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1. Cardiovascular Remodeling Experienced by Real-World, Unsupervised, Young Novice Marathon Runners

Author

Andrew D’Silva, Anish N. Bhuva, Jet van Zalen, Rachel Bastiaenen, Amna Abdel-Gadir, Siana Jones, Niromila Nadarajan, Katia D. Menacho Medina, Yang Ye, Joao Augusto, Thomas A. Treibel, Stefania Rosmini, Manish Ramlall, Paul R. Scully, Camilla Torlasco, James Willis, Gherardo Finocchiaro, Efstathios Papatheodorou, Harshil Dhutia, Della Cole, Irina Chis Ster, Alun D. Hughes, Rajan Sharma, Charlotte Manisty, Guy Lloyd, James C. Moon, and Sanjay Sharma

Subjects
cardiovascular remodeling, athlete’s heart, sports cardiology, endurance exercise, cardiorespiratory fitness, marathon, Physiology, QP1-981
Abstract

AimsMarathon running is a popular ambition in modern societies inclusive of non-athletes. Previous studies have highlighted concerning transient myocardial dysfunction and biomarker release immediately after the race. Whether this method of increasing physical activity is beneficial or harmful remains a matter of debate. We examine in detail the real-world cardiovascular remodeling response following competition in a first marathon.MethodsSixty-eight novice marathon runners (36 men and 32 women) aged 30 ± 3 years were investigated 6 months before and 2 weeks after the 2016 London Marathon race in a prospective observational study. Evaluation included electrocardiography, cardiopulmonary exercise testing, echocardiography, and cardiovascular magnetic resonance imaging.ResultsAfter 17 weeks unsupervised marathon training, runners revealed a symmetrical, eccentric remodeling response with 3–5% increases in left and right ventricular cavity sizes, respectively. Blood pressure (BP) fell by 4/2 mmHg (P < 0.01) with reduction in arterial stiffness, despite only 11% demonstrating a clinically meaningful improvement in peak oxygen consumption with an overall non-significant 0.4 ml/min/kg increase in peak oxygen consumption (P = 0.14).ConclusionIn the absence of supervised training, exercise-induced cardiovascular remodeling in real-world novice marathon runners is more modest than previously described and occurs even without improvement in cardiorespiratory fitness. The responses are similar in men and women, who experience a beneficial BP reduction and no evidence of myocardial fibrosis or persistent edema, when achieving average finishing times.

Published
2020
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2. Full left ventricular coverage is essential for the accurate quantification of the area-at-risk by T1 and T2 mapping

Author

Heerajnarain Bulluck, Jennifer A. Bryant, Mei Xing Lim, Xiao Wei Tan, Manish Ramlall, Rohin Francis, Tushar Kotecha, Hector A. Cabrera-Fuentes, Daniel S. Knight, Marianna Fontana, James C. Moon, and Derek J. Hausenloy

Subjects
Medicine, Science
Abstract

Abstract T2-weighted cardiovascular magnetic resonance (CMR) using a 3-slice approach has been shown to accurately quantify the edema-based area-at-risk (AAR) in ST-segment elevation myocardial infarction (STEMI). We aimed to compare the performance of a 3-slice approach to full left ventricular (LV) coverage for the AAR by T1 and T2 mapping and MI size. Forty-eight STEMI patients were prospectively recruited and underwent a CMR at 4 ± 2 days. There was no difference between the AARfull LV and AAR3-slices by T1 (P = 0.054) and T2-mapping (P = 0.092), with good correlations but small biases and wide limits of agreements (T1-mapping: N = 30, R2 = 0.85, bias = 1.7 ± 9.4% LV; T2-mapping: N = 48, R2 = 0.75, bias = 1.7 ± 12.9% LV). There was also no significant difference between MI size3-slices and MI sizefull LV (P = 0.93) with an excellent correlation between the two (R2 0.92) but a small bias of 0.5% and a wide limit of agreement of ±7.7%. Although MSI was similar between the 2 approaches, MSI3-slices performed poorly when MSI was

Published
2017
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3. Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Author

Heerajnarain Bulluck, Stefania Rosmini, Amna Abdel‐Gadir, Steven K. White, Anish N. Bhuva, Thomas A. Treibel, Marianna Fontana, Esther Gonzalez‐Lopez, Patricia Reant, Manish Ramlall, Ashraf Hamarneh, Alex Sirker, Anna S. Herrey, Charlotte Manisty, Derek M. Yellon, Peter Kellman, James C. Moon, and Derek J. Hausenloy

Subjects
extracellular volume fraction, left ventricular remodeling, ST‐segment elevation myocardial infarction, T1 mapping, T2 mapping, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundWhether the remote myocardium of reperfused ST‐segment elevation myocardial infarction (STEMI) patients plays a part in adverse left ventricular (LV) remodeling remains unclear. We aimed to use automated extracellular volume fraction (ECV) mapping to investigate whether changes in the ECV of the remote (ECVRemote) and infarcted myocardium (ECVInfarct) impacted LV remodeling. Methods and ResultsForty‐eight of 50 prospectively recruited reperfused STEMI patients completed a cardiovascular magnetic resonance at 4±2 days and 40 had a follow‐up scan at 5±2 months. Twenty healthy volunteers served as controls. Mean segmental values for native T1, T2, and ECV were obtained. Adverse LV remodeling was defined as ≥20% increase in LV end‐diastolic volume. ECVRemote was higher on the acute scan when compared to control (27.9±2.1% vs 26.4±2.1%; P=0.01). Eight patients developed adverse LV remodeling and had higher ECVRemote acutely (29.5±1.4% vs 27.4±2.0%; P=0.01) and remained higher at follow‐up (28.6±1.5% vs 26.6±2.1%; P=0.02) compared to those without. Patients with a higher ECVRemote and a lower myocardial salvage index (MSI) acutely were significantly associated with adverse LV remodeling, independent of T1Remote, T1Core and microvascular obstruction, whereas a higher ECVInfarct was significantly associated with worse wall motion recovery. ConclusionsECVRemote was increased acutely in reperfused STEMI patients. Those with adverse LV remodeling had higher ECVRemote acutely, and this remained higher at follow‐up than those without adverse LV remodeling. A higher ECVRemote and a lower MSI acutely were significantly associated with adverse LV remodeling whereas segments with higher ECVInfarct were less likely to recover wall motion.

