverse hemodynamics and raised hepatic afterload may blunt vasoreactivity in the legs and the celiac axis in Fontan physiology. Further study is needed to determine whether blunted celiac or mesenteric vasoreactivity is linked to deteriorating hemodynamics and poor prognosis in Fontan patients.NEW & NOTEWORTHY Novel data on cardiovascular physiology in response to a meal in Fontan patients are presented. Using a previously validated dynamic MRI protocol, we demonstrated that the usual increase in cardiac output and the dilation of the superior mesenteric artery are preserved in clinically well Fontan patients. In contrast, vasoconstriction of the legs may have prevented redistribution of blood flow from this region in response to the meal. This may also affect responses to other types of stress. Celiac vasodilation was also absent in Fontan patients. This may be due to abnormal hepatic circulation. The proposed protocol may be used to study Fontan complications secondary to abnormal regional hemodynamics.
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Affiliation(s)
- Jakob A Hauser
- Centre for Translational Cardiovascular Imaging, University College London, London, United Kingdom
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Jones
- Centre for Translational Cardiovascular Imaging, University College London, London, United Kingdom
- Department of Pediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Andrew M Taylor
- Centre for Translational Cardiovascular Imaging, University College London, London, United Kingdom
- Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Vivek Muthurangu
- Centre for Translational Cardiovascular Imaging, University College London, London, United Kingdom
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Steeden JA, Quail M, Gotschy A, Mortensen KH, Hauptmann A, Arridge S, Jones R, Muthurangu V. Rapid whole-heart CMR with single volume super-resolution. J Cardiovasc Magn Reson 2020; 22:56. [PMID: 32753047 PMCID: PMC7405461 DOI: 10.1186/s12968-020-00651-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Three-dimensional, whole heart, balanced steady state free precession (WH-bSSFP) sequences provide delineation of intra-cardiac and vascular anatomy. However, they have long acquisition times. Here, we propose significant speed-ups using a deep-learning single volume super-resolution reconstruction, to recover high-resolution features from rapidly acquired low-resolution WH-bSSFP images. METHODS A 3D residual U-Net was trained using synthetic data, created from a library of 500 high-resolution WH-bSSFP images by simulating 50% slice resolution and 50% phase resolution. The trained network was validated with 25 synthetic test data sets. Additionally, prospective low-resolution data and high-resolution data were acquired in 40 patients. In the prospective data, vessel diameters, quantitative and qualitative image quality, and diagnostic scoring was compared between the low-resolution, super-resolution and reference high-resolution WH-bSSFP data. RESULTS The synthetic test data showed a significant increase in image quality of the low-resolution images after super-resolution reconstruction. Prospectively acquired low-resolution data was acquired ~× 3 faster than the prospective high-resolution data (173 s vs 488 s). Super-resolution reconstruction of the low-resolution data took < 1 s per volume. Qualitative image scores showed super-resolved images had better edge sharpness, fewer residual artefacts and less image distortion than low-resolution images, with similar scores to high-resolution data. Quantitative image scores showed super-resolved images had significantly better edge sharpness than low-resolution or high-resolution images, with significantly better signal-to-noise ratio than high-resolution data. Vessel diameters measurements showed over-estimation in the low-resolution measurements, compared to the high-resolution data. No significant differences and no bias was found in the super-resolution measurements in any of the great vessels. However, a small but significant for the underestimation was found in the proximal left coronary artery diameter measurement from super-resolution data. Diagnostic scoring showed that although super-resolution did not improve accuracy of diagnosis, it did improve diagnostic confidence compared to low-resolution imaging. CONCLUSION This paper demonstrates the potential of using a residual U-Net for super-resolution reconstruction of rapidly acquired low-resolution whole heart bSSFP data within a clinical setting. We were able to train the network using synthetic training data from retrospective high-resolution whole heart data. The resulting network can be applied very quickly, making these techniques particularly appealing within busy clinical workflow. Thus, we believe that this technique may help speed up whole heart CMR in clinical practice.
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Affiliation(s)
- Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
| | - Michael Quail
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Alexander Gotschy
- Great Ormond Street Hospital, London, WC1N 3JH, UK
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | | | - Andreas Hauptmann
- Department of Computer Science, University College London, London, WC1E 6BT, UK
- Research Unit of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Simon Arridge
- Department of Computer Science, University College London, London, WC1E 6BT, UK
| | - Rodney Jones
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK
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Montalt-Tordera J, Kowalik G, Gotschy A, Steeden J, Muthurangu V. Rapid 3D whole-heart cine imaging using golden ratio stack of spirals. Magn Reson Imaging 2020; 72:1-7. [PMID: 32562742 DOI: 10.1016/j.mri.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
Three-dimensional cine imaging provides a wealth of information about cardiac anatomy and function, but its use in the clinical environment is limited because data acquisition is very time consuming. In this work, a free-breathing 3D whole-heart cine imaging framework was developed using a time-efficient stack of spirals trajectory and accelerated reconstruction. Two suitable view ordering methods are considered with different spacing between k-space readouts in the partition dimension: uniform and tiny golden ratio based. A simulation study suggested the latter did not present any benefits in terms of similarity to the true image. The proposed method was subsequently tested on 10 prospective subjects and compared with conventional multi-slice breath-hold imaging. Image quality was evaluated using objective and subjective scores and ventricular measurements were compared to assess clinical accuracy. Image quality was lower in the proposed technique than in breath-hold images but good agreement was found in clinically relevant ventricular measurements. In addition, the proposed method was fast to acquire, required minimal planning and provided full anatomical coverage with isotropic resolution.
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Affiliation(s)
| | | | - Alexander Gotschy
- Great Ormond Street Hospital, London, UK; Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
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Quail MA, Muthurangu V. Letter by Quail and Muthurangu Regarding Article, "Doppler-Derived Arterial Load Indices Better Reflect Left Ventricular Afterload Than Systolic Blood Pressure in Coarctation of Aorta". Circ Cardiovasc Imaging 2020; 13:e010643. [PMID: 32295397 DOI: 10.1161/circimaging.120.010643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael A Quail
- Paediatric Cardiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, United Kingdom (M.A.Q.).,Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, United Kingdom (M.A.Q., V.M.)
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, United Kingdom (M.A.Q., V.M.)
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