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1. The Impact of Bariatric Surgery on Coronary Microvascular Function Assessed Using Automated Quantitative Perfusion CMR.

Author

Crane, James D., Joy, George, Knott, Kristopher D., Augusto, João B., Lau, Clement, Bhuva, Anish N., Seraphim, Andreas, Evain, Timothée, Brown, Louise A.E., Chowdhary, Amrit, Kotecha, Tushar, Fontana, Marianna, Plein, Sven, Ramar, Sasindran, Rubino, Francesco, Kellman, Peter, Xue, Hui, Pierce, Iain, Davies, Rhodri H., and Moon, James C.

Abstract

Coronary microvascular function is impaired in patients with obesity, contributing to myocardial dysfunction and heart failure. Bariatric surgery decreases cardiovascular mortality and heart failure, but the mechanisms are unclear. The authors studied the impact of bariatric surgery on coronary microvascular function in patients with obesity and its relationship with metabolic syndrome. Fully automated quantitative perfusion cardiac magnetic resonance and metabolic markers were performed before and 6 months after bariatric surgery. Compared with age- and sex-matched healthy volunteers, 38 patients living with obesity had lower stress myocardial blood flow (MBF) (P = 0.001) and lower myocardial perfusion reserve (P < 0.001). A total of 27 participants underwent paired follow-up 6 months post-surgery. Metabolic abnormalities reduced significantly at follow-up including mean body mass index by 11 ± 3 kg/m2 (P < 0.001), glycated hemoglobin by 9 mmol/mol (Q1-Q3: 4-19 mmol/mol; P < 0.001), fasting insulin by 142 ± 131 pmol/L (P < 0.001), and hepatic fat fraction by 5.6% (Q1-Q3: 2.6%-15.0%; P < 0.001). Stress MBF increased by 0.28 mL/g/min (Q1-Q3: −0.02 to 0.75 mL/g/min; P = 0.003) and myocardial perfusion reserve by 0.13 (Q1-Q3: −0.25 to 1.10; P = 0.036). The increase in stress MBF was lower in those with preoperative type 2 diabetes mellitus (0.1 mL/g/min [Q1-Q3: −0.09 to 0.46 mL/g/min] vs 0.75 mL/g/min [Q1-Q3: 0.31-1.25 mL/g/min]; P = 0.002). Improvement in stress MBF was associated with reduction in fasting insulin (beta = −0.45 [95% CI: −0.05 to 0.90]; P = 0.03). Coronary microvascular function is impaired in patients with obesity, but can be improved significantly with bariatric surgery. Improvements in microvascular function are associated with improvements in insulin resistance but are attenuated in those with preoperative type 2 diabetes mellitus. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2024
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2. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Author

