68 results on '"Zemrak F"'
Search Results
2. Cardiac implantable electronic device infections: prognostic value of the PADIT score and its cost-utility implications for antimicrobial envelope use in the United Kingdom
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Mahtani, K, primary, Maclean, E, additional, Honarbakhsh, S, additional, Bhuva, A, additional, Finlay, M, additional, Creta, A, additional, Earley, M J, additional, Zemrak, F, additional, Moore, P, additional, Muthumala, A, additional, Sporton, S, additional, Schilling, R J, additional, Hunter, R J, additional, Monkhouse, C, additional, and Chow, A, additional
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- 2022
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3. Pharmacist-led medicines optimisation clinic for implantable cardiac device patients
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Patel, M, primary, Fhadil, S, additional, Zemrak, F, additional, Wright, P, additional, Rochford, C, additional, Jones, S, additional, Earley, M, additional, and Antoniou, S, additional
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- 2021
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4. Association between ambient air pollution and cardiac morpho-functional phenotypes: insights from the UK Biobank Population Imaging Study
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Aung, N, Sanghvi, MM, Zemrak, F, Lee, AM, Cooper, JA, Paiva, JM, Thomson, RJ, Fung, K, Khanji, MY, Lukaschuk, E, Carapella, V, Kim, YJ, Munroe, PB, Piechnik, SK, Neubauer, S, and Petersen, SE
- Abstract
Background: Exposure to ambient air pollution is strongly associated with increased cardiovascular morbidity and mortality. Little is known about the influence of air pollutants on cardiac structure and function. We aim to investigate the relationship between chronic past exposure to traffic-related pollutants and the cardiac chamber volume, ejection fraction, and left ventricular remodeling patterns after accounting for potential confounders. Methods: Exposure to ambient air pollutants including particulate matter and nitrogen dioxide was estimated from the Land Use Regression models for the years between 2005 and 2010. Cardiac parameters were measured from cardiovascular magnetic resonance imaging studies of 3920 individuals free from pre-existing cardiovascular disease in the UK Biobank population study. The median (interquartile range) duration between the year of exposure estimate and the imaging visit was 5.2 (0.6) years. We fitted multivariable linear regression models to investigate the relationship between cardiac parameters and traffic-related pollutants after adjusting for various confounders. Results: The studied cohort was 62±7 years old, and 46% were men. In fully adjusted models, particulate matter with an aerodynamic diameter Conclusions: In a large asymptomatic population with no prevalent cardiovascular disease, higher past exposure to particulate matter with an aerodynamic diameter
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- 2019
5. The impact of menopausal hormone therapy (MHT) on cardiac structure and function: Insights from the UK Biobank imaging enhancement study
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Sanghvi, MM, Aung, N, Cooper, JA, Paiva, JM, Lee, AM, Zemrak, F, Fung, K, Thomson, RJ, Lukaschuk, E, Carapella, V, Kim, YJ, Harvey, NC, Piechnik, SK, Neubauer, S, and Petersen, SE
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Aging ,Physiology ,Blood Pressure ,Comorbidity ,Cardiovascular Medicine ,Vascular Medicine ,Diagnostic Radiology ,Endocrinology ,Risk Factors ,Medicine and Health Sciences ,Cardiovascular Imaging ,Organic Compounds ,Radiology and Imaging ,Middle Aged ,Magnetic Resonance Imaging ,Stroke ,Postmenopause ,Chemistry ,Neurology ,Cardiovascular Diseases ,Physical Sciences ,Medicine ,Female ,Menopause ,Research Article ,Endocrine Disorders ,Imaging Techniques ,Hormone Replacement Therapy ,Science ,Cerebrovascular Diseases ,Heart Ventricles ,Cardiology ,Research and Analysis Methods ,Diagnostic Medicine ,Diabetes Mellitus ,Humans ,Heart Atria ,Endocrine Physiology ,Organic Chemistry ,Chemical Compounds ,Biology and Life Sciences ,Stroke Volume ,United Kingdom ,Cross-Sectional Studies ,Alcohols ,Metabolic Disorders ,Ejection Fraction ,Follow-Up Studies - Abstract