Published
2016
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4. Effect of remote ischaemic conditioning on infarct size and remodelling in ST-segment elevation myocardial infarction patients:the CONDI-2/ERIC-PPCI CMR substudy

Author

Alexander Perkins, Richard Evans, Vanessa M Ferreira, Tushar Kotecha, Chiara Bucciarelli-Ducci, Rajesh K. Kharbanda, Thomas Engstrøm, Anthony Mathur, Matthew Dodd, Ulla Kristine Møller, Jun Chong, Derek J. Hausenloy, Hans Erik Bøtker, Tim Clayton, Rohin Francis, Roby Rakhit, Won Yong Kim, James C. Moon, John P Greenwood, Marianna Fontana, Derek M. Yellon, Heerajnarain Bulluck, Manish Ramlall, and Jacob Lønborg

Subjects
medicine.medical_specialty, Magnetic Resonance Spectroscopy, Physiology, medicine.medical_treatment, Myocardial Infarction, Cardioprotection, Ventricular Function, Left, Myocardial infarct size, Percutaneous Coronary Intervention, Interquartile range, Physiology (medical), Internal medicine, hemic and lymphatic diseases, medicine, Clinical endpoint, Humans, ST segment, Single-Blind Method, Myocardial infarction, cardiovascular diseases, Ejection fraction, medicine.diagnostic_test, business.industry, Percutaneous coronary intervention, Stroke Volume, Magnetic resonance imaging, Original Contribution, medicine.disease, Treatment Outcome, Cuff, Cardiology, cardiovascular system, ST Elevation Myocardial Infarction, Cardiovascular magnetic resonance, Remote ischaemic conditioning, Cardiology and Cardiovascular Medicine, business, circulatory and respiratory physiology
Abstract

The effect of limb remote ischaemic conditioning (RIC) on myocardial infarct (MI) size and left ventricular ejection fraction (LVEF) was investigated in a pre-planned cardiovascular magnetic resonance (CMR) substudy of the CONDI-2/ERIC-PPCI trial. This single-blind multi-centre trial (7 sites in UK and Denmark) included 169 ST-segment elevation myocardial infarction (STEMI) patients who were already randomised to either control (n = 89) or limb RIC (n = 80) (4 × 5 min cycles of arm cuff inflations/deflations) prior to primary percutaneous coronary intervention. CMR was performed acutely and at 6 months. The primary endpoint was MI size on the 6 month CMR scan, expressed as median and interquartile range. In 110 patients with 6-month CMR data, limb RIC did not reduce MI size [RIC: 13.0 (5.1–17.1)% of LV mass; control: 11.1 (7.0–17.8)% of LV mass, P = 0.39], or LVEF, when compared to control. In 162 patients with acute CMR data, limb RIC had no effect on acute MI size, microvascular obstruction and LVEF when compared to control. In a subgroup of anterior STEMI patients, RIC was associated with lower incidence of microvascular obstruction and higher LVEF on the acute scan when compared with control, but this was not associated with an improvement in LVEF at 6 months. In summary, in this pre-planned CMR substudy of the CONDI-2/ERIC-PPCI trial, there was no evidence that limb RIC reduced MI size or improved LVEF at 6 months by CMR, findings which are consistent with the neutral effects of limb RIC on clinical outcomes reported in the main CONDI-2/ERIC-PPCI trial.

Published
2021

5. Cardiovascular Remodeling Experienced by Real-World, Unsupervised, Young Novice Marathon Runners

Author

Charlotte Manisty, James Willis, Thomas A. Treibel, N Nadarajan, João B Augusto, Paul Scully, Della Cole, Manish Ramlall, Alun D. Hughes, Harshil Dhutia, Siana Jones, Efstathios Papatheodorou, Sanjay Sharma, Irina Chis Ster, Anish N Bhuva, Guy Lloyd, Camilla Torlasco, Yang Ye, Stefania Rosmini, James C. Moon, Amna Abdel-Gadir, Rajan Sharma, Gherardo Finocchiaro, Katia D. Menacho Medina, Jet van Zalen, Rachel Bastiaenen, Andrew D'Silva, D'Silva, A, Bhuva, A, van Zalen, J, Bastiaenen, R, Abdel-Gadir, A, Jones, S, Nadarajan, N, Menacho Medina, K, Ye, Y, Augusto, J, Treibel, T, Rosmini, S, Ramlall, M, Scully, P, Torlasco, C, Willis, J, Finocchiaro, G, Papatheodorou, E, Dhutia, H, Cole, D, Chis Ster, I, Hughes, A, Sharma, R, Manisty, C, Lloyd, G, Moon, J, and Sharma, S

Subjects
medicine.medical_specialty, Physiology, endurance exercise, athlete’s heart, cardiorespiratory fitness, cardiovascular remodeling, endurance exercise, marathon, sports cardiology, 030204 cardiovascular system & hematology, lcsh:Physiology, 03 medical and health sciences, 0302 clinical medicine, Endurance training, Physiology (medical), Internal medicine, medicine, Eccentric, 030212 general & internal medicine, Original Research, cardiovascular remodeling, cardiorespiratory fitness, lcsh:QP1-981, medicine.diagnostic_test, business.industry, Cardiorespiratory fitness, cardiorespiratory fitne, medicine.disease, Blood pressure, Arterial stiffness, Cardiology, Biomarker (medicine), Observational study, athlete’s heart, marathon, business, sports cardiology, human activities, Electrocardiography
Abstract

Aims: Marathon running is a popular ambition in modern societies inclusive of non-athletes. Previous studies have highlighted concerning transient myocardial dysfunction and biomarker release immediately after the race. Whether this method of increasing physical activity is beneficial or harmful remains a matter of debate. We examine in detail the real-world cardiovascular remodeling response following competition in a first marathon. Methods: Sixty-eight novice marathon runners (36 men and 32 women) aged 30 ± 3 years were investigated 6 months before and 2 weeks after the 2016 London Marathon race in a prospective observational study. Evaluation included electrocardiography, cardiopulmonary exercise testing, echocardiography, and cardiovascular magnetic resonance imaging. Results: After 17 weeks unsupervised marathon training, runners revealed a symmetrical, eccentric remodeling response with 3-5% increases in left and right ventricular cavity sizes, respectively. Blood pressure (BP) fell by 4/2 mmHg (P < 0.01) with reduction in arterial stiffness, despite only 11% demonstrating a clinically meaningful improvement in peak oxygen consumption with an overall non-significant 0.4 ml/min/kg increase in peak oxygen consumption (P = 0.14). Conclusion: In the absence of supervised training, exercise-induced cardiovascular remodeling in real-world novice marathon runners is more modest than previously described and occurs even without improvement in cardiorespiratory fitness. The responses are similar in men and women, who experience a beneficial BP reduction and no evidence of myocardial fibrosis or persistent edema, when achieving average finishing times.

Published
2020

6. Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI):a single-blind randomised controlled trial