Raman, Betty, McCracken, Celeste, Cassar, Mark P, Moss, Alastair J, Finnigan, Lucy, Samat, Azlan Helmy A, Ogbole, Godwin, Tunnicliffe, Elizabeth M, Alfaro-Almagro, Fidel, Menke, Ricarda, Xie, Cheng, Gleeson, Fergus, Lukaschuk, Elena, Lamlum, Hanan, McGlynn, Kevin, Popescu, Iulia A, Sanders, Zeena-Britt, Saunders, Laura C, Piechnik, Stefan K, Ferreira, Vanessa M, Nikolaidou, Chrysovalantou, Rahman, Najib M, Ho, Ling-Pei, Harris, Victoria C, Shikotra, Aarti, Singapuri, Amisha, Pfeffer, Paul, Manisty, Charlotte, Kon, Onn M, Beggs, Mark, O'Regan, Declan P, Fuld, Jonathan, Weir-McCall, Jonathan R, Parekh, Dhruv, Steeds, Rick, Poinasamy, Krisnah, Cuthbertson, Dan J, Kemp, Graham J, Semple, Malcolm G, Horsley, Alexander, Miller, Christopher A, O'Brien, Caitlin, Shah, Ajay M, Chiribiri, Amedeo, Leavy, Olivia C, Richardson, Matthew, Elneima, Omer, McAuley, Hamish J C, Sereno, Marco, Saunders, Ruth M, Houchen-Wolloff, Linzy, Greening, Neil J, Bolton, Charlotte E, Brown, Jeremy S, Choudhury, Gourab, Diar Bakerly, Nawar, Easom, Nicholas, Echevarria, Carlos, Marks, Michael, Hurst, John R, Jones, Mark G, Wootton, Daniel G, Chalder, Trudie, Davies, Melanie J, De Soyza, Anthony, Geddes, John R, Greenhalf, William, Howard, Luke S, Jacob, Joseph, Man, William D-C, Openshaw, Peter J M, Porter, Joanna C, Rowland, Matthew J, Scott, Janet T, Singh, Sally J, Thomas, David C, Toshner, Mark, Lewis, Keir E, Heaney, Liam G, Harrison, Ewen M, Kerr, Steven, Docherty, Annemarie B, Lone, Nazir I, Quint, Jennifer, Sheikh, Aziz, Zheng, Bang, Jenkins, R Gisli, Cox, Eleanor, Francis, Susan, Halling-Brown, Mark, Chalmers, James D, Greenwood, John P, Plein, Sven, Hughes, Paul J C, Thompson, A A Roger, Rowland-Jones, Sarah L, Wild, James M, Kelly, Matthew, Treibel, Thomas A, Bandula, Steven, Aul, Raminder, Miller, Karla, Jezzard, Peter, Smith, Stephen, Nichols, Thomas E, McCann, Gerry P, Evans, Rachael A, Wain, Louise V, Brightling, Christopher E, Neubauer, Stefan, Baillie, J K, Shaw, Alison, Hairsine, Brigid, Kurasz, Claire, Henson, Helen, Armstrong, Lisa, Shenton, Liz, Dobson, H, Dell, Amanda, Lucey, Alice, Price, Andrea, Storrie, Andrew, Pennington, Chris, Price, Claire, Mallison, Georgia, Willis, Gemma, Nassa, Heeah, Haworth, Jill, Hoare, Michaela, Hawkings, Nancy, Fairbairn, Sara, Young, Susan, Walker, S, Jarrold, I, Sanderson, Amy, David, C, Chong-James, K, Zongo, O, James, W Y, Martineau, A, King, Bernie, Armour, C, McAulay, D, Major, E, McGinness, Jade, McGarvey, L, Magee, N, Stone, Roisin, Drain, S, Craig, T, Bolger, A, Haggar, Ahmed, Lloyd, Arwel, Subbe, Christian, Menzies, Daniel, Southern, David, McIvor, Emma, Roberts, K, Manley, R, Whitehead, Victoria, Saxon, W, Bularga, A, Mills, N L, El-Taweel, Hosni, Dawson, Joy, Robinson, Leanne, Saralaya, Dinesh, Regan, Karen, Storton, Kim, Brear, Lucy, Amoils, S, Bermperi, Areti, Elmer, Anne, Ribeiro, Carla, Cruz, Isabel, Taylor, Jessica, Worsley, J, Dempsey, K, Watson, L, Jose, Sherly, Marciniak, S, Parkes, M, McQueen, Alison, Oliver, Catherine, Williams, Jenny, Paradowski, Kerry, Broad, Lauren, Knibbs, Lucy, Haynes, Matthew, Sabit, Ramsey, Milligan, L, Sampson, Claire, Hancock, Alyson, Evenden, Cerys, Lynch, Ceri, Hancock, Kia, Roche, Lisa, Rees, Meryl, Stroud, Natalie, Thomas-Woods, T, Heller, S, Robertson, E, Young, B, Wassall, Helen, Babores, M, Holland, Maureen, Keenan, Natalie, Shashaa, Sharlene, Price, Carly, Beranova, Eva, Ramos, Hazel, Weston, Heather, Deery, Joanne, Austin, Liam, Solly, Reanne, Turney, Sharon, Cosier, Tracey, Hazelton, Tracy, Ralser, M, Wilson, Ann, Pearce, Lorraine, Pugmire, S, Stoker, Wendy, McCormick, W, Dewar, A, Arbane, Gill, Kaltsakas, G, Kerslake, Helen, Rossdale, J, Bisnauthsing, Karen, Aguilar Jimenez, Laura A, Martinez, L M, Ostermann, Marlies, Magtoto, Murphy M, Hart, Nicholas, Marino, Philip, Betts, Sarah, Solano, Teresa S, Arias, Ava Maria, Prabhu, A, Reed, Annabel, Wrey Brown, Caroline, Griffin, Denise, Bevan, Emily, Martin, Jane, Owen, J, Alvarez Corral, Maria, Williams, Nick, Payne, Sheila, Storrar, Will, Layton, Alison, Lawson, Cathy, Mills, Clare, Featherstone, James, Stephenson, Lorraine, Burdett, Tracy, Ellis, Y, Richards, A, Wright, C, Sykes, D L, Brindle, K, Drury, Katie, Holdsworth, L, Crooks, M G, Atkin, Paul, Flockton, Rachel, Thackray-Nocera, Susannah, Mohamed, Abdelrahman, Taylor, Abigail, Perkins, Emma, Ross, Gavin, McGuinness, Heather, Tench, Helen, Phipps, Janet, Loosley, Ronda, Wolf-Roberts, Rebecca, Coetzee, S, Omar, Zohra, Ross, Alexandra, Card, Bethany, Carr, Caitlin, King, Clara, Wood, Chloe, Copeland, D, Calvelo, Ellen, Chilvers, Edwin R, Russell, Emily, Gordon, Hussain, Nunag, Jose Lloyd, Schronce, J, March, Katherine, Samuel, Katherine, Burden, L, Evison, Lynsey, McLeavey, Laura, Orriss-Dib, Lorna, Tarusan, Lawrence, Mariveles, Myril, Roy, Maura, Mohamed, Noura, Simpson, Neil, Yasmin, Najira, Cullinan, P, Daly, Patrick, Haq, Sulaimaan, Moriera, Silvia, Fayzan, Tamanah, Munawar, Unber, Nwanguma, Uchechi, Lingford-Hughes, A, Altmann, Danny, Johnston, D, Mitchell, J, Valabhji, J, Price, L, Molyneaux, P L, Thwaites, Ryan S, Walsh, S, Frankel, A, Lightstone, L, Wilkins, M, Willicombe, M, McAdoo, S, Touyz, R, Guerdette, Anne-Marie, Warwick, Katie, Hewitt, Melanie, Reddy, R, White, Sonia, McMahon, A, Hoare, Amy, Knighton, Abigail, Ramos, Albert, Te, Amelie, Jolley, Caroline J, Speranza, Fabio, Assefa-Kebede, Hosanna, Peralta, Ida, Breeze, Jonathon, Shevket, K, Powell, Natassia, Adeyemi, Oluwaseun, Dulawan, Pearl, Adrego, Rita, Byrne, S, Patale, Sheetal, Hayday, A, Malim, M, Pariante, C, Sharpe, C, Whitney, J, Bramham, K, Ismail, K, Wessely, S, Nicholson, T, Ashworth, Andrew, Humphries, Amy, Tan, Ai Lyn, Whittam, Beverley, Coupland, C, Favager, Clair, Peckham, D, Wade, Elaine, Saalmink, Gwen, Clarke, Jude, Glossop, Jodie, Murira, Jennifer, Rangeley, Jade, Woods, Janet, Hall, Lucy, Dalton, Matthhew, Window, Nicola, Beirne, Paul, Hardy, Tim, Coakley, G, Turtle, Lance, Berridge, Anthony, Cross, Andy, Key, Angela L, Rowe, Anna, Allt, Ann Marie, Mears, Chloe, Malein, Flora, Madzamba, Gladys, Hardwick, H E, Earley, Joanne, Hawkes, Jenny, Pratt, James, Wyles, J, Tripp, K A, Hainey, Kera, Allerton, Lisa, Lavelle-Langham, L, Melling, Lucy, Wajero, Lilian O, Poll, L, Noonan, Matthew J, French, N, Lewis-Burke, N, Williams-Howard, S A, Cooper, Shirley, Kaprowska, Sabina, Dobson, S L, Marsh, Sophie, Highett, Victoria, Shaw, V, Beadsworth, M, Defres, S, Watson, Ekaterina, Tiongson, Gerlynn F, Papineni, Padmasayee, Gurram, Sambasivarao, Diwanji, Shalin N, Quaid, Sheena, Briggs, A, Hastie, Claire, Rogers, Natalie, Stensel, D, Bishop, L, McIvor, K, Rivera-Ortega, P, Al-Sheklly, B, Avram, Cristina, Faluyi, David, Blaikely, J, Piper Hanley, K, Radhakrishnan, K, Buch, M, Hanley, N A, Odell, Natasha, Osbourne, Rebecca, Stockdale, Sue, Felton, T, Gorsuch, T, Hussell, T, Kausar, Zunaira, Kabir, T, McAllister-Williams, H, Paddick, S, Burn, D, Ayoub, A, Greenhalgh, Alan, Sayer, A, Young, A, Price, D, Burns, G, MacGowan, G, Fisher, Helen, Tedd, H, Simpson, J, Jiwa, Kasim, Witham, M, Hogarth, Philip, West, Sophie, Wright, S, McMahon, Michael J, Neill, Paula, Dougherty, Andrew, Morrow, A, Anderson, David, Grieve, D, Bayes, Hannah, Fallon, K, Mangion, K, Gilmour, L, Basu, N, Sykes, R, Berry, C, McInnes, I B, Donaldson, A, Sage, E K, Barrett, Fiona, Welsh, B, Bell, Murdina, Quigley, Jackie, Leitch, Karen, Macliver, L, Patel, Manish, Hamil, R, Deans, Andrew, Furniss, J, Clohisey, S, Elliott, Anne, Solstice, A