Background The effect of menopausal hormone therapy (MHT)±previously known as hormone replacement therapy±on cardiovascular health remains unclear and controversial. This cross-sectional study examined the impact of MHT on left ventricular (LV) and left atrial (LA) structure and function, alterations in which are markers of subclinical cardiovascular disease, in a population-based cohort. Methods Post-menopausal women who had never used MHT and those who had used MHT ≥3 years participating in the UK Biobank who had undergone cardiovascular magnetic resonance (CMR) imaging and free of known cardiovascular disease were included. Multivariable linear regression was performed to examine the relationship between cardiac parameters and MHT use ≥3 years. To explore whether MHT use on each of the cardiac outcomes differed by age, multivariable regression models were constructed with a crossproduct of age and MHT fitted as an interaction term. Results Of 1604 post-menopausal women, 513 (32%) had used MHT ≥3 years. In the MHT cohort, median age at menopause was 50 (IQR: 45±52) and median duration of MHT was 8 years. In the non-MHT cohort, median age at menopause was 51 (IQR: 48±53). MHT use was associated with significantly lower LV end-diastolic volume (122.8 ml vs 119.8 ml, effect size = -2.4%, 95% CI: -4.2% to -0.5%; p = 0.013) and LA maximal volume (60.2 ml vs 57.5 ml, effect size = -4.5%, 95% CI: -7.8% to -1.0%; p = 0.012). There was no significant difference in LV mass. MHT use significantly modified the effect between age and CMR parameters; MHT users had greater decrements in LV end-diastolic volume, LV end-systolic volume and LA maximal volume with advancing age. Conclusions MHT use was not associated with adverse, subclinical changes in cardiac structure and function. Indeed, significantly smaller LV and LA chamber volumes were observed which have been linked to favourable cardiovascular outcomes. These findings represent a novel approach to examining MHT's effect on the cardiovascular system.
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- 2018
6. Automated cardiovascular magnetic resonance image analysis with fully convolutional networks
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Bai, W, Sinclair, M, Tarroni, G, Oktay, O, Rajchl, M, Vaillant, G, Lee, AM, Aung, N, Lukaschuk, E, Sanghvi, MM, Zemrak, F, Fung, K, Paiva, JM, Carapella, V, Kim, YJ, Suzuki, H, Kainz, B, Matthews, PM, Petersen, SE, Piechnik, SK, Neubauer, S, Glocker, B, Rueckert, D, Engineering & Physical Science Research Council (E, Engineering & Physical Science Research Council (EPSRC), UK DRI Ltd, Medical Research Council (MRC), and Imperial College London
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FOS: Computer and information sciences ,Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,LEFT-VENTRICLE ,Cardiac & Cardiovascular Systems ,Databases, Factual ,Heart Diseases ,Computer Vision and Pattern Recognition (cs.CV) ,Computer Science - Computer Vision and Pattern Recognition ,SEGMENTATION ,Magnetic Resonance Imaging, Cine ,DIAGNOSIS ,Ventricular Function, Left ,Automation ,Deep Learning ,Predictive Value of Tests ,Machine learning ,Image Interpretation, Computer-Assisted ,LEVEL SET ,Humans ,Fully convolutional networks ,1102 Cardiorespiratory Medicine and Haematology ,cs.CV ,080104 Computer Vision ,Aged ,Observer Variation ,Science & Technology ,T1 ,Research ,Radiology, Nuclear Medicine & Medical Imaging ,Reproducibility of Results ,Stroke Volume ,Middle Aged ,Myocardial Contraction ,Nuclear Medicine & Medical Imaging ,CMR image analysis ,lcsh:RC666-701 ,Cardiovascular System & Cardiology ,cardiovascular system ,Ventricular Function, Right ,HEART-FAILURE ,Female ,08 Information and Computing Sciences ,Neural Networks, Computer ,Life Sciences & Biomedicine ,RC - Abstract