Author

Derek J Hausenloy, Rajesh K Kharbanda, Ulla Kristine Møller, Manish Ramlall, Jens Aarøe, Robert Butler, Heerajnarain Bulluck, Tim Clayton, Ali Dana, Matthew Dodd, Thomas Engstrom, Richard Evans, Jens Flensted Lassen, Erika Frischknecht Christensen, José Manuel Garcia-Ruiz, Diana A Gorog, Jakob Hjort, Richard F Houghton, Borja Ibanez, Rosemary Knight, Freddy K Lippert, Jacob T Lønborg, Michael Maeng, Dejan Milasinovic, Ranjit More, Jennifer M Nicholas, Lisette Okkels Jensen, Alexander Perkins, Nebojsa Radovanovic, Roby D Rakhit, Jan Ravkilde, Alisdair D Ryding, Michael R Schmidt, Ingunn Skogstad Riddervold, Henrik Toft Sørensen, Goran Stankovic, Madhusudhan Varma, Ian Webb, Christian Juhl Terkelsen, John P Greenwood, Derek M Yellon, Hans Erik Bøtker, Anders Junker, Anne Kaltoft, Morten Madsen, Evald Høj Christiansen, Lars Jakobsen, Steen Carstensen, Steen Dalby Kristensen, Troels Thim, Karin Møller Pedersen, Mette Tidemand Korsgaard, Allan Iversen, Erik Jørgensen, Francis Joshi, Frants Pedersen, Hans Henrik Tilsted, Karam Alzuhairi, Kari Saunamäki, Lene Holmvang, Ole Ahlehof, Rikke Sørensen, Steffen Helqvist, Bettina Løjmand Mark, Anton Boel Villadsen, Bent Raungaard, Leif Thuesen, Martin Kirk Christiansen, Philip Freeman, Svend Eggert Jensen, Charlotte Schmidt Skov, Ahmed Aziz, Henrik Steen Hansen, Julia Ellert, Karsten Veien, Knud Erik Pedersen, Knud Nørregård Hansen, Ole Ahlehoff, Helle Cappelen, Daniel Wittrock, Poul Anders Hansen, Jens Peter Ankersen, Kim Witting Hedegaard, John Kempel, Henning Kaus, Dennis Erntgaard, Danny Mejsner Pedersen, Matthias Giebner, Troels Martin Hansen Hansen, Mina Radosavljevic-Radovanovic, Maja Prodanovic, Lidija Savic, Marijana Pejic, Dragan Matic, Ana Uscumlic, Ida Subotic, Ratko Lasica, Vladan Vukcevic, Alfonso Suárez, Beatriz Samaniego, César Morís, Eduardo Segovia, Ernesto Hernández, Iñigo Lozano, Isaac Pascual, Jose M. Vegas-Valle, José Rozado, Juan Rondán, Pablo Avanzas, Raquel del Valle, Remigio Padrón, Alfonso García-Castro, Amalia Arango, Ana B. Medina-Cameán, Ana I. Fente, Ana Muriel-Velasco, Ángeles Pomar-Amillo, César L. Roza, César M. Martínez-Fernández, Covadonga Buelga-Díaz, David Fernández-Gonzalo, Elena Fernández, Eloy Díaz-González, Eugenio Martinez-González, Fernando Iglesias-Llaca, Fernando M. Viribay, Francisco J. Fernández-Mallo, Francisco J. Hermosa, Ginés Martínez-Bastida, Javier Goitia-Martín, José L. Vega-Fernández, Jose M. Tresguerres, Juan A. Rodil-Díaz, Lara Villar-Fernández, Lucía Alberdi, Luis Abella-Ovalle, Manuel de la Roz, Marcos Fernández-Carral Fernández-Carral, María C. Naves, María C. Peláez, María D. Fuentes, María García-Alonso, María J. Villanueva, María S. Vinagrero, María Vázquez-Suárez, Marta Martínez-Valle, Marta Nonide, Mónica Pozo-López, Pablo Bernardo-Alba, Pablo Galván-Núñez, Polácido J. Martínez-Pérez, Rafael Castro, Raquel Suárez-Coto, Raquel Suárez-Noriega, Rocío Guinea, Rosa B. Quintana, Sara de Cima, Segundo A. Hedrera, Sonia I. Laca, Susana Llorente-Álvarez, Susana Pascual, Teodorna Cimas, Anthony Mathur, Eleanor McFarlane-Henry, Gerry Leonard, Jessry Veerapen, Mark Westwood, Martina Colicchia, Mary Prossora, Mervyn Andiapen, Saidi Mohiddin, Valentina Lenzi, Jun Chong, Rohin Francis, Amy Pine, Caroline Jamieson-Leadbitter, Debbie Neal, J. Din, Jane McLeod, Josh Roberts, Karin Polokova, Kristel Longman, Lucy Penney, Nicki Lakeman, Nicki Wells, Oliver Hopper, Paul Coward, Peter O'Kane, Ruth Harkins, Samantha Guyatt, Sarah Kennard, Sarah Orr, Stephanie Horler, Steve Morris, Tom Walvin, Tom Snow, Michael Cunnington, Amanda Burd, Anne Gowing, Arvindra Krishnamurthy, Charlotte Harland, Derek Norfolk, Donna Johnstone, Hannah Newman, Helen Reed, James O'Neill, John Greenwood, Josephine Cuxton, Julie Corrigan, Kathryn Somers, Michelle Anderson, Natalie Burtonwood, Petra Bijsterveld, Richard Brogan, Tony Ryan, Vivek Kodoth, Arif Khan, Deepti Sebastian, Diana Gorog, Georgina Boyle, Lucy Shepherd, Mahmood Hamid, Mohamed Farag, Nicholas Spinthakis, Paulina Waitrak, Phillipa De Sousa, Rishma Bhatti, Victoria Oliver, Siobhan Walshe, Toral Odedra, Ying Gue, Rahim Kanji, Alisdair Ryding, Amanda Ratcliffe, Angela Merrick, Carol Horwood, Charlotte Sarti, Clint Maart, Donna Moore, Francesca Dockerty, Karen Baucutt, Louise Pitcher, Mary Ilsley, Millie Clarke, Rachel Germon, Sara Gomes, Thomas Clare, Sunil Nair, Jocasta Staines, Susan Nicholson, Oliver Watkinson, Ian Gallagher, Faye Nelthorpe, Janine Musselwhite, Konrad Grosser, Leah Stimson, Michelle Eaton, Richard Heppell, Sharon Turney, Victoria Horner, Natasha Schumacher, Angela Moon, Paula Mota, Joshua O'Donnell, Abeesh Sadasiva Panicker, Anntoniette Musa, Luke Tapp, Suresh Krishnamoorthy, Valerie Ansell, Danish Ali, Samantha Hyndman, Prithwish Banerjee, Martin Been, Ailie Mackenzie, Andrew McGregor, David Hildick-Smith, Felicity Champney, Fiona Ingoldby, Kirstie Keate, Lorraine Bennett, Nicola Skipper, Sally