R, Deas, C, Tee, Caroline, Connell, David, Sutherland, Debbie, George, J, Mohammed, S, Bunker, Jenny, Holmes, Katie, Dipper, A, Morley, Anna, Arnold, David, Adamali, H, Welch, H, Morrison, Leigh, Stadon, Louise, Maskell, Nick, Barratt, Shaney, Dunn, Sarah, Waterson, Samuel, Jayaraman, Bhagy, Light, Tessa, Selby, N, Hosseini, A, Shaw, Karen, Almeida, Paula, Needham, Robert, Thomas, Andrew K, Matthews, Laura, Gupta, Ayushman, Nikolaidis, Athanasios, Dupont, Catherine, Bonnington, J, Chrystal, Melanie, Greenhaff, P L, Linford, S, Prosper, Sabrina, Jang, W, Alamoudi, Asma, Bloss, Angela, Megson, Clare, Nicoll, Debby, Fraser, Emily, Pacpaco, Edmund, Conneh, Florence, Ogg, G, McShane, H, Koychev, Ivan, Chen, Jin, Pimm, John, Ainsworth, Mark, Pavlides, M, Sharpe, M, Havinden-Williams, May, Petousi, Nayia, Talbot, Nick, Carter, Penny, Kurupati, Prathiba, Dong, T, Peng, Yanchun, Burns, A, Kanellakis, N, Korszun, A, Connolly, B, Busby, J, Peto, T, Patel, B, Nolan, C M, Cristiano, Daniele, Walsh, J A, Liyanage, Kamal, Gummadi, Mahitha, Dormand, N, Polgar, Oliver, George, P, Barker, R E, Patel, Suhani, Price, L, Gibbons, M, Matila, Darwin, Jarvis, Hannah, Lim, Lai, Olaosebikan, Olaoluwa, Ahmad, Shanaz, Brill, Simon, Mandal, S, Laing, C, Michael, Alice, Reddy, A, Johnson, C, Baxendale, H, Parfrey, H, Mackie, J, Newman, J, Pack, Jamie, Parmar, J, Paques, K, Garner, Lucie, Harvey, Alice, Summersgill, C, Holgate, D, Hardy, E, Oxton, J, Pendlebury, Jessica, McMorrow, L, Mairs, N, Majeed, N, Dark, P, Ugwuoke, R, Knight, Sean, Whittaker, S, Strong-Sheldrake, Sophia, Matimba-Mupaya, Wadzanai, Chowienczyk, P, Pattenadk, Dibya, Hurditch, E, Chan, Flora, Carborn, H, Foot, H, Bagshaw, J, Hockridge, J, Sidebottom, J, Lee, Ju Hee, Birchall, K, Turner, Kim, Haslam, L, Holt, L, Milner, L, Begum, M, Marshall, M, Steele, N, Tinker, N, Ravencroft, Phillip, Butcher, Robyn, Misra, S, Walker, S, Coburn, Zach, Fairman, Alexandra, Ford, Amber, Holbourn, Ailsa, Howell, Alice, Lawrie, Allan, Lye, Alison, Mbuyisa, Angeline, Zawia, Amira, Holroyd-Hind, B, Thamu, B, Clark, Cameron, Jarman, Claire, Norman, C, Roddis, C, Foote, David, Lee, Elvina, Ilyas, F, Stephens, G, Newell, Helen, Turton, Helena, Macharia, Irene, Wilson, Imogen, Cole, Joby, McNeill, J, Meiring, J, Rodger, J, Watson, James, Chapman, Kerry, Harrington, Kate, Chetham, Luke, Hesselden, L, Nwafor, Lorenza, Dixon, Myles, Plowright, Megan, Wade, Phillip, Gregory, Rebecca, Lenagh, Rebecca, Stimpson, R, Megson, Sharon, Newman, Tom, Cheng, Yutung, Goodwin, Camelia, Heeley, Cheryl, Sissons, D, Sowter, D, Gregory, Heidi, Wynter, Inez, Hutchinson, John, Kirk, Jill, Bennett, Kaytie, Slack, Katie, Allsop, Lynne, Holloway, Leah, Flynn, Margaret, Gill, Mandy, Greatorex, M, Holmes, Megan, Buckley, Phil, Shelton, Sarah, Turner, Sarah, Sewell, Terri Ann, Whitworth, V, Lovegrove, Wayne, Tomlinson, Johanne, Warburton, Louise, Painter, Sharon, Vickers, Carinna, Redwood, Dawn, Tilley, Jo, Palmer, Sue, Wainwright, Tania, Breen, G, Hotopf, M, Dunleavy, A, Teixeira, J, Ali, Mariam, Mencias, Mark, Msimanga, N, Siddique, Sulman, Samakomva, T, Tavoukjian, Vera, Forton, D, Ahmed, R, Cook, Amanda, Thaivalappil, Favas, Connor, Lynda, Rees, Tabitha, McNarry, M, Williams, N, McCormick, Jacqueline, McIntosh, Jerome, Vere, Joanne, Coulding, Martina, Kilroy, Susan, Turner, Victoria, Butt, Al-Tahoor, Savill, Heather, Fraile, Eva, Ugoji, Jacinta, Landers, G, Lota, Harpreet, Portukhay, Sofiya, Nasseri, Mariam, Daniels, Alison, Hormis, Anil, Ingham, Julie, Zeidan, Lisa, Osborne, Lynn, Chablani, Manish, Banerjee, A, David, A, Pakzad, A, Rangelov, B, Williams, B, Denneny, E, Willoughby, J, Xu, M, Mehta, P, Batterham, R, Bell, R, Aslani, S, Lilaonitkul, W, Checkley, A, Bang, Dongchun, Basire, Donna, Lomas, D, Wall, E, Plant, Hannah, Roy, K, Heightman, M, Lipman, M, Merida Morillas, Marta, Ahwireng, Nyarko, Chambers, R C, Jastrub, Roman, Logan, S, Hillman, T, Botkai, A, Casey, A, Neal, A, Newton-Cox, A, Cooper, B, Atkin, C, McGee, C, Welch, C, Wilson, D, Sapey, E, Qureshi, H, Hazeldine, J, Lord, J M, Nyaboko, J, Short, J, Stockley, J, Dasgin, J, Draxlbauer, K, Isaacs, K, Mcgee, K, Yip, K P, Ratcliffe, L, Bates, M, Ventura, M, Ahmad Haider, N, Gautam, N, Baggott, R, Holden, S, Madathil, S, Walder, S, Yasmin, S, Hiwot, T, Jackson, T, Soulsby, T, Kamwa, V, Peterkin, Z, Suleiman, Z, Chaudhuri, N, Wheeler, H, Djukanovic, R, Samuel, R, Sass, T, Wallis, T, Marshall, B, Childs, C, Marouzet, E, Harvey, M, Fletcher, S, Dickens, C, Beckett, P, Nanda, U, Daynes, E, Charalambou, A, Yousuf, A J, Lea, A, Prickett, A, Gooptu, Bibek, Hargadon, Beverley, Bourne, Charlotte, Christie, C, Edwardson, C, Lee, D, Baldry, E, Stringer, E, Woodhead, F, Mills, G, Arnold, H, Aung, H, Qureshi, I N, Finch, J, Skeemer, J, Hadley, K, Khunti, Kamlesh, Carr, Liesel, Ingram, L, Aljaroof, M, Bakali, M, Bakau, M, Baldwin, M, Bourne, Michelle, Pareek, Manish, Soares, M, Tobin, Martin, Armstrong, Natalie, Brunskill, Nigel, Goodman, N, Cairns, P, Haldar, Pranab, McCourt, P, Dowling, R, Russell, Richard, Diver, Sarah, Edwards, Sarah, Glover, Sarah, Parker, S, Siddiqui, Salman, Ward, T J C, Mcnally, T, Thornton, T, Yates, Tom, Ibrahim, W, Monteiro, Will, Thickett, D, Wilkinson, D, Broome, M, McArdle, P, Upthegrove, R, Wraith, D, Langenberg, C, Summers, C, Bullmore, E, Heeney, J L, Schwaeble, W, Sudlow, C L, Adeloye, D, Newby, D E, Rudan, I, Shankar-Hari, M, Thorpe, M, Pius, R, Walmsley, S, McGovern, A, Ballard, C, Allan, L, Dennis, J, Cavanagh, J, Petrie, J, O'Donnell, K, Spears, M, Sattar, N, MacDonald, S, Guthrie, E, Henderson, M, Guillen Guio, Beatriz, Zhao, Bang, Lawson, C, Overton, Charlotte, Taylor, Chris, Tong, C, Mukaetova-Ladinska, Elizabeta, Turner, E, Pearl, John E, Sargant, J, Wormleighton, J, Bingham, Michelle, Sharma, M, Steiner, Mike, Samani, Nilesh, Novotny, Petr, Free, Rob, Allen, R J, Finney, Selina, Terry, Sarah, Brugha, Terry, Plekhanova, Tatiana, McArdle, A, Vinson, B, Spencer, L G, Reynolds, W, Ashworth, M, Deakin, B, Chinoy, H, Abel, K, Harvie, M, Stanel, S, Rostron, A, Coleman, C, Baguley, D, Hufton, E, Khan, F, Hall, I, Stewart, I, Fabbri, L, Wright, L, Kitterick, P, Morriss, R, Johnson, S, Bates, A, Antoniades, C, Clark, D, Bhui, K, Channon, K M, Motohashi, K, Sigfrid, L, Husain, M, Webster, M, Fu, X, Li, X, Kingham, L, Klenerman, P, Miiler, K, Carson, G, Simons, G, Huneke, N, Calder, P C, Baldwin, D, Bain, S, Lasserson, D, Daines, L, Bright, E, Stern, M, Crisp, P, Dharmagunawardena, R, Reddington, A, Wight, A, Bailey, L, Ashish, A, Robinson, E, Cooper, J, Broadley, A, Turnbull, A, Brookes, C, Sarginson, C, Ionita, D, Redfearn, H, Elliott, K, Barman, L, Griffiths, L, Guy, Z, Gill, Rhyan, Nathu, Rashmita, Harris, Edward, Moss, P, Finnigan, J, Saunders, Kathryn, Saunders, Peter, Kon, S, Kon, Samantha S, O'Brien, Linda, Shah, K, Shah, P, Richardson, Emma, Brown, V, Brown, M, Brown, Jo, Brown, J, Brown, Ammani, Brown, Angela, Brown, M, Choudhury, N, Jones, S, Jones, H, Jones, L, Jones, I, Jones, G, Jones, Heather, Jones, Don, Davies, Ffyon, Davies, Ellie, Davies, Kim, Davies, Gareth, Davies, Gwyneth A, Howard, K, Porter, Julie, Rowland, J, Rowland, A, Scott, Kathryn, Singh, Suver, Singh, Claire, Thomas, S, Thomas, Caradog, Lewis, Victoria, Lewis, J, Lewis, D, Harrison, P, Francis, C, Francis, R, Hughes, Rachel Ann, Hughes, Joan, Hughes, A D, Thompson, T, Kelly, S, Smith, D, Smith, Nikki, Smith, Andrew, Smith, Jacqui, Smith, Laurie, Smith, Susan, Evans, Teriann, Evans, Ranuromanana I, Evans, D, Evans, R, Evans, H, and Evans, J