Cardiovascular magnetic resonance (CMR) imaging is a standard imaging modality for assessing cardiovascular diseases (CVDs), the leading cause of death globally. CMR enables accurate quantification of the cardiac chamber volume, ejection fraction and myocardial mass, providing information for diagnosis and monitoring of CVDs. However, for years, clinicians have been relying on manual approaches for CMR image analysis, which is time consuming and prone to subjective errors. It is a major clinical challenge to automatically derive quantitative and clinically relevant information from CMR images. Deep neural networks have shown a great potential in image pattern recognition and segmentation for a variety of tasks. Here we demonstrate an automated analysis method for CMR images, which is based on a fully convolutional network (FCN). The network is trained and evaluated on a large-scale dataset from the UK Biobank, consisting of 4,875 subjects with 93,500 pixelwise annotated images. The performance of the method has been evaluated using a number of technical metrics, including the Dice metric, mean contour distance and Hausdorff distance, as well as clinically relevant measures, including left ventricle (LV) end-diastolic volume (LVEDV) and end-systolic volume (LVESV), LV mass (LVM); right ventricle (RV) end-diastolic volume (RVEDV) and end-systolic volume (RVESV). By combining FCN with a large-scale annotated dataset, the proposed automated method achieves a high performance on par with human experts in segmenting the LV and RV on short-axis CMR images and the left atrium (LA) and right atrium (RA) on long-axis CMR images., Comment: Accepted for publication by Journal of Cardiovascular Magnetic Resonance
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- 2018
7. Variation in lung function and alterations in cardiac structure and function-Analysis of the UK Biobank cardiovascular magnetic resonance imaging substudy
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Thomson, RJ, Aung, N, Sanghvi, MM, Paiva, JM, Lee, AM, Zemrak, F, Fung, K, Pfeffer, PE, Mackay, AJ, McKeever, TM, Lukaschuk, E, Carapella, V, Kim, YJ, Bolton, CE, Piechnik, SK, Neubauer, S, and Petersen, SE
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Male ,Pulmonology ,Physiology ,Science ,Cerebrovascular Diseases ,Cardiology ,Pulmonary Function ,Blood Pressure ,Linear Regression Analysis ,Research and Analysis Methods ,Vascular Medicine ,Mathematical and Statistical Techniques ,Heart Rate ,Forced Expiratory Volume ,Medicine and Health Sciences ,Respiratory Analysis ,Humans ,Respiratory Physiology ,Prospective Studies ,Statistical Methods ,Lung ,Biological Specimen Banks ,Myocardium ,Biology and Life Sciences ,Heart ,Stroke Volume ,Middle Aged ,Magnetic Resonance Imaging ,United Kingdom ,Respiratory Function Tests ,Stroke ,Bioassays and Physiological Analysis ,Neurology ,Spirometry ,Physical Sciences ,Linear Models ,Medicine ,Regression Analysis ,Female ,Mathematics ,Statistics (Mathematics) ,Research Article ,Ejection Fraction - Abstract
Background Reduced lung function is common and associated with increased cardiovascular morbidity and mortality, even in asymptomatic individuals without diagnosed respiratory disease. Previous studies have identified relationships between lung function and cardiovascular structure in individuals with pulmonary disease, but the relationships in those free from diagnosed cardiorespiratory disease have not been fully explored. Methods UK Biobank is a prospective cohort study of community participants in the United Kingdom. Individuals self-reported demographics and co-morbidities, and a subset underwent cardiovascular magnetic resonance (CMR) imaging and spirometry. CMR images were analysed to derive ventricular volumes and mass. The relationships between CMR-derived measures and spirometry and age were modelled with multivariable linear regression, taking account of the effects of possible confounders. Results Data were available for 4,975 individuals, and after exclusion of those with pre-existing cardiorespiratory disease and unacceptable spirometry, 1,406 were included in the analyses. In fully-adjusted multivariable linear models lower FEV1 and FVC were associated with smaller left ventricular end-diastolic (−5.21ml per standard deviation (SD) change in FEV1, −5.69ml per SD change in FVC), end-systolic (−2.34ml, −2.56ml) and stroke volumes (−2.85ml, −3.11ml); right ventricular end-diastolic (−5.62ml, −5.84ml), end-systolic (−2.47ml, −2.46ml) and stroke volumes (−3.13ml, −3.36ml); and with lower left ventricular mass (−2.29g, −2.46g). Changes of comparable magnitude and direction were observed per decade increase in age. Conclusions This study shows that reduced FEV1 and FVC are associated with smaller ventricular volumes and reduced ventricular mass. The changes seen per standard deviation change in FEV1 and FVC are comparable to one decade of ageing.