Gregory, Scott Harfield, Alexandra Mudd, Christopher Wragg, David Barmby, Ever Grech, Ian Hall, Janet Middle, Joann Barker, Joyce Fofie, Julian Gunn, Kay Housley, Laura Cockayne, Louise Weatherlley, Nana Theodorou, Nigel Wheeldon, Pene Fati, Robert F. Storey, James Richardson, Javid Iqbal, Zul Adam, Sarah Brett, Michael Agyemang, Cecilia Tawiah, Kai Hogrefe, Prashanth Raju, Christine Braybrook, Jay Gracey, Molly Waldron, Rachael Holloway, Senem Burunsuzoglu, Sian Sidgwick, Simon Hetherington, Charmaine Beirnes, Olga Fernandez, Nicoleta Lazar, Abigail Knighton, Amrit Rai, Amy Hoare, Jonathan Breeze, Katherine Martin, Michelle Andrews, Sheetal Patale, Amy Bennett, Andrew Smallwood, Elizabeth Radford, James Cotton, Joe Martins, Lauren Wallace, Sarah Milgate, Shahzad Munir, Stella Metherell, Victoria Cottam, Ian Massey, Jane Copestick, Jane Delaney, Jill Wain, Kully Sandhu, Lisa Emery, Charlotte Hall, Chiara Bucciarelli-Ducci, Rissa Besana, Jodie Hussein, Sheila Bell, Abby Gill, Emily Bales, Gary Polwarth, Clare East, Ian Smith, Joana Oliveira, Saji Victor, Sarah Woods, Stephen Hoole, Angelo Ramos, Annaliza Sevillano, Anne Nicholson, Ashley Solieri, Emily Redman, Jean Byrne, Joan Joyce, Joanne Riches, John Davies, Kezia Allen, Louie Saclot, Madelaine Ocampo, Mark Vertue, Natasha Christmas, Raiji Koothoor, Reto Gamma, Wilson Alvares, Stacey Pepper, Barbara Kobson, Christy Reeve, Iqbal Malik, Emma Chester, Heidi Saunders, Idah Mojela, Joanna Smee, Justin Davies, Nina Davies, Piers Clifford, Priyanthi Dias, Ramandeep Kaur, Silvia Moreira, Yousif Ahmad, Lucy Tomlinson, Clare Pengelley, Amanda Bidle, Sharon Spence, Rasha Al-Lamee, Urmila Phuyal, Hakam Abbass, Tuhina Bose, Rebecca Elliott, Aboo Foundun, Alan Chung, Beth Freestone, Dr Kaeng Lee, Dr Mohamed Elshiekh, George Pulikal, Gurbir Bhatre, James Douglas, Lee Kaeng, Mike Pitt, Richard Watkins, Simrat Gill, Amy Hartley, Andrew Lucking, Berni Moreby, Damaris Darby, Ellie Corps, Georgina Parsons, Gianluigi De Mance, Gregor Fahrai, Jenny Turner, Jeremy Langrish, Lisa Gaughran, Mathias Wolyrum, Mohammed Azkhalil, Rachel Bates, Rachel Given, Rajesh Kharbanda, Rebecca Douthwaite, Steph Lloyd, Stephen Neubauer, Deborah Barker, Anne Suttling, Charlotte Turner, Clare Smith, Colin Longbottom, David Ross, Denise Cunliffe, Emily Cox, Helena Whitehead, Karen Hudson, Leslie Jones, Martin Drew, Nicholas Chant, Peter Haworth, Robert Capel, Rosalynn Austin, Serena Howe, Trevor Smith, Alex Hobson, Philip Strike, Huw Griffiths, Brijesh Anantharam, Pearse Jack, Emma Thornton, Adrian Hodgson, Alan Jennison, Anna McSkeane, Bethany Smith, Caroline Shaw, Chris Leathers, Elissa Armstrong, Gayle Carruthers, Holly Simpson, Jan Smith, Jeremy Hodierne, Julie Kelly, Justin Barclay, Kerry Scott, Lisa Gregson, Louise Buchanan, Louise McCormick, Nicci Kelsall, Rachel Mcarthy, Rebecca Taylor, Rebecca Thompson, Rhidian Shelton, Roger Moore, Sharon Tomlinson, Sunil Thambi, Theresa Cooper, Trevor Oakes, Zakhira Deen, Chris Relph, Scott prentice, Lorna Hall, Angela Dillon, Deborah Meadows, Emma Frank, Helene Markham-Jones, Isobel Thomas, Joanne Gale, Joanne Denman, John O'Connor, Julia Hindle, Karen Jackson-Lawrence, Karen Warner, Kelvin Lee, Robert Upton, Ruth Elston, Sandra Lee, Vinod Venugopal, Amanda Finch, Catherine Fleming, Charlene Whiteside, Chris Pemberton, Conor Wilkinson, Deepa Sebastian, Ella Riedel, Gaia Giuffrida, Gillian Burnett, Helen Spickett, James Glen, Janette Brown, Lauren Thornborough, Lauren Pedley, Maureen Morgan, Natalia Waddington, Oliver Brennan, Rebecca Brady, Stephen Preston, Chris Loder, Ionela Vlad, Julia Laurence, Angelique Smit, Kirsty Dimond, Michelle Hayes, Loveth Paddy, Jacolene Crause, Nadifa Amed, Priya Kaur-Babooa, Roby Rakhit, Tushar Kotecha, Hossam Fayed, Antonis Pavlidis, Bernard Prendergast, Brian Clapp, Divaka Perara, Emma Atkinson, Howard Ellis, Karen Wilson, Kirsty Gibson, Megan Smith, Muhammed Zeeshan Khawaja, Ruth Sanchez-Vidal, Simon Redwood, Sophie Jones, Aoife Tipping, Anu Oommen, Cara Hendry, DR Fazin Fath-Orboubadi, Hannah Phillips, Laurel Kolakaluri, Martin Sherwood, Sarah Mackie, Shilpa Aleti, Thabitha Charles, Liby Roy, Rob Henderson, Rod Stables, Michael Marber, Alan Berry, Andrew Redington, Kristian Thygesen, Henning Rud Andersen, Colin Berry, Andrew Copas, Tom Meade, Henning Kelbæk, Hector Bueno, Paul von Weitzel-Mudersbach, Grethe Andersen, Andrew Ludman, Nick Cruden, Dragan Topic, Zlatko Mehmedbegovic, Jesus Maria de la Hera Galarza, Steven Robertson, Laura Van Dyck, Rebecca Chu, Josenir Astarci, Zahra Jamal, Daniel Hetherington, Lucy Collier, British Heart Foundation, University College London Hospitals NHS Foundation Trust, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden, National Institute for Health Research (Reino Unido), Singapore Ministry of Health, Ministry of Education (Singapur), and Unión Europea. European Cooperation in Science and Technology (COST)