Abstract

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

Published
2023
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3. Acute cardiovascular complications of immune-mediated systemic inflammatory diseases

Author

Weber, Brittany N, Garshick, Michael, Abbate, Antonio, Youngstein, Taryn, Stewart, Garrick, Bohula, Erin, Plein, Sven, and Mukherjee, Monica

Abstract

Immune-mediated systemic inflammatory conditions (IMIDs) are associated with an increased risk of atherosclerosis and adverse cardiovascular (CV) events secondary to pathogenic inflammation and derangements in the innate and adaptive immune responses inherent to the underlying rheumatic diseases. As the intersection of cardio-rheumatology continues to expand, a multi-disciplinary approach must be considered to optimize clinical outcomes and long-term survival. This review will highlight acute cardiac manifestations of systemic inflammatory diseases and propose a clinically relevant framework for diagnosis, management, and the role of integrated multimodality imaging.Graphical AbstractConceptual model of the role of multi-disciplinary care in patients with IMIDs who require ICU-level care. *If available, consider cardio-rheumatology consultation. **For pulmonary hypertension management, consider pulmonary vascular specialists as available. ^Advanced heart failure involvement for mechanical support and/or heart transplant evaluation.

Published
2023
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4. Consensus on the assessment of systemic sclerosis–associated primary heart involvement: World Scleroderma Foundation/Heart Failure Association guidance on screening, diagnosis, and follow-up assessment

Author

Bruni, Cosimo, Buch, Maya H, Djokovic, Aleksandra, De Luca, Giacomo, Dumitru, Raluca B, Giollo, Alessandro, Galetti, Ilaria, Steelandt, Alexia, Bratis, Konstantinos, Suliman, Yossra Atef, Milinkovic, Ivan, Baritussio, Anna, Hasan, Ghadeer, Xintarakou, Anastasia, Isomura, Yohei, Markousis-Mavrogenis, George, Mavrogeni, Sophie, Gargani, Luna, Caforio, Alida LP, Tschöpe, Carsten, Ristic, Arsen, Plein, Sven, Behr, Elijah, Allanore, Yannick, Kuwana, Masataka, Denton, Christopher P, Furst, Daniel E, Khanna, Dinesh, Krieg, Thomas, Marcolongo, Renzo, Pepe, Alessia, Distler, Oliver, Sfikakis, Petros, Seferovic, Petar, and Matucci-Cerinic, Marco

Abstract

Introduction: Heart involvement is a common problem in systemic sclerosis. Recently, a definition of systemic sclerosis primary heart involvement had been proposed. Our aim was to establish consensus guidance on the screening, diagnosis and follow-up of systemic sclerosis primary heart involvement patients.Methods: A systematic literature review was performed to investigate the tests used to evaluate heart involvement in systemic sclerosis. The extracted data were categorized into relevant domains (conventional radiology, electrocardiography, echocardiography, cardiac magnetic resonance imaging, laboratory, and others) and presented to experts and one patient research partner, who discussed the data and added their opinion. This led to the formulation of overarching principles and guidance statements, then reviewed and voted on for agreement. Consensus was attained when the mean agreement was ⩾7/10 and of ⩾70% of voters.Results: Among 2650 publications, 168 met eligibility criteria; the data extracted were discussed over three meetings. Seven overarching principles and 10 guidance points were created, revised and voted on. The consensus highlighted the importance of patient counseling, differential diagnosis and multidisciplinary team management, as well as defining screening and diagnostic approaches. The initial core evaluation should integrate history, physical examination, rest electrocardiography, trans-thoracic echocardiography and standard serum cardiac biomarkers. Further investigations should be individually tailored and decided through a multidisciplinary management. The overall mean agreement was 9.1/10, with mean 93% of experts voting above 7/10.Conclusion: This consensus-based guidance on screening, diagnosis and follow-up of systemic sclerosis primary heart involvement provides a foundation for standard of care and future feasibility studies that are ongoing to support its application in clinical practice.

Published
2023
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5. Pathophysiology of LV Remodeling Following STEMI: A Longitudinal Diffusion Tensor CMR Study.

Author

Das, Arka, Kelly, Christopher, Teh, Irvin, Stoeck, Christian T., Kozerke, Sebastian, Sharrack, Noor, Swoboda, Peter P., Greenwood, John P., Schneider, Jürgen E., Plein, Sven, and Dall'Armellina, Erica

Abstract

Adverse LV remodeling post–ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis, but the underlying mechanisms are not fully understood. Diffusion tensor (DT)-cardiac magnetic resonance (CMR) allows in vivo characterization of myocardial architecture and provides unique mechanistic insight into pathophysiologic changes following myocardial infarction. This study evaluated the potential associations between DT-CMR performed soon after STEMI and long-term adverse left ventricular (LV) remodeling following STEMI. A total of 100 patients with STEMI underwent CMR at 5 days and 12 months post-reperfusion. The protocol included DT-CMR for assessing fractional anisotropy (FA), secondary eigenvector angle (E2A) and helix angle (HA), cine imaging for assessing LV volumes, and late gadolinium enhancement for calculating infarct and microvascular obstruction size. Adverse remodeling was defined as a 20% increase in LV end-diastolic volume at 12 months. A total of 32 patients experienced adverse remodeling at 12 months. Compared with patients without adverse remodeling, they had lower FA (0.23 ± 0.03 vs 0.27 ± 0.04; P < 0.001), lower E2A (37 ± 6° vs 51 ± 7°; P < 0.001), and, on HA maps, a lower proportion of myocytes with right-handed orientation (RHM) (8% ± 5% vs 17% ± 9%; P < 0.001) in their acutely infarcted myocardium. On multivariable logistic regression analysis, infarct FA (odds ratio [OR]: <0.01; P = 0.014) and E2A (OR: 0.77; P = 0.001) were independent predictors of adverse LV remodeling after adjusting for left ventricular ejection fraction (LVEF) and infarct size. There were no significant changes in infarct FA, E2A, or RHM between the 2 scans. Extensive cardiomyocyte disorganization (evidenced by low FA), acute loss of sheetlet angularity (evidenced by low E2A), and a greater loss of organization among cardiomyocytes with RHM, corresponding to the subendocardium, can be detected within 5 days post-STEMI. These changes persist post-injury, and low FA and E2A are independently associated with long-term adverse remodeling. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2023
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6. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of...

Author

Edvardsen, Thor, Asch, Federico M., Davidson, Brian, Delgado, Victoria, DeMaria, Anthony, Dilsizian, Vasken, Gaemperli, Oliver, Garcia, Mario J., Kamp, Otto, Lee, Daniel C., Neglia, Danilo, Neskovic, Aleksandar N., Pellikka, Patricia A., Plein, Sven, Sechtem, Udo, Shea, Elaine, Sicari, Rosa, Villines, Todd C., Lindner, Jonathan R., and Popescu, Bogdan A.

Published
2022
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8. Competency based curriculum for cardiovascular magnetic resonance: A position statement of the Society for Cardiovascular Magnetic Resonance

Author

Nguyen, Elsie T., Ordovas, Karen, Herbst, Phil, Kozor, Rebecca, Ng, Ming-Yen, Natale, Luigi, Nijveldt, Robin, Salgado, Rodrigo, Sanchez, Felipe, Shah, Dipan, Stojanovska, Jadranka, Valente, Anne Marie, Westwood, Mark, and Plein, Sven

Abstract

This position statement guides cardiovascular magnetic resonance (CMR) imaging program directors and learners on the key competencies required for Level II and III CMR practitioners, whether trainees come from a radiology or cardiology background. This document is built upon existing curricula and was created and vetted by an international panel of cardiologists and radiologists on behalf of the Society for Cardiovascular Magnetic Resonance (SCMR).

Published
2024
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9. Deep learning based automated left ventricle segmentation and flow quantification in 4D flow cardiac MRI

Author

Sun, Xiaowu, Cheng, Li-Hsin, Plein, Sven, Garg, Pankaj, and van der Geest, Rob J.

Abstract

4D flow MRI enables assessment of cardiac function and intra-cardiac blood flow dynamics from a single acquisition. However, due to the poor contrast between the chambers and surrounding tissue, quantitative analysis relies on the segmentation derived from a registered cine MRI acquisition. This requires an additional acquisition and is prone to imperfect spatial and temporal inter-scan alignment. Therefore, in this work we developed and evaluated deep learning-based methods to segment the left ventricle (LV) from 4D flow MRI directly.

Published
2024
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10. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance

Author

Edvardsen, Thor, Asch, Federico M., Davidson, Brian, Delgado, Victoria, DeMaria, Anthony, Dilsizian, Vasken, Gaemperli, Oliver, Garcia, Mario J., Kamp, Otto, Lee, Daniel C., Neglia, Danilo, Neskovic, Aleksandar N., Pellikka, Patricia A., Plein, Sven, Sechtem, Udo, Shea, Elaine, Sicari, Rosa, Villines, Todd C., Lindner, Jonathan R., and Popescu, Bogdan A.