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- 2018
8. 247Characterisation of pleural and pericardial effusions with T1 mapping
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Rosmini, S, primary, Seraphim, A, additional, Captur, G, additional, Gomes, A C, additional, Zemrak, F, additional, Treibel, T A, additional, Cash, L, additional, Culotta, V, additional, O"mahony, C, additional, Kellman, P, additional, Moon, J C, additional, and Manisty, C, additional
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- 2019
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9. Human-level CMR image analysis with deep fully convolutional networks
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Bai, W, Sinclair, M, Tarroni, G, Oktay, O, Rajchl, M, Vaillant, G, Lee, AM, Aung, N, Lukaschuk, E, Sanghvi, MM, Zemrak, F, Fung, K, Paiva, JM, Carapella, V, Kim, YJ, Suzuki, H, Kainz, B, Matthews, PM, Petersen, SE, Piechnik, SK, Neubauer, S, Glocker, B, and Rueckert, D
- Subjects
cardiovascular system ,cardiovascular diseases ,cs.CV - Abstract
Cardiovascular magnetic resonance (CMR) imaging is a standard imaging modality for assessing cardiovascular diseases (CVDs), the leading cause of death globally. CMR enables accurate quantification of the cardiac chamber volume, ejection fraction and myocardial mass, providing a wealth of information for sensitive and specific diagnosis and monitoring of CVDs. However, for years, clinicians have been relying on manual approaches for CMR image analysis, which is time consuming and prone to subjective errors. It is a major clinical challenge to automatically derive quantitative and clinically relevant information from CMR images. Deep neural networks have shown a great potential in image pattern recognition and segmentation for a variety of tasks. Here we demonstrate an automated analysis method for CMR images, which is based on a fully convolutional network (FCN). The network is trained and evaluated on a dataset of unprecedented size, consisting of 4,875 subjects with 93,500 pixelwise annotated images, which is by far the largest annotated CMR dataset. By combining FCN with a large-scale annotated dataset, we show for the first time that an automated method achieves a performance on par with human experts in analysing CMR images and deriving clinical measures. We anticipate this to be a starting point for automated and comprehensive CMR analysis with human-level performance, facilitated by machine learning. It is an important advance on the pathway towards computer-assisted CVD assessment.
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- 2017
10. The impact of cardiovascular risk factors on cardiac structure and function: Insights from the UK Biobank imaging enhancement study
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Petersen, SE, Sanghvi, MM, Aung, N, Cooper, JA, Paiva, JM, Zemrak, F, Fung, K, Lukaschuk, E, Lee, AM, Carapella, V, Kim, YJ, Piechnik, SK, Neubauer, S, and Fukumoto, Y
- Abstract
Aims The UK Biobank is a large-scale population-based study utilising cardiovascular magnetic resonance (CMR) to generate measurements of atrial and ventricular structure and function. This study aimed to quantify the association between modifiable cardiovascular risk factors and cardiac morphology and function in individuals without known cardiovascular disease. Methods Age, sex, ethnicity (non-modifiable) and systolic blood pressure, diastolic blood pressure, smoking status, exercise, body mass index (BMI), high cholesterol, diabetes, alcohol intake (modifiable) were considered important cardiovascular risk factors. Multivariable regression models were built to ascertain the association of risk factors on left ventricular (LV), right ventricular (RV), left atrial (LA) and right atrial (RA) CMR parameters. Results 4,651 participants were included in the analysis. All modifiable risk factors had significant effects on differing atrial and ventricular parameters. BMI was the modifiable risk factor most consistently associated with subclinical changes to CMR parameters, particularly in relation to higher LV mass (+8.3% per SD [4.3 kg/m2], 95% CI: 7.6 to 8.9%), LV (EDV: +4.8% per SD, 95% CI: 4.2 to 5.4%); ESV: +4.4% per SD, 95% CI: 3.5 to 5.3%), RV (EDV: +5.3% per SD, 95% CI: 4.7 to 5.9%; ESV: +5.4% per SD, 95% CI: 4.5 to 6.4%) and LA maximal (+8.6% per SD, 95% CI: 7.4 to 9.7%) volumes. Increases in SBP were associated with higher LV mass (+6.8% per SD, 95% CI: 5.9 to 7.7%), LV (EDV: +4.5% per SD, 95% CI: 3.6 to 5.4%; ESV: +2.0% per SD, 95% CI: 0.8 to 3.3%) volumes. The presence of diabetes or high cholesterol resulted in smaller volumes and lower ejection fractions. Conclusions Modifiable risk factors are associated with subclinical alterations in structure and function in all four cardiac chambers. BMI and systolic blood pressure are the most important modifiable risk factors affecting CMR parameters known to be linked to adverse outcomes.