Subjects
Male, Death, Sudden, Cardiac/prevention & control, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Medicine, ST-SEGMENT ELEVATION, Single-Blind Method, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Prospective cohort study, Heart Failure/etiology, 11 Medical and Health Sciences, Myocardial Infarction/complications, General Medicine, Middle Aged, RC666, Combined Modality Therapy, LIMB, 3. Good health, Intention to Treat Analysis, Hospitalization, Treatment Outcome, Ischemic Preconditioning, Myocardial, Female, Life Sciences & Biomedicine, Ischemic Preconditioning, Myocardial/methods, medicine.medical_specialty, CONDI-2/ERIC-PPCI Investigators, ISCHEMIA/REPERFUSION INJURY, 03 medical and health sciences, CARDIOPROTECTION, Medicine, General & Internal, Percutaneous Coronary Intervention, General & Internal Medicine, Humans, In patient, Aged, Heart Failure, Intention-to-treat analysis, Science & Technology, ADJUNCT, business.industry, Percutaneous coronary intervention, medicine.disease, United Kingdom, SIZE, Death, Sudden, Cardiac, Emergency medicine, Myocardial infarction complications, Single blind, business, TASK-FORCE
Abstract

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden. The ERIC-PPCI trial was funded by a British Heart Foundation clinical study grant (grant number CS/14/3/31002) and a University College London Hospitals/University College London Biomedical Research Centre clinical research grant. The CONDI-2 trial was funded by Danish Innovation Foundation grants (grant numbers 11-108354 and 11-115818), Novo Nordisk Foundation (grant number NNF13OC0007447), and TrygFonden (grant number 109624). DJH was supported by the British Heart Foundation (grant number FS/10/039/28270), the National Institute for Health Research (NIHR) Biomedical Research Centre at University College London Hospitals, the Duke-National University Singapore Medical School, the Singapore Ministry of Health’s National Medical Research Council under its Clinician Scientist-Senior Investigator scheme (grant number NMRC/CSA-SI/0011/2017) and its Collaborative Centre Grant scheme (grant number NMRC/CGAug16C006), and the Singapore Ministry of Education Academic Research Fund Tier 2 (grant number MOE2016-T2-2-021). HEB was supported by the Novo Nordisk Foundation (grant numbers NNF14OC0013337, NNF15OC0016674). RKK is supported by the Oxford NIHR Biomedical Centre. The research was also supported by the NIHR infrastructure at Leeds. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, or the Department of Health. This article is based on the work of COST Action EU-CARDIOPROTECTION (CA16225) and supported by COST (European Cooperation in Science and Technology). We thank all study personnel for their invaluable assistance. Sí

Published
2019

7. MODERATED EPOSTERS1385Longitudinal strain assessment in dilated cardiomyopathy patients using a novel accelerated DENSE sequence1407Simultaneous T1 and T2 cardiac quantification with CABIRIA: initial clinical experience1423Head-to-head comparison of acceleration algorithms in 4-dimensional flow CMR1502Left ventricular function and size evaluated by hybrid cardiac positron emission tomography-magnetic resonance: Intraindividual comparison of left ventricular ejection fraction and ventricular volumes derived by two modalities1510Left Atrium assessed by Cardiovascular Magnetic Resonance at 1.5 and 3 Tesla – age and gender effects1514Comparison of Free Breathing Cardiac MRI Radial technique to the Standard Multi breath-hold cine SSFP CMR technique for the assessment of LV Volumes and Function1536Self-navigated free-breathing isotropic 3D whole heart phase sensitive inversion recovery magnetic resonance without navigator for detection of myocardial infarction1547Assessment of Right Ventricular Strain Using Myocardial Deformation Recovery Semi Automated Technique: Initial Experience and Normal Values1586Tissue tracking myocardial deformation analysis and prediction of left ventricular remodeling in acute myocardial infarction1589Investigating strategies for optimal 31P MRS clinical cardiac at 3T: Initial Results1620Quantitative Criteria for the Diagnosis of the Congenital Absence of Pericardium by Cardiac Magnetic Resonance1632Widespread tissue injury during acute myocardial infarction: evidence from advanced CMR relaxometry1322Computed tomography coronary angiography verSus sTRess cArdiac magneTic rEsonance for the manaGement of sYmptomatic revascularized patients: a cost effectiveness study (STRATEGY study)1339Comparison of low- versus high-dose of gadobutrol for late gadolinium enhancement imaging at 1.5 Tesla: a clinical feasibility study1347Multi-parametric Cardiac Magnetic Resonance for Prediction of Cardiac Complications in Thalassemia Intermedia: a Prospective Multicenter Study1461Prognostic value of Cardiovascular Magnetic Resonance derived indexes of myocardial fibrosis in heart transplant recipients1523The role of CMR in the acute phase of hospitalization: changing paradigms1542Preoperative CMR-based score predict ventricular response after surgical left ventricular reconstruction in ischemic heart failure patients1555Excellent response rate to cardiac resynchronization therapy guided with magnetic resonance imaging1626The ECG as a predictor of arrhythmogenic substrate on Cardiac Magnetic Resonance Imaging in patients undergoing ablation for premature ventricular contractions1649Comparison of T1-mapping at 3.0T CMR and angiographic APPROACH score for area at risk assessment in ST-segment elevation myocardial infarction1340Pathological correlates of left bundle branch disease in patients with non-ischemic cardiomyopathy: a cardiovascular magnetic resonance study1342Myocardial remodelling and fibrosis in nonischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance1411The association between fibrosis and contractile dysfunction in hypertrophic cardiomyopathy assessed by cardiovascular magnetic resonance1622Persistent myocardial inflammation due to intramyocardial haemorrhage in reperfused STEMI as a precursor to adverse LV remodelling - insights from multi-parametric mapping1566Semiquantitative analysis of low and high b value DWI for detecting myocardial edema in acute myocarditis1567Value of Cardiac MRI In Detecting Coronary Artery Disease In Newly Diagnosed Systolic Dysfunction1570Usefulness of cardiac magnetic resonance in tuberous sclerosis complex1578Papillary muscles offer further insight into hypertrophied hearts: a cardiovascular magnetic resonance study1627Diagnostic and clinical implications of CMR timing (early versus late) in patients with troponin positive acute coronary syndromes and unobstructed coronary arteries: Table 1