Published
2022
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11. Atrial CARdiac Magnetic resonance imaging in patients with embolic stroke of unknown source without documented Atrial Fibrillation (CARM-AF): Study design and clinical protocol

Author

Kotadia, Irum D., O’Dowling, Robert, Aboagye, Akosua, Sim, Iain, O’Hare, Daniel, Lemus-Solis, José-Alonso, Roney, Caroline H., Dweck, Marc, Chiribiri, Amedeo, Plein, Sven, Sztriha, Laszlo, Scott, Paul, Harrison, James, Ramsay, Deborah, Birns, Jonathan, Somerville, Peter, Bhalla, Ajay, Niederer, Steven, O’Neill, Mark, and Williams, Steven E.

Abstract

Initiation of anticoagulation therapy in ischemic stroke patients is contingent on a clinical diagnosis of atrial fibrillation (AF). Results from previous studies suggest thromboembolic risk may predate clinical manifestations of AF. Early identification of this cohort of patients may allow early initiation of anticoagulation and reduce the risk of secondary stroke.

Published
2022
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12. Primary systemic sclerosis heart involvement: A systematic literature review and preliminary data-driven, consensus-based WSF/HFA definition

Author

Bruni, Cosimo, Buch, Maya H, Furst, Daniel E, De Luca, Giacomo, Djokovic, Aleksandra, Dumitru, Raluca B, Giollo, Alessandro, Polovina, Marija, Steelandt, Alexia, Bratis, Kostantinos, Suliman, Yossra Atef, Milinkovic, Ivan, Baritussio, Anna, Hasan, Ghadeer, Xintarakou, Anastasia, Isomura, Yohei, Markousis-Mavrogenis, George, Tofani, Lorenzo, Mavrogeni, Sophie, Gargani, Luna, Caforio, Alida LP, Tschöpe, Carsten, Ristic, Arsen, Klingel, Karin, Plein, Sven, Behr, Elijah R, Allanore, Yannick, Kuwana, Masataka, Denton, Christopher P, Khanna, Dinesh, Krieg, Thomas, Marcolongo, Renzo, Galetti, Ilaria, Zanatta, Elisabetta, Tona, Francesco, Seferovic, Petar, and Matucci-Cerinic, Marco

Abstract

Introduction: Primary heart involvement in systemic sclerosis may cause morpho-functional and electrical cardiac abnormalities and is a common cause of death. The absence of a clear definition of primary heart involvement in systemic sclerosis limits our understanding and ability to focus on clinical research. We aimed to create an expert consensus definition for primary heart involvement in systemic sclerosis.Methods: A systematic literature review of cardiac involvement and manifestations in systemic sclerosis was conducted to inform an international and multi-disciplinary task force. In addition, the nominal group technique was used to derive a definition that was then subject to voting. A total of 16 clinical cases were evaluated to test face validity, feasibility, reliability and criterion validity of the newly created definition.Results: In total, 171 publications met eligibility criteria. Using the nominal group technique, experts added their opinion, provided statements to consider and ranked them to create the consensus definition, which received 100% agreement on face validity. A median 60(5–300) seconds was taken for the feasibility on a single case. Inter-rater agreement was moderate (mKappa (95% CI) = 0.56 (0.46–1.00) for the first round and 0.55 (0.44–1.00) for the second round) and intra-rater agreement was good (mKappa (95% CI) = 0.77 (0.47–1.00)). Criterion validity showed a 78 (73–84)% correctness versus gold standard.Conclusion: A preliminary primary heart involvement in systemic sclerosis consensus-based definition was created and partially validated, for use in future clinical research.

Published
2022
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13. Assessment of Multivessel Coronary Artery Disease Using Cardiovascular Magnetic Resonance Pixelwise Quantitative Perfusion Mapping.

Author

Kotecha, Tushar, Chacko, Liza, Chehab, Omar, O'Reilly, Nanci, Martinez-Naharro, Ana, Lazari, Jonathan, Knott, Kristopher D., Brown, James, Knight, Daniel, Muthurangu, Vivek, Hawkins, Philip, Plein, Sven, Moon, James C., Xue, Hui, Kellman, Peter, Rakhit, Roby, Patel, Niket, and Fontana, Marianna

Abstract

The authors sought to compare the diagnostic accuracy of quantitative perfusion maps to visual assessment (VA) of first-pass perfusion images for the detection of multivessel coronary artery disease (MVCAD). VA of first-pass stress perfusion cardiac magnetic resonance (CMR) may underestimate ischemia in MVCAD. Pixelwise perfusion mapping allows quantitative measurement of regional myocardial blood flow, which may improve ischemia detection in MVCAD. One hundred fifty-one subjects recruited at 2 centers underwent stress perfusion CMR with myocardial perfusion mapping, and invasive coronary angiography with coronary physiology assessment. Ischemic burden was assessed by VA of first-pass images and by quantitative measurement of stress myocardial blood flow using perfusion maps. In patients with MVCAD (2-vessel [2VD] or 3-vessel disease [3VD]; n = 95), perfusion mapping identified significantly more segments with perfusion defects (median segments per patient 12 [interquartile range (IQR): 9 to 16] by mapping vs. 8 [IQR: 5 to 9.5] by VA; p < 0.001). Ischemic burden (IB) measured using mapping was higher in MVCAD compared with IB measured using VA (3VD mapping 100 % (75% to 100%) vs. first-pass 56% (38% to 81%) ; 2VD mapping 63% (50% to 75%) vs. first-pass 41% (31% to 50%); both p < 0.001), but there was no difference in single-vessel disease (mapping 25% (13% to 44%) vs. 25% (13% to 31%). Perfusion mapping was superior to VA for the correct identification of extent of coronary disease (78% vs. 58%; p < 0.001) due to better identification of 3VD (87% vs. 40%) and 2VD (71% vs. 48%). VA of first-pass stress perfusion underestimates ischemic burden in MVCAD. Pixelwise quantitative perfusion mapping increases the accuracy of CMR in correctly identifying extent of coronary disease. This has important implications for assessment of ischemia and therapeutic decision-making. [ABSTRACT FROM AUTHOR]

Published
2020
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17. Normal Values of High-resolution Transmural Perfusion Distribution Metrics for Automated Quantitative Pixel-wise Myocardial Perfusion Cardiovascular Magnetic Resonance

Author

Kamani, Christel Hermann, Brown, Louise, Botis, Ioannis, Gulsin, Gaurav, Onciul, Sebastian, Broadbent, David, Wood, Alice, Saunderson, Christopher, Das, Arka, Jex, Nicholas, Chowdhary, Amrit, Thirunavukarasu, Sharmaine, Sharrack, Noor, Knott, Kristopher, Levelt, Eylem, Swoboda, Peter, Xue, Hui, Greenwood, John P, Moon, James, McCann, Gerry, Kellman, Peter, and Plein, Sven

Published
2024
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26. Improving Sex-based Differences in ECG Diagnostic Performance for CMR Abnormalities Post Severe COVID-19 Infections

Author

Samat, Azlan Helmy Abd, Mahmod, Masliza, Lewandowski, Adam, McCracken, Celeste, Cassar, Mark P, Akhtar, Abid M, Ashkir, Zakariye, Moss, Alastair J, Manisty, Charlotte, Treibel, Thomas A, Lukaschuk, Elena, Piechnik, Stefan, Ferreira, Vanessa, Nikolaidou, Chrysovalantou, Miller, Christopher, Chiribiri, Amedeo, O'Regan, Declan, Steeds, Richard P, Weir-McCall, Jonathan R, Plein, Sven, McCann, Gerry, Evans, Rachael A, Brightling, Christopher E., Neubauer, Stefan, and Raman, Betty

Published
2024
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27. Role of epicardial adipose tissue in diabetic cardiomyopathy through the lens of cardiovascular magnetic resonance imaging – a narrative review

Author

Kotha, Sindhoora, Plein, Sven, Greenwood, John P., and Levelt, Eylem

Abstract

Accumulating evidence suggests that ectopic/visceral adiposity may play a key role in the pathogenesis of nonischaemic cardiovascular diseases associated with type 2 diabetes. Epicardial adipose tissue (EAT) is a complex visceral fat depot, covering 80% of the cardiac surface with anatomical and functional contiguity to the myocardium and coronary arteries. EAT interacts with the biology of the underlying myocardium by secreting a wide range of adipokines. Magnetic resonance imaging (MRI) is the reference modality for structural and functional imaging of the heart. The technique is now also emerging as the reference imaging modality for EAT quantification. With this narrative review, we (a) surveyed contemporary clinical studies that utilized cardiovascular MRI to characterize EAT (studies published 2010–2023); (b) listed the clinical trials monitoring the response to treatment in EAT size as well as myocardial functional and structural parameters and (c) discussed the potential pathophysiological role of EAT in the development of diabetic cardiomyopathy. We concluded that increased EAT quantity and its inflammatory phenotype correlate with early signs of left ventricle dysfunction and may have a role in the pathogenesis of cardiac disease in diabetes with and without coronary artery disease.