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- 2017
11. P3693Impact of cardiovascular risk factors on atlas-based left ventricular shape phenotypes
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Aung, N, primary, Gilbert, K, additional, Suinesiaputra, A, additional, Lee, A, additional, Sanghvi, M M, additional, Zemrak, F, additional, Fung, K, additional, Paiva, J M, additional, Lukaschuk, E, additional, Carapella, V, additional, Kim, Y J, additional, Piechnik, S K, additional, Neubauer, S, additional, Young, A A, additional, and Petersen, S E, additional
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- 2018
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12. 2896Age attenuates the relationship between systolic blood pressure and left ventricular mass: evidence from the UK Biobank
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Aung, N., primary, Sanghvi, M.M., additional, Zemrak, F., additional, Cooper, J.A., additional, Paiva, J.M., additional, Thomson, R.J., additional, Fung, K., additional, Lukaschuk, E., additional, Lee, A., additional, Carapella, V., additional, Kim, Y.J., additional, Piechnik, S.K., additional, Neubauer, S., additional, and Petersen, S.E., additional
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- 2017
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13. P3992Relationship between left ventricular trabeculation and physical activity in a middle-aged population cohort
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Aung, N., primary, Woodbridge, S.P., additional, Paiva, J.M., additional, Sanghvi, M.M., additional, Zemrak, F., additional, Cooper, J.A., additional, Thomson, R.J., additional, Fung, K., additional, Lukaschuk, E., additional, Lee, A., additional, Carapella, V., additional, Kim, Y.J., additional, Piechnik, S.K., additional, Neubauer, S., additional, and Petersen, S.E., additional
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- 2017
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14. LB01.07
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Khanji, M., primary, Balawon, A., additional, Boubertakh, R., additional, Zemrak, F., additional, Collier, D., additional, Caulfield, M.J., additional, and Petersen, S.E., additional
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- 2015
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15. These abstracts have been selected for presentation in 4 sessions throughout the meeting. Please refer to the PROGRAM for more details.
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Munch, F., primary, Retel, J., additional, Jeuthe, S., additional, van Rossum, B., additional, Oh-Ici, D., additional, Berger, F., additional, Kuhne, T., additional, Oschkinat, H., additional, Messroghli, D., additional, Rodriguez Palomares, J., additional, Gutierrez Garcia Moreno, L., additional, Maldonado, G., additional, Garcia, G., additional, Otaegui, I., additional, Garcia Del Blanco, B., additional, Barrabes, J., additional, Gonzalez Alujas, M., additional, Evangelista, A., additional, Garcia Dorado, D., additional, Barison, A., additional, Del Torto, A., additional, Chiappino, S., additional, Del Franco, A., additional, Pugliese, N., additional, Aquaro, G., additional, Positano, V., additional, Passino, C., additional, Emdin, M., additional, Masci, P., additional, Fischer, K., additional, Guensch, D., additional, Shie, N., additional, Friedrich, M., additional, Captur, G., additional, Zemrak, F., additional, Muthurangu, V., additional, Chunming, L., additional, Petersen, S., additional, Kawel-Boehm, N., additional, Bassett, P., additional, Elliott, P., additional, Lima, J., additional, Bluemke, D., additional, Moon, J., additional, Pontone, G., additional, Bertella, E., additional, Loguercio, M., additional, Baggiano, A., additional, Mushtaq, S., additional, Salerni, S., additional, Rossi, C., additional, Andreini, D., additional, Ucar, E., additional, Baydes, R., additional, Ngah, N., additional, Kuo, Y., additional, Dabir, D., additional, Cummins, C., additional, Higgins, D., additional, Schaeffter, T., additional, Gaddum, N., additional, Chowienczyk, P., additional, Carr-White, G., additional, Marber, M., additional, Ucar, S., additional, Reinstadler, S., additional, Klug, G., additional, Feistritzer, H., additional, Greber, K., additional, Mair, J., additional, Schocke, M., additional, Franz, W., additional, Metzler, B., additional, Moschetti, K., additional, Pilz, G., additional, Wasserfallen, J., additional, Lombardi, M., additional, Korosoglou, G., additional, Van Rossum, A., additional, Bruder, O., additional, Mahrholdt, H., additional, Schwitter, J., additional, Ferreira