Author

Amardeep Ghosh Dastidar, Rebecca Kozor, Zorba Blázquez Bermejo, L.M. Desroche, J. Broncano, Heerajnarain Bulluck, Peter P Swoboda, A Barison, Chrysanthos Grigoratos, Sheraz A. Nazir, S. Oebel, R. Kockova, Giulia Careri, Estefania De Garate, Patrizia Pedrotti, Antonella Meloni, Gianluca Pontone, F. Macaione, R. Murdoch, F. Valente, Komal S Safdar, Tobias Rutz, Shimon Kolker, Stephanie Funk, D. Beitzke, P. Garg, Alexandros Kallifatidis, Upasana Tayal, Andrew D Scott, Rick Wage, Pedro Ferreira, Dudley Pennell, Xiaodong Zhong, Fred Epstein, David Firmin, Sanjay Prasad, Anastasios Prousalis, Sophia-Anastasia Mouratoglou, George Giannakoulas, Xenia Deligianni, Michail Bakaloudis, Nikolaos Magganaris, George Sianos, Haralampos Karvounis, Francesco Santini, R. Aziz, J.R.J. Foley, G. Fent, T.A. Musa, P. Haaf, L. Dobson, P.P. Swoboda, J.P. Greenwood, S. Plein, R.J.V.D. Geest, J.J.M. Westenberg, S. Rasul, W. Wadsak, M. Mitterhauser, R. Nolz, M. Stelzmueller, C. Loewe, M. Hacker, Josephine Kermer, Serkan Dogangüzel, Florian von Knobelsdorff-Brenkenhoff, Jeanette Schulz-Menger, Giora Weisz, Naama Bogot, Irit Hadas Halpern, Arik Wolak, Giulia Ginami, Davide Piccini, Simone Coppo, Gabriella Vincenti, Matthias Stuber, Jürg Schwitter, Xuexin Gao, Stephanie Ambach, Michal D Taylor, Ryan Moore, Robin J Taylor, Olga Toro-Salazar, John L Jeffries, Cheryl Bartone, Subha V Raman, Wojciech Mazur, J.F. Rodriguez-Palomares, L. Gutierrez, V. Pineda, B. Agliano, L. Galian, G. Teixido, M.T. Gonzalez-Alujas, A. Evangelista, D. Garcia-Dorado, S. Gandy, R. Nicholas, G. Houston, P. Martin, J. Muir, S. Matthew, P. Guntur- Ramkumar, I. Cavin, A. Barison, I. Pescetelli, F. Pali, F. Pizzino, A. Terrizzi, D. Di Lisi, G. Novo, G. Todiere, P. Assennato, S. Novo, G.D. Aquaro, Elisa McAlindon, Jonathan Rodrigues, Anna Baritussio, Alessandra Scatteia, Chris Benny Lawton, Tamas Erdei, Gergely Szantho, Mark Hamilton, Chiara Bucciarelli-Ducci, Daniele Andreini, Cristina Rota, Marco Guglielmo, Saima Mushtaq, Andrea Baggiano, Virginia Beltrama, Anna Solbiati, Andrea I. Guaricci, Mauro Pepi, Konstantinos Bratis, Markus Henningson, Matteo Dell'Omodarme, Valentina O. Puntmann, Eike Nagel, Nicola Giunta, Pietro Giuliano, Maria Giovanna Neri, Gennaro Restaino, Stefania Renne, Alessandra Quota, Vincenzo Positano, Daniele De Marchi, Alessia Pepe, Paola Campadello, Gabriella Masciocco, Rita Facchetti, Angela Milazzo, Giuseppina Quattrocchi, Cristina Giannattasio, Maria Frigerio, Alberto Roghi, Ornella Rimoldi, Antonio Amadu, Giuseppe Venuti, Jonathan C. Rodrigues, Serenella Castelvecchio, Antonia Camporeale, Francesco Secchi, Lorenzo Menicanti, Massimo Lombardi, K. Sedlacek, D. Wichterle, V. Sikula, J. Tintera, L. Sukupova, D. Kautznerova, M. Segetova, A. Praveckova, R. Langova, L. Kryze, W. El-Husseini, J. Kautzner, B. Dinov, A. Arya, S. Hilbert, P. Sommer, A. Bollmann, G. Hindricks, I. Paetsch, C. Jahnke, John P. Greenwood, Abhishek Shetye, Jamal N. Khan, Anvesha Singh, Prathap Kanagala, Daniel Swarbrick, Gaurav Gulsin, Matthew Graham-Brown, Anthony Gershlick, Gerry P. McCann, Riccardo Liga, Elena Bennatti, Andrea Barison, Giancarlo Todiere, Giovanni Donato Aquaro, Michele Emdin, Pier Giorgio Masci, A Ortalda, G Todiere, C Grigoratos, G Vergaro, G Mirizzi, N Martini, D De Marchi, P Keilberg, C Passino, GD Aquaro, M Emdin, Adam K McDiarmid, Bara Erhayiem, Graham J Fent, Laura E Dobson, Pankaj Garg, Tarique A Musa, James R Foley, Stephen P Page, John P Greenwood, Sven Plein, Stefania Rosmini, Amna Abdel-Gadir, Anish Bhuva, Thomas A Treibel, Steven K White, Marianna Fontana, Manish Ramlall, Ashraf Hamarneh, Alex Sirker, Anna Herrey, Charlotte Manisty, Derek M Yellon, Peter Kellman, James C Moon, Derek J Hausenloy, A. Luna, T. Martin – Noguerol, P. Caro, R. Toro-Cebada, J. Sanchez – Gonzalez, O. Milleron, B. Safar, Y. Lavie-Badie, D. Millischer, J. Abtan, G. Jondeau, Emilio Cuesta, Sandra O. Rosillo, Gabriela Guzmán, Inmaculada Pinilla, Óscar González, Juan Caro, Inés Ponz, Teresa López, Elena Refoyo, Sabrina Nordin, Silvia Castelleti, Gabriella Captur, Rick Steeds, Shanat Baig, Stuart M Grieve, Gemma A Figtree, Priyanka Singhal, Julian Strange, Angus Nightingale, Andreas Baumbach, Tom Johnson, and Victoria Delgado

Subjects
Radiology, Nuclear Medicine and imaging, General Medicine, Cardiology and Cardiovascular Medicine
Published
2016

8. Clinical impact of cardiovascular magnetic resonance with optimized myocardial scar detection in patients with cardiac implantable devices

Author

Charlotte Manisty, Richard J. Schilling, Martin Lowe, Angela Hawkins, Neha Sekhri, Anish N Bhuva, Manish Ramlall, Adam J. Graham, Pier D. Lambiase, Redha Boubertakh, Patricia Feuchter, Peter Kellman, and James C. Moon

Subjects
Adult, Male, medicine.medical_specialty, Pacemaker, Artificial, medicine.medical_treatment, Magnetic Resonance Imaging, Cine, 030204 cardiovascular system & hematology, 03 medical and health sciences, Cicatrix, Random Allocation, 0302 clinical medicine, Internal medicine, medicine, Implantable loop recorder, Late gadolinium enhancement, Humans, In patient, cardiovascular diseases, 030212 general & internal medicine, Medical diagnosis, Aged, Artifact (error), medicine.diagnostic_test, business.industry, Myocardium, Magnetic resonance imaging, Middle Aged, Implantable cardioverter-defibrillator, Defibrillators, Implantable, embryonic structures, Cardiology, Female, Cardiology and Cardiovascular Medicine, Complication, business
Abstract

Background Myocardial scar assessment using late gadolinium enhancement Cardiovascular Magnetic Resonance (LGE CMR) is commonly indicated for patients with cardiac implantable electronic devices (CIEDs), however metal artifact can degrade images. We evaluated the clinical impact of LGE CMR incorporating a device-dependent metal artifact reduction strategy in patients with CIEDs. Methods 136 CMR studies were performed in 133 consecutive patients (age 56 ± 19 years, 69% male) with CIEDs (22% implantable loop recorders [ILRs], 40% permanent pacemakers [PPMs], 38% implantable cardioverter defibrillators [ICDs]; 42% non-MRI conditional) over 2 years, without complication. LGE imaging was tailored to the CIED, using a wideband sequence for left-sided PPMs and ICDs and conventional sequences for ILRs and right-sided PPMs, scoring segmental artifact. Diagnostic utility and impact on clinical management were scored by consensus of experts. Results CMR provided unexpected diagnoses in 22 (16%) and changed management in 113 (83%) patients. Myocardial scar was present in 92 (68%), with other abnormalities detected in another 13%. Using conventional LGE, 43 (32%) studies were non-diagnostic (79% of defibrillators) compared to 0% using wideband LGE imaging. Wideband LGE results changed clinical management in an additional 39 (75%) defibrillator patients and 10 (19%) pacemaker patients when compared to imaging with conventional LGE sequences. Conclusion The clinical yield from CMR using optimized LGE sequences in patients with CIEDs is high with no demonstrated clinical risk. A device-dependent LGE imaging strategy using wideband LGE is needed to achieve clinical utility especially in ICD recipients.

Published
2018

9. CardioPulse ArticlesEditors' network of the European Society of Cardiology National Cardiovascular Journals: scientific input from the National SocietiesHand grip strength predicts myocardial infarction and strokeEffect of remote ischaemic conditioning on clinical outcomes in patients presenting with an ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Table 1

Author

Tim Clayton, Ulla Kristine Møller, Rosemary Knight, Jennifer M. Nicholas, Nebosja Radovanovic, Derek J. Hausenloy, Derek M. Yellon, Jan Ravkilde, Henrik Toft Sørensen, Thomas Engstrøm, Michael Schmidt, Richard Evans, Rajesh K. Kharbanda, Erica F Christensen, Josè M. Garcia Ruiz, Heerajnarain Bulluck, Lisette Okkels Jensen, Hans Erik Bøtker, and Manish Ramlall

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, education, Treatment outcome, Percutaneous coronary intervention, medicine.disease, law.invention, Randomized controlled trial, law, Internal medicine, parasitic diseases, Cardiology, Medicine, ST segment, Ischemic preconditioning, In patient, Myocardial infarction, Young adult, Cardiology and Cardiovascular Medicine, business
Abstract

The rationale and study design for the multicentre, randomized, controlled CONDI2/ERIC-PPCI study are discussed.