Published
2024
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28. Acute Microstructural Changes after ST-Segment Elevation Myocardial Infarction Assessed with Diffusion Tensor Imaging

Author

Das, Arka, Kelly, Christopher, Teh, Irvin, Stoeck, Christian T., Kozerke, Sebastian, Chowdhary, Amrit, Brown, Louise A. E., Saunderson, Christopher E. D., Craven, Thomas P., Chew, Pei G., Jex, Nicholas, Swoboda, Peter P., Levelt, Eylem, Greenwood, John P., Schneider, Jurgen E., Plein, Sven, and Dall’Armellina, Erica

Abstract

Cardiac diffusion tensor imaging can be used to detect early and irreversible myocardial microstructural remodeling that may improve the prediction of left ventricular functional recovery at 3 months.

Published
2021
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30. Cost-effectiveness of cardiovascular imaging for stable coronary heart disease

Author

Walker, Simon, Cox, Edward, Rothwell, Ben, Berry, Colin, McCann, Gerry P, Bucciarelli-Ducci, Chiara, Dall’Armellina, Erica, Prasad, Abhiram, Foley, James Robert John, Mangion, Kenneth, Bijsterveld, Petra, Everett, Colin, Stocken, Deborah, Plein, Sven, Greenwood, John P, and Sculpher, Mark

Abstract

ObjectiveTo assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): (1) cardiovascular magnetic resonance (CMR); (2) myocardial perfusion scintigraphy (MPS); and (3) UK National Institute for Health and Care Excellence (NICE) guideline-guided care.MethodsUsing UK data for 1202 patients from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial, we conducted an economic evaluation to assess the cost-effectiveness of CMR, MPS and NICE guidelines. Health outcomes were expressed as quality-adjusted life-years (QALYs), and costs reflected UK pound sterling in 2016–2017. Cost-effectiveness results were presented as incremental cost-effectiveness ratios and incremental net health benefits overall and for low, medium and high pretest likelihood of CHD subgroups.ResultsCMR had the highest estimated QALY gain overall (2.21 (95% credible interval 2.15, 2.26) compared with 2.07 (1.92, 2.20) for NICE and 2.11 (2.01, 2.22) for MPS) and incurred comparable costs (overall £1625 (£1431, £1824) compared with £1753 (£1473, £2032) for NICE and £1768 (£1572, £1989) for MPS). Overall, CMR was the cost-effective strategy, being the dominant strategy (more effective, less costly) with incremental net health benefits per patient of 0.146 QALYs (−0.18, 0.406) compared with NICE guidelines at a cost-effectiveness threshold of £15 000 per QALY (93% probability of cost-effectiveness). Results were similar in the pretest likelihood subgroups.ConclusionsCMR-guided care is cost-effective overall and across all pretest likelihood subgroups, compared with MPS and NICE guidelines.

Published
2021
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31. Cardiovascular magnetic resonance imaging: emerging techniques and applications

Author

Chowdhary, Amrit, Garg, Pankaj, Das, Arka, Nazir, Muhummad Sohaib, and Plein, Sven

Abstract

This review gives examples of emerging cardiovascular magnetic resonance (CMR) techniques and applications that have the potential to transition from research to clinical application in the near future. Four-dimensional flow CMR (4D-flow CMR) allows time-resolved three-directional, three-dimensional (3D) velocity-encoded phase-contrast imaging for 3D visualisation and quantification of valvular or intracavity flow. Acquisition times of under 10 min are achievable for a whole heart multidirectional data set and commercial software packages are now available for data analysis, making 4D-flow CMR feasible for inclusion in clinical imaging protocols. Diffusion tensor imaging (DTI) is based on the measurement of molecular water diffusion and uses contrasting behaviour in the presence and absence of boundaries to infer tissue structure. Cardiac DTI is capable of non-invasively phenotyping the 3D micro-architecture within a few minutes, facilitating transition of the method to clinical protocols. Hybrid positron emission tomography-magnetic resonance (PET-MR) provides quantitative PET measures of biological and pathological processes of the heart combined with anatomical, morphological and functional CMR imaging. Cardiac PET-MR offers opportunities in ischaemic, inflammatory and infiltrative heart disease.

Published
2021
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32. The Prognostic Significance of Quantitative Myocardial Perfusion

Author

Knott, Kristopher D., Seraphim, Andreas, Augusto, Joao B., Xue, Hui, Chacko, Liza, Aung, Nay, Petersen, Steffen E., Cooper, Jackie A., Manisty, Charlotte, Bhuva, Anish N., Kotecha, Tushar, Bourantas, Christos V., Davies, Rhodri H., Brown, Louise A.E., Plein, Sven, Fontana, Marianna, Kellman, Peter, and Moon, James C.

Abstract

Supplemental Digital Content is available in the text.

Published
2020
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33. Automated Pixel-Wise Quantitative Myocardial Perfusion Mapping by CMR to Detect Obstructive Coronary Artery Disease and Coronary Microvascular Dysfunction: Validation Against Invasive Coronary Physiology.

Author

Kotecha, Tushar, Martinez-Naharro, Ana, Boldrini, Michele, Knight, Daniel, Hawkins, Philip, Kalra, Sundeep, Patel, Deven, Coghlan, Gerry, Moon, James, Plein, Sven, Lockie, Tim, Rakhit, Roby, Patel, Niket, Xue, Hui, Kellman, Peter, and Fontana, Marianna

Abstract

This study sought to assess the performance of cardiovascular magnetic resonance (CMR) myocardial perfusion mapping against invasive coronary physiology reference standards for detecting coronary artery disease (CAD, defined by fractional flow reserve [FFR] ≤0.80), microvascular dysfunction (MVD) (defined by index of microcirculatory resistance [IMR] ≥25) and the ability to differentiate between the two. Differentiation of epicardial (CAD) and MVD in patients with stable angina remains challenging. Automated in-line CMR perfusion mapping enables quantification of myocardial blood flow (MBF) to be performed rapidly within a clinical workflow. Fifty patients with stable angina and 15 healthy volunteers underwent adenosine stress CMR at 1.5T with quantification of MBF and myocardial perfusion reserve (MPR). FFR and IMR were measured in 101 coronary arteries during subsequent angiography. Twenty-seven patients had obstructive CAD and 23 had nonobstructed arteries (7 normal IMR, 16 abnormal IMR). FFR positive (epicardial stenosis) areas had significantly lower stress MBF (1.47 ± 0.48 ml/g/min) and MPR (1.75 ± 0.60) than FFR-negative IMR-positive (MVD) areas (stress MBF: 2.10 ± 0.35 ml/g/min; MPR: 2.41 ± 0.79) and normal areas (stress MBF: 2.47 ± 0.50 ml/g/min; MPR: 2.94 ± 0.81). Stress MBF ≤1.94 ml/g/min accurately detected obstructive CAD on a regional basis (area under the curve: 0.90; p < 0.001). In patients without regional perfusion defects, global stress MBF <1.82 ml/g/min accurately discriminated between obstructive 3-vessel disease and MVD (area under the curve: 0.94; p < 0.001). This novel automated pixel-wise perfusion mapping technique can be used to detect physiologically significant CAD defined by FFR, MVD defined by IMR, and to differentiate MVD from multivessel coronary disease. A CMR-based diagnostic algorithm using perfusion mapping for detection of epicardial disease and MVD warrants further clinical validation. [ABSTRACT FROM AUTHOR]

Published
2019
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35. Occult coronary microvascular dysfunction and ischaemic heart disease in patients with diabetes and heart failure

Author

Sharrack, Noor, Brown, Louise AE, Farley, Jonathan, Wahab, Ali, Jex, Nicholas, Thirunavukarasu, Sharmaine, Chowdhary, Amrit, Gorecka, Miroslawa, Javed, Wasim, Xue, Hui, Levelt, Eylem, Dall’Armellina, Erica, Kellman, Peter, Garg, Pankaj, Greenwood, John P, Plein, Sven, and Swoboda, Peter P

Abstract

Patients with diabetes (DM) and heart failure (HF) have worse outcomes than normoglycaemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischaemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify extent of silent IHD and CMD in patients with DM presenting with HF.