Gonzalez, I., additional, Pineda, V., additional, Ruiz Salmeron, R., additional, San Roman, A., additional, Fernandez Aviles, F., additional, Winkler, S., additional, Allison, T., additional, Conn, H., additional, Bandettini, P., additional, Shanbhag, S., additional, Kellman, P., additional, Hsu, L., additional, Arai, A., additional, Pernter, B., additional, Pica, S., additional, Sado, D., additional, Maestrini, V., additional, Fontana, M., additional, White, S., additional, Treibel, T., additional, Anderson, S., additional, Piechnik, S., additional, Robson, M., additional, Lachmann, R., additional, Murphy, E., additional, Mehta, A., additional, Hughes, D., additional, Ferreira, V., additional, Dall'Armellina, E., additional, Karamitsos, T., additional, Francis, J., additional, Choudhury, R., additional, Banning, A., additional, Channon, K., additional, Kharbanda, R., additional, Forfar, C., additional, Ormerod, O., additional, Prendergast, B., additional, Kardos, A., additional, Newton, J., additional, Neubauer, S., additional, Vergaro, G., additional, Mirizzi, G., additional, Florian, A., additional, Ludwig, A., additional, Rosch, S., additional, Sechtem, U., additional, Yilmaz, A., additional, Greulich, S., additional, Kitterer, D., additional, Latus, J., additional, Bentz, K., additional, Birkmeier, S., additional, Alscher, M., additional, Braun, N., additional, Perfetto, F., additional, Secchi, F., additional, Petrini, M., additional, Cannao, P., additional, Di Leo, G., additional, Sardanelli, F., additional, Yoshihara, H., additional, Bastiaansen, J., additional, Berthonneche, C., additional, Comment, A., additional, Gerber, B., additional, Noppe, G., additional, Marquet, N., additional, Buchlin, P., additional, Vanoverschelde, J., additional, Bertrand, L., additional, Horman, S., additional, Dorota, P., additional, Piotr, W., additional, Marek, G., additional, Almeida, A., additional, Cortez-Dias, N., additional, de Sousa, J., additional, Carpinteiro, L., additional, Magalhaes, A., additional, Silva, G., additional, Bernardes, A., additional, Pinto, F., additional, and Nunes Diogo, A., additional
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- 2014
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16. Rennies, Crohn's disease and severe hypercalcaemia
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Zemrak, F., primary, McNeil, L., additional, and Peden, N., additional
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- 2010
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17. Late Gadolinium Enhancement CMR Predicts Adverse Cardiovascular Outcomes and Mortality in Patients With Coronary Artery Disease: Systematic Review and Meta-Analysis.
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Zemrak F and Petersen SE
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Cardiovascular magnetic resonance (CMR) has a recognized role in diagnosing and monitoring coronary artery disease (CAD). Multiple studies have shown that CMR can predict adverse outcomes. We reviewed contemporary available literature to establish the role of CMR with late gadolinium enhancement (LGE) in predicting mortality and major adverse cardiac events (MACEs) in patients with CAD. Meta-analysis of available prospective studies showed that the presence of LGE increases the hazards of death by more than 4 times and of MACE by almost 4 times. The size of LGE (per gram or percent) increases the hazards of death and MACE by 4% and 5%, respectively. The presence and size of LGE predict mortality and MACE in CAD. Various parameters derived from LGE images enhance the predictive value. Large randomized controlled trials are needed to establish the actual value of LGE and other derived parameters in the wider population. [ABSTRACT FROM AUTHOR]
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- 2011
18. 247 Characterisation of pleural and pericardial effusions with T1 mapping.
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Rosmini, S, Seraphim, A, Captur, G, Gomes, A C, Zemrak, F, Treibel, T A, Cash, L, Culotta, V, O"mahony, C, Kellman, P, Moon, J C, and Manisty, C
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CONFERENCES & conventions ,EXUDATES & transudates ,MAGNETIC resonance imaging ,PLEURAL effusions ,PERICARDIAL effusion - Published
- 2019
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19. Relationship of regional myocardial deformation and myocardial fibrosis to myocardial trabeculation: The Multi-Ethnic Study of Atherosclerosis
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Kawel-Boehm N, McClelland R, Zemrak F, Captur G, Hundley G, Liu C, Moon J, Steffen Petersen, Ba, Venkatesh, Ja, Lima, and Da, Bluemke
20. Can left ventricular endocardial surface roughness be measured by fractal dimension on fast gradient echo sequences?
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Zemrak F, Captur G, Feuchter P, Manisty C, Westwood M, Saidi Mohiddin, Jc, Moon, and Se, Petersen
21. Automatic left ventricular analysis with Inline VF performs well compared to manual analysis: results from Barts Cardiovascular Registry
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Mm, Sanghvi, Feuchter P, Zemrak F, Boubertakh R, Suinesiaputra A, Young A, Weerackody R, Sekhri N, As, Herrey, Manisty C, Davies C, Westwood M, Moon J, and Steffen Petersen
22. The association of left atrial volume with age, ethnicity and cardiovascular risk factors in men and women: the Multi-Ethnic Study of Atherosclerosis (MESA)
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Zemrak F, Ba, Venkatesh, Captur G, Chrispin J, Eh, Chamera, Habibi M, Nazarian S, Sa, Mohiddin, Moon J, Steffen Petersen, Ja, Lima, and Da, Bluemke
23. Diffuse interstitial fibrosis in well-controlled hypertension
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Treibel Thomas A, Zemrak Filip, White Steven K, Sado Daniel, Banypersad Sanjay M, Maestrini Viviana, Caulfield Mark, Petersen Steffen E, and Moon James
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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24. Cardiac magnetic resonance myocardial feature tracking: feasibility for use in left ventricular non-compaction
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Stone Ian S, Boubertakh Redha, Stephenson Edward J, Zemrak Filip, Weerackody Roshan, Sekhri Neha, Westwood Mark A, Davies Ceri, Mohiddin Saidi A, and Petersen Steffen E
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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25. Interstitial expansion in pressure overload left ventricular hypertrophy
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Treibel Thomas A, White Steven K, Sado Daniel, Zemrak Filip, Banypersad Sanjay M, Flett Andrew, Caulfield Mark, Herrey Anna S, Petersen Steffen E, and Moon James
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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26. Cardiovascular changes in patients with adult-onset growth hormone deficiency assessed by CMR
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Dattani Abhishek, Thomas Julia, Zemrak Filip, Burchell Thomas R, Petersen Steffen E, Grossman Ashley, Korbonits Marta, and Davies Ceri
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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27. Left and right ventricular function in acutely presenting myocarditis: sparing of the right ventricle
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Davies Ceri, Petersen Steffen, Westwood Mark, Mathur Anthony, Pugliese Francesca, Anand Vijay, Mozid Abdul, Sekhri Neha, Zemrak Filip, Velmurugan Shanti, Mohiddin Saidi, and Boubertakh Redha
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2011
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28. Emergency pacemaker implantation in nonagenarians with CHB: single-versus dual-chamber pacing.
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Mahtani K, Maclean E, Parker M, Vyas R, Wang RB, Roelas M, Ahluwalia N, Kanthasamy V, Creta A, Finlay M, Hunter RJ, Ahsan S, Earley MJ, Lambiase PD, Elliott J, Zemrak F, Muthumala A, Moore P, Sporton S, Chow A, and Monkhouse C
- Abstract
In ambulatory patients with complete heart block (CHB), dual-chamber (DDD) pacing confers physiological benefits versus single-chamber (VVI) pacing, however, the impact on mortality is disputed. Nonagenarians constitute an expanding proportion of pacemaker recipients, yet data on device selection and outcomes are limited, especially in emergency situations. In nonagenarians with emergent CHB, we compared the clinical characteristics and outcomes of patients receiving VVI versus DDD pacemakers. Cox proportional-hazards analysis examined all-cause mortality and death from congestive cardiac failure (CCF). There were 168 consecutive patients followed-up for 30.6 ± 15.5 months. Of these, 22 patients (13.1%) received VVI pacemakers; when compared with DDD recipients, these patients had similar median age (93 vs. 91 years, p=0.15) and left ventricular (LV) systolic function (LV ejection fraction [EF] 49.2% ± 9.7 vs. 50.7% ± 10.1, p=0.71), but were more frail (Rockwood scale 5.2 ± 1.8 vs. 4.3 ± 1.1, p=0.004) and more likely to have dementia (27.3% vs. 8.9%, p=0.011). Post-implant, device interrogation demonstrated that VVI recipients had higher respiratory rates (21.3 ± 2.4 vs. 17.5 ± 2.6 breaths per minute, p=0.002), lower mean heart rates (65.5 ± 10.1 vs. 71.9 ± 8.6 bpm, p=0.002), and lower daily activity levels (0.57 ± 0.3 vs. 1.5 ± 1.1 hours of activity, p=0.016) than DDD recipients. Adjusting for age, frailty and dementia, VVI pacing was associated with an increased risk of all-cause mortality (adjusted hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.08 to 4.1, p=0.03) and death from CCF (adjusted HR 7.