Published
2015

10. 57 The effect of remote ischemic conditioning and glyceryl trinitrate on perioperative myocardial injury in cardiac bypass surgery patients: the eric-gtn study

Author

H Bulluck, Derek J. Hausenloy, E Hardman, H Shanahan, P Wicks, Robin Chung, Robert M. Bell, R Cordery, Ashraf Hamarneh, Derek M. Yellon, and Manish Ramlall

Subjects
Cardioprotection, medicine.medical_specialty, business.industry, Perioperative, Placebo, Interim analysis, Cardiac surgery, medicine.anatomical_structure, Bypass surgery, hemic and lymphatic diseases, Anesthesia, cardiovascular system, medicine, Clinical endpoint, business, circulatory and respiratory physiology, Artery
Abstract

Introduction Remote Ischaemic Conditioning (RIC) using transient limb ischemia/reperfusion has been reported to reduce peri-operative myocardial injury (PMI) in patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery. The role of intravenous Glyceryl Trinitrate (GTN) therapy administered during cardiac surgery as a cardioprotective agent and whether it interferes with RIC cardioprotection is not clear and is investigated in the ERIC-GTN trial (Clinicaltrial.govidentifier:NCT01864252). Aims The ERIC-GTN trial has been designed to determine whether intraoperatively administered IV GTN is cardioprotective during cardiac surgery and to investigate the interaction between RIC and IV GTN in their cardioprotective effects. Hypothesis 1: Intra-operative intravenous GTN will reduce PMI in patients undergoing CABG and/or valve surgery. Hypothesis 2: RIC will reduce PMI in the absence of GTN in patients undergoing CABG and/or valve surgery. Hypothesis 3: RIC will not reduce PMI in the presence of GTN in patients undergoing CABG and/or valve surgery. Design The ERIC-GTN trial is a single site, double-blind, randomised placebo-controlled study. Consenting adult patients (>18 years) undergoing elective CABG ±valve surgery with blood cardioplegia will be eligible for inclusion. 260 patients will be randomised to one of four treatment groups following aesthetic induction: (1) RIC alone : RIC protocol comprising three 5-minutes cycles of simultaneous upper arm and thigh cuff inflation/deflation followed by an intravenous (IV) placebo infusion; (2) GTN alone : A simulated sham RIC protocol will be applied followed by an IV GTN infusion; (3) RIC+GTN : RIC protocol followed by IV GTN infusion; and (4) Neither RIC or GTN : Sham RIC protocol followed by IV placebo infusion. The primary endpoint will be peri-operative myocardial injury as quantified by the 72 hour area-under-the-curve (AUC) serum high sensitive Troponin-T. Implication The ERIC-GTN trial will determine whether intra-operative GTN therapy is cardioprotective during cardiac surgery, and whether it affects RIC cardioprotection. We recruited 180 out of 260 patients so far and are currently undertaking a pre-specified interim analysis.

Published
2017

11. Diagnostic performance of T

Author

Heerajnarain, Bulluck, Stefania, Rosmini, Amna, Abdel-Gadir, Anish N, Bhuva, Thomas A, Treibel, Marianna, Fontana, Esther, Gonzalez-Lopez, Manish, Ramlall, Ashraf, Hamarneh, Alex, Sirker, Anna S, Herrey, Charlotte, Manisty, Derek M, Yellon, James C, Moon, and Derek J, Hausenloy

Subjects
Male, microvascular obstruction, Myocardial Infarction, Reproducibility of Results, Heart, Hemorrhage, Myocardial Reperfusion, Middle Aged, T1 mapping, Magnetic Resonance Imaging, Sensitivity and Specificity, T2 mapping, T2* mapping, ST‐segment elevation myocardial infarction, Humans, Female, Prospective Studies, Cardiac, intramyocardial hemorrhage, Original Research
Abstract

Purpose To investigate the performance of T 1 and T 2 mapping to detect intramyocardial hemorrhage (IMH) in ST‐segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). Materials and Methods Fifty STEMI patients were prospectively recruited between August 2013 and July 2014 following informed consent. Forty‐eight patients completed a 1.5T cardiac magnetic resonance imaging (MRI) with native T 1, T 2, and T2* maps at 4 ± 2 days. Receiver operating characteristic (ROC) analyses were performed to assess the performance of T 1 and T 2 to detect IMH. Results The mean age was 59 ± 13 years old and 88% (24/48) were male. In all, 39 patients had interpretable T2* maps and 26/39 (67%) of the patients had IMH ( T2*

Published
2016

12. High-sensitivity Troponin-T levels in reperfused STEMI patients: A comparison with CMR

Author

Ashraf Hamarneh, Steven K White, Derek J. Hausenloy, Heerajnarain Bulluck, James C. Moon, Manish Ramlall, Derek M. Yellon, and John Davies

Subjects
Medicine(all), medicine.medical_specialty, Radiological and Ultrasound Technology, business.industry, High Sensitivity Troponin T, Stemi patient, Text mining, Internal medicine, Poster Presentation, Cardiology, Medicine, Late gadolinium enhancement, Radiology, Nuclear Medicine and imaging, Radiology, Cardiology and Cardiovascular Medicine, business, Acute STEMI, Angiology
Published
2016

13. Left ventricular remodeling after reperfused acute myocardial infarction: insights from automated ECV mapping

Author

Thomas A. Treibel, Stefania Rosmini, Steven K White, James C. Moon, Derek J. Hausenloy, Peter Kellman, Charlotte Manisty, Anish N Bhuva, Patricia Reant, Ashraf Hamarneh, Heerajnarain Bulluck, Amna Abdel-Gadir, Anna S Herrey, Manish Ramlall, Marianna Fontana, and Alex Sirker

Subjects
Medicine(all), medicine.medical_specialty, Radiological and Ultrasound Technology, business.industry, medicine.disease, Infarct size, Walking Poster Presentation, Text mining, Internal medicine, medicine, Cardiology, Late gadolinium enhancement, Radiology, Nuclear Medicine and imaging, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Ventricular remodeling, Angiology
Published
2016

14. Chronic iron deposit and left ventricular remodeling in reperfused STEMI patients

Author

Patricia Reant, Peter Kellman, Anna S Herrey, Manish Ramlall, Derek J. Hausenloy, Heerajnarain Bulluck, Ashraf Hamarneh, Charlotte Manisty, Alex Sirker, Amna Abdel-Gadir, Stefania Rosmini, Marianna Fontana, Thomas A. Treibel, James C. Moon, Steven K White, and Anish N Bhuva

Subjects
Medicine(all), medicine.medical_specialty, Radiological and Ultrasound Technology, business.industry, 030204 cardiovascular system & hematology, medicine.disease, Stemi patient, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, Poster Presentation, Cardiology, Medicine, Late gadolinium enhancement, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Ventricular remodeling, Angiology
Published
2016

15. 014 Wideband free breathing MOCO LGE changes patient care in patients with implantable cardiac defibrillators

Author

Patricia Feuchter, Redha Boubertakh, James C. Moon, Richard J. Schilling, Peter Kellman, Kristopher D Knott, Manish Ramlall, Anish N Bhuva, Neha Sekhri, and Charlotte Manisty

Subjects
medicine.medical_specialty, business.industry, Steady-state free precession imaging, Patient care, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Ventricular tachycardia ablation, 030220 oncology & carcinogenesis, Internal medicine, Cardiology, Breathing, Medicine, Late gadolinium enhancement, Clinical significance, In patient, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Intensive care medicine, Free breathing
Abstract

Background There is a growing need for CMR in patients with implanted devices, who represent a high-risk cohort. Recent reports suggest CMR may be safely performed but artefact remains a significant limitation to late gadolinium enhancement (LGE). It is still unknown whether novel sequences to reduce artefact can be used efficiently or provide clinically useful information from scar imaging. Methods We used a novel free- breathing wideband MOCO sequence with PSIR (WB-MOCO) designed for a clinical environment. Patients with implantable cardiac devices (including MR non-conditional) referred clinically for CMR were scanned according to local standard operating procedure (based on national guidelines and Magnasafe Registry). WB-MOCO LGE approach was used primarily, with paired comparator conventional PSIR FLASH LGE or free breathing MOCO SSFP. Conventional and WB-MOCO LGE were assessed for artefact on a scale of 0 to 4 (0=no artefact, 4=completely obscured). A panel of three CMR cardiologists judged impact on patient care. Results Of the 67 patients (age 54±19 years, 47 male), 17 had ICDs, 9 cardiac resynchronisation devices, 19 pacemakers and 22 implantable loop recorders (ILR). 20 (44%) pulse generators were non-conditional; 11 (16%) inpatients; 10 (15%) with AF; 7 (10%) pacing dependent. Every patient referred was scanned successfully. 10 leads had parameter changes by Magnasafe criteria with no clinical significance, and 80% normalising at follow up (66±40 days). With conventional LGE imaging, 22 (33%) scans were non-diagnostic. WB-MOCO LGE completely removed artefact in 19 (87%), and achieved diagnosis in the remaining 3. 10 (15%) patients had significant artefact on conventional LGE, which WB completely or almost completely removed. Overall, CMR with WB-MOCO LGE changed management in an additional 26 (39%) patients compared to CMR with conventional LGE (33 patients, 49%). This benefit was in 77% of defibrillators, 25% of pacemakers and 5% of the ILR groups. Conclusion The WB-MOCO sequence permits high quality LGE imaging in device patients, and is robust enough for a clinical setting. This adds clinical utility particularly in defibrillator patients, also pacemaker patients but with limited utility in ILRs. Our electrophysiology department has now incorporated this into their protocol prior to ventricular tachycardia ablation.

Published
2017

17. Effekten af remote iskæmisk perkonditionering ved primær perkutan intervention af akut ST-elevations myokardieinfarkt

Author

Hausenloy, Derek J., Rajesh Kharbanda, Michael Rahbek Schmidt, Ulla Kristine Møller, Jan Ravkilde, Lisette Okkels Jensen, Thomas Engstrøm, Jose Manuel Garcia Ruiz, Nebosja Radovanovic, Christensen, Erica F., Henrik Toft Sørensen, Manish Ramlall, Heerajnarain Bulluck, Richard Evans, Jennifer Nicholas, Rosemary Knight, Tim Clayton, Yellon, Derek M., and Hans Erik Bøtker

Subjects
Adult, Male, education, Myocardial Infarction, Myocardial Reperfusion Injury, Middle Aged, Young Adult, Percutaneous Coronary Intervention, Treatment Outcome, parasitic diseases, Ischemic Preconditioning, Myocardial, Humans, Multicenter Studies as Topic, Female, Aged, Randomized Controlled Trials as Topic
Abstract

The rationale and study design for the multicentre, randomized, controlled CONDI2/ERIC-PPCI study are discussed.

Published
2015

18. Negative interaction between nitrates and remote ischemic preconditioning in patients undergoing cardiac surgery: the ERIC-GTN and ERICCA studies

Author

Ashraf Hamarneh, Andrew Fu Wah Ho, Heerajnarain Bulluck, Vivek Sivaraman, Federico Ricciardi, Jennifer Nicholas, Hilary Shanahan, Elizabeth A. Hardman, Peter Wicks, Manish Ramlall, Robin Chung, John McGowan, Roger Cordery, David Lawrence, Tim Clayton, Bonnie Kyle, Maria Xenou, Cono Ariti, Derek M. Yellon, and Derek J. Hausenloy

Subjects
Nitrates, Treatment Outcome, Troponin T, Physiology, Physiology (medical), Ischemic Preconditioning, Myocardial, Myocardial Infarction, Humans, Cardiac Surgical Procedures, Ischemic Preconditioning, Cardiology and Cardiovascular Medicine
Abstract

Remote ischaemic preconditioning (RIPC) using transient limb ischaemia failed to improve clinical outcomes following cardiac surgery and the reasons for this remain unclear. In the ERIC-GTN study, we evaluated whether concomitant nitrate therapy abrogated RIPC cardioprotection. We also undertook a post-hoc analysis of the ERICCA study, to investigate a potential negative interaction between RIPC and nitrates on clinical outcomes following cardiac surgery. In ERIC-GTN, 185 patients undergoing cardiac surgery were randomized to: (1) Control (no RIPC or nitrates); (2) RIPC alone; (3); Nitrates alone; and (4) RIPC + Nitrates. An intravenous infusion of nitrates (glyceryl trinitrate 1 mg/mL solution) was commenced on arrival at the operating theatre at a rate of 2–5 mL/h to maintain a mean arterial pressure between 60 and 70 mmHg and was stopped when the patient was taken off cardiopulmonary bypass. The primary endpoint was peri-operative myocardial injury (PMI) quantified by a 48-h area-under-the-curve high-sensitivity Troponin-T (48 h-AUC-hs-cTnT). In ERICCA, we analysed data for 1502 patients undergoing cardiac surgery to investigate for a potential negative interaction between RIPC and nitrates on clinical outcomes at 12-months. In ERIC-GTN, RIPC alone reduced 48 h-AUC-hs-cTnT by 37.1%, when compared to control (ratio of AUC 0.629 [95% CI 0.413–0.957], p = 0.031), and this cardioprotective effect was abrogated in the presence of nitrates. Treatment with nitrates alone did not reduce 48 h-AUC-hs-cTnT, when compared to control. In ERICCA there was a negative interaction between nitrate use and RIPC for all-cause and cardiovascular mortality at 12-months, and for risk of peri-operative myocardial infarction. RIPC alone reduced the risk of peri-operative myocardial infarction, compared to control, but no significant effect of RIPC was demonstrated for the other outcomes. When RIPC and nitrates were used together they had an adverse impact in patients undergoing cardiac surgery with the presence of nitrates abrogating RIPC-induced cardioprotection and increasing the risk of mortality at 12-months post-cardiac surgery in patients receiving RIPC.

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