Published
2024
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40. Deep Learning–based Method for Fully Automatic Quantification of Left Ventricle Function from Cine MR Images: A Multivendor, Multicenter Study

Author

Tao, Qian, Yan, Wenjun, Wang, Yuanyuan, Paiman, Elisabeth H. M., Shamonin, Denis P., Garg, Pankaj, Plein, Sven, Huang, Lu, Xia, Liming, Sramko, Marek, Tintera, Jarsolav, de Roos, Albert, Lamb, Hildo J., and van der Geest, Rob J.

Abstract

A deep learning–based algorithm can achieve fully automated, accurate left ventricle segmentation from short-axis cine MR images when tested against a multivendor, multicenter data set.

Published
2019
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41. Carotid artery volumetric measures associate with clinical ten-year cardiovascular (CV) risk scores and individual traditional CV risk factors in rheumatoid arthritis; a carotid-MRI feasibility study

Author

Bissell, Lesley-Anne, Erhayiem, Bara, Fent, Graham, Hensor, Elizabeth, Burska, Agata, Donica, Helena, Plein, Sven, Buch, Maya, Greenwood, John, and Andrews, Jacqueline

Abstract

Common carotid artery intima-media thickness (CIMT), as measured by ultrasound, has utility in stratification of the accelerated cardiovascular risk seen in rheumatoid arthritis (RA); however, the technique has limitations. Carotid magnetic resonance imaging (MRI) is emerging as a useful research tool in the general population, but has yet to be applied in RA populations. Our objectives were to describe the utility of carotid artery MRI (carotid-MRI) in patients with RA in comparison to healthy controls and to describe the association with RA disease phenotype. Sixty-four patients with RA and no history of cardiovascular (CV) disease/diabetes mellitus were assessed for RA and CV profile, including homeostasis model assessment-estimated insulin resistance (HOMA-IR) and N-terminal pro-brain natriuretic peptide (NT-proBNP). All underwent carotid-MRI (3 T), and were compared to 24 healthy controls. Univariable analysis (UVA) and multivariable linear regression models (MVA) were used to determine associations between disease phenotype and carotid-MRI measures. There were no significant differences in carotid arterial wall measurements between patients with RA and controls. Wall and luminal volume correlated with 10-year CV risk scores (adjusted as per 2017 European League Against Rheumatism (EULAR) guidance); rho = 0.33 (p= 0.012) and rho = 0.35 (p= 0.008), respectively, for Joint British Societies-2 risk score. In UVA, carotid-MRI volumetric measures predominantly were associated with traditional CV risk factors including age, ever-smoking and HOMA-IR (p< 0.05). Lower body mass index was associated with wall maximum thickness (r= − 0.25 p= 0.026). In MVA, age was independently associated with wall volume (B 1.13 (95% CI 0.32, 1.93), p= 0.007) and luminal volume (B 3.69 (95% CI 0.55, 6.83, p= 0.022), and RA disease duration was associated with luminal volume (B 3.88 (95% CI 0.80, 6.97), p= 0.015). This study demonstrates the utility of carotid-MRI in RA, reporting an association between three-dimensional measures in particular and CV risk scores, individual traditional CV risk factors and RA disease duration. Carotid-MRI in RA is a promising research tool in the investigation of CVD.

Published
2018
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42. Myocardial Extracellular Volume Estimation by CMR Predicts Functional Recovery Following Acute MI.

Author

Kidambi, Ananth, Motwani, Manish, Uddin, Akhlaque, Ripley, David P., McDiarmid, Adam K., Swoboda, Peter P., Broadbent, David A., Musa, Tarique Al, Erhayiem, Bara, Leader, Joshua, Croisille, Pierre, Clarysse, Patrick, Greenwood, John P., and Plein, Sven

Abstract

Objectives In the setting of reperfused acute myocardial infarction (AMI), the authors sought to compare prediction of contractile recovery by infarct extracellular volume (ECV), as measured by T1-mapping cardiac magnetic resonance (CMR), with late gadolinium enhancement (LGE) transmural extent. Background The transmural extent of myocardial infarction as assessed by LGE CMR is a strong predictor of functional recovery, but accuracy of the technique may be reduced in AMI. ECV mapping by CMR can provide a continuous measure associated with the severity of tissue damage within infarcted myocardium. Methods Thirty-nine patients underwent acute (day 2) and convalescent (3 months) CMR scans following AMI. Cine imaging, tissue tagging, T2-weighted imaging, modified Look-Locker inversion T1 mapping natively and 15 min post–gadolinium-contrast administration, and LGE imaging were performed. The ability of acute infarct ECV and acute transmural extent of LGE to predict convalescent wall motion, ejection fraction (EF), and strain were compared per-segment and per-patient. Results Per-segment, acute ECV and LGE transmural extent were associated with convalescent wall motion score (p < 0.01; p < 0.01, respectively). ECV had higher accuracy than LGE extent to predict improved wall motion (area under receiver-operating characteristics curve 0.77 vs. 0.66; p = 0.02). Infarct ECV ≤0.5 had sensitivity 81% and specificity 65% for prediction of improvement in segmental function; LGE transmural extent ≤0.5 had sensitivity 61% and specificity 71%. Per-patient, ECV and LGE correlated with convalescent wall motion score (r = 0.45; p < 0.01; r = 0.41; p = 0.02, respectively) and convalescent EF (p < 0.01; p = 0.04). ECV and LGE extent were not significantly correlated (r = 0.34; p = 0.07). In multivariable linear regression analysis, acute infarct ECV was independently associated with convalescent infarct strain and EF (p = 0.03; p = 0.04), whereas LGE was not (p = 0.29; p = 0.24). Conclusions Acute infarct ECV in reperfused AMI can complement LGE assessment as an additional predictor of regional and global LV functional recovery that is independent of transmural extent of infarction. [ABSTRACT FROM AUTHOR]

Published
2017
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43. Acute Infarct Extracellular Volume Mapping to Quantify Myocardial Area at Risk and Chronic Infarct Size on Cardiovascular Magnetic Resonance Imaging.

Author

Garg, Pankaj, Broadbent, David A., Swoboda, Peter P., Foley, James R. J., Fent, Graham J., Musa, Tarique A., Ripley, David P., Erhayiem, Bara, Dobson, Laura E., McDiarmid, Adam K., Haaf, Philip, Kidambi, Ananth, van der Geest, Rob J., Greenwood, John P., and Plein, Sven

Abstract

Background—Late gadolinium enhancement (LGE) imaging overestimates acute infarct size. The main aim of this study was to investigate whether acute extracellular volume (ECV) maps can reliably quantify myocardial area at risk (AAR) and final infarct size (IS). Methods and Results—Fifty patients underwent cardiovascular magnetic resonance imaging acutely (24–72 hours) and at convalescence (3 months). The cardiovascular magnetic resonance protocol included cines, T2-weighted imaging, native T1 maps, 15-minute post-contrast T1 maps, and LGE. Optimal AAR and IS ECV thresholds were derived in a validation group of 10 cases (160 segments). Eight hundred segments (16 per patient) were analyzed to quantify AAR/IS by ECV maps (ECV thresholds for AAR is 33% and IS is 46%), T2-weighted imaging, T1 maps, and acute LGE. Follow-up LGE imaging was used as the reference standard for final IS and viability assessment. The AAR derived from ECV maps (threshold of >33) demonstrated good agreement with T2-weighted imaging–derived AAR (bias, 0.18; 95% confidence interval [CI], −1.6 to 1.3) and AAR derived from native T1 maps (bias=1; 95% CI, −0.37 to 2.4). ECV demonstrated the best linear correlation to final IS at a threshold of >46% (R=0.96; 95% CI, 0.92–0.98; P<0.0001). ECV maps demonstrated better agreement with final IS than acute IS on LGE (ECV maps: bias, 1.9; 95% CI, 0.4–3.4 versus LGE imaging: bias, 10; 95% CI, 7.7–12.4). On multiple variable regression analysis, the number of nonviable segments was independently associated with IS by ECV maps (β=0.86; P<0.0001). Conclusions—ECV maps can reliably quantify AAR and final IS in reperfused acute myocardial infarction. Acute ECV maps were superior to acute LGE in terms of agreement with final IS. IS quantified by ECV maps are independently associated with viability at follow-up. [ABSTRACT FROM AUTHOR]

Published
2017
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45. Patient-specific coronary blood supply territories for quantitative perfusion analysis

Author

Zakkaroff, Constantine, Biglands, John D., Greenwood, John P., Plein, Sven, Boyle, Roger D., Radjenovic, Aleksandra, and Magee, Derek R.

Abstract

AbstractMyocardial perfusion imaging, coupled with quantitative perfusion analysis, provides an important diagnostic tool for the identification of ischaemic heart disease caused by coronary stenoses. The accurate mapping between coronary anatomy and under-perfused areas of the myocardium is important for diagnosis and treatment. However, in the absence of the actual coronary anatomy during the reporting of perfusion images, areas of ischaemia are allocated to a coronary territory based on a population-derived 17-segment (American Heart Association) AHA model of coronary blood supply. This work presents a solution for the fusion of 2D Magnetic Resonance (MR) myocardial perfusion images and 3D MR angiography data with the aim to improve the detection of ischaemic heart disease. The key contribution of this work is a novel method for the mediated spatiotemporal registration of perfusion and angiography data and a novel method for the calculation of patient-specific coronary supply territories. The registration method uses 4D cardiac MR cine series spanning the complete cardiac cycle in order to overcome the under-constrained nature of non-rigid slice-to-volume perfusion-to-angiography registration. This is achieved by separating out the deformable registration problem and solving it through phase-to-phase registration of the cine series. The use of patient-specific blood supply territories in quantitative perfusion analysis (instead of the population-based model of coronary blood supply) has the potential of increasing the accuracy of perfusion analysis. Quantitative perfusion analysis diagnostic accuracy evaluation with patient-specific territories against the AHA model demonstrates the value of the mediated spatiotemporal registration in the context of ischaemic heart disease diagnosis.

Published
2018
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46. Role of cardiovascular magnetic resonance in the management of patients with stable coronary artery disease

Author

Motwani, Manish, Swoboda, Peter P, Plein, Sven, and Greenwood, John P

Abstract

Cardiovascular magnetic resonance (CMR) assesses cardiac function, ischaemia, viability and tissue characterisation, all within a single scan. Many studies regarding the role of CMR in stable coronary artery disease (CAD) have been published over the last decade providing important technical advances, large-scale clinical validation and prognostic data. As a result, CMR has emerged as a highly accurate technique for diagnosis and risk stratification in stable CAD and has been incorporated into national and international guidelines. Furthermore, clinical pathways utilising CMR have been shown to be the most cost-effective in several healthcare systems. In this review, we summarise the key roles and guideline recommendations for CMR in stable CAD supported by contemporary clinical evidence.

Published
2018
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47. Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling after aortic valve replacement: A cardiovascular magnetic resonance study.

Author

Dobson, Laura E., Fairbairn, Timothy A., Musa, Tarique A., Uddin, Akhlaque, Mundie, Cheryl A., Swoboda, Peter P., Ripley, David P., McDiarmid, Adam K., Erhayiem, Bara, Garg, Pankaj, Malkin, Christopher J., Blackman, Daniel J., Sharples, Linda D., Plein, Sven, and Greenwood, John P.

Abstract

Background: Cardiac adaptation to aortic stenosis (AS) appears to differ according to sex, but reverse remodeling after aortic valve replacement has not been extensively described. The aim of the study was to determine using cardiac magnetic resonance imaging whether any sex-related differences exist in AS in terms of left ventricular (LV) remodeling, myocardial fibrosis, and reverse remodeling after valve replacement.Methods: One hundred patients (men, n = 60) with severe AS undergoing either transcatheter or surgical aortic valve replacement underwent cardiac magnetic resonance scans at baseline and 6 months after valve replacement.Results: Despite similar baseline comorbidity and severity of AS, women had a lower indexed LV mass than did men (65.3 ± 18.4 vs 81.5 ± 21.3 g/m(2), P < .001) and a smaller indexed LV end-diastolic volume (87.3 ± 17.5 vs 101.2 ± 28.6 mL/m(2), P = .002) with a similar LV ejection fraction (58.6% ± 10.2% vs 54.8% ± 12.9%, P = .178). Total myocardial fibrosis mass was similar between sexes (2.3 ± 4.1 vs 1.3 ± 1.1 g, P = .714), albeit with a differing distribution according to sex. After aortic valve replacement, men had more absolute LV mass regression than did women (18.3 ± 10.6 vs 12.7 ± 8.8 g/m(2), P = .007). When expressed as a percentage reduction of baseline indexed LV mass, mass regression was similar between the sexes (men 21.7% ± 10.1% vs women 18.4% ± 11.0%, P = .121). There was no sex-related difference in postprocedural LV ejection fraction or aortic regurgitation. Sex was not found to be a predictor of LV reverse remodeling on multiple regression analysis.Conclusions: There are significant differences in the way that male and female hearts adapt to AS. Six months after aortic valve replacement, there are no sex-related differences in reverse remodeling, but superior reverse remodeling in men as a result of their more adverse remodeling profile at baseline. [ABSTRACT FROM AUTHOR]

Published
2016
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48. Athletic Cardiac Adaptation in Males Is a Consequence of Elevated Myocyte Mass.

Author

McDiarmid, Adam K., Swoboda, Peter P., Erhayiem, Bara, Lancaster, Rosalind E., Lyall, Gemma K., Broadbent, David A., Dobson, Laura E., Musa, Tarique A., Ripley, David P., Garg, Pankaj, Greenwood, John P., Ferguson, Carrie, and Plein, Sven

Abstract

Background--Cardiac remodeling occurs in response to regular athletic training, and the degree of remodeling is associated with fitness. Understanding the myocardial structural changes in athlete's heart is important to develop tools that differentiate athletic from cardiomyopathic change. We hypothesized that athletic left ventricular hypertrophy is a consequence of increased myocardial cellular rather than extracellular mass as measured by cardiovascular magnetic resonance. Methods and Results--Forty-five males (30 athletes and 15 sedentary age-matched healthy controls) underwent comprehensive cardiovascular magnetic resonance studies, including native and postcontrast T1 mapping for extracellular volume calculation. In addition, the 30 athletes performed a maximal exercise test to assess aerobic capacity and anaerobic threshold. Participants were grouped by athleticism: untrained, low performance, and high performance (VO2max <60 or>60 mL/kg per min, respectively). In athletes, indexed cellular mass was greater in high- than low-performance athletes 60.7±7.5 versus 48.6±6.3 g/m²; P<0.001), whereas extracellular mass was constant (16.3±2.2 versus 15.3±2.2 g/m²; P=0.20). Indexed left ventricular end-diastolic volume and mass correlated with VO2max (r=0.45, P=0.01; r=0.55, P=0.002) and differed significantly by group (P=0.01; P<0.001, respectively). Extracellular volume had an inverse correlation with VO2max (r=-0.53, P=0.003 and left ventricular mass index (r=-0.44, P=0.02). Conclusions--Increasing left ventricular mass in athlete's heart occurs because of an expansion of the cellular compartment while the extracellular volume becomes relatively smaller: a difference which becomes more marked as left ventricular mass increases. Athletic remodeling, both on a macroscopic and cellular level, is associated with the degree of an individual's fitness. Cardiovascular magnetic resonance ECV quantification may have a future role in differentiating athlete's heart from change secondary to cardiomyopathy. [ABSTRACT FROM AUTHOR]

Published
2016
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49. Physiology of Angina and Its Alleviation With Nitroglycerin

Author

Asrress, Kaleab N., Williams, Rupert, Lockie, Timothy, Khawaja, Muhammed Z., De Silva, Kalpa, Lumley, Matthew, Patterson, Tiffany, Arri, Satpal, Ihsan, Sana, Ellis, Howard, Guilcher, Antoine, Clapp, Brian, Chowienczyk, Philip J., Plein, Sven, Perera, Divaka, Marber, Michael S., and Redwood, Simon R.

Abstract

Supplemental Digital Content is available in the text.

Published
2017
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50. Acute Reverse Remodelling After Transcatheter Aortic Valve Implantation: A Link Between Myocardial Fibrosis and Left Ventricular Mass Regression

Author

Dobson, Laura Elizabeth, Musa, Tarique A., Uddin, Akhlaque, Fairbairn, Timothy A., Swoboda, Peter P., Erhayiem, Bara, Foley, James, Garg, Pankaj, Haaf, Philip, Fent, Graham J., Malkin, Christopher J., Blackman, Daniel J., Plein, Sven, and Greenwood, John P.

Abstract

Despite the wealth of data showing the positive effects on cardiac reverse remodelling in the long-term, the immediate effects of transcatheter aortic valve implantation (TAVI) on the left ventricle are yet to be comprehensively described using cardiovascular magnetic resonance imaging. Also, the link between myocardial fibrosis and acute left ventricular (LV) mass regression is unknown.

Published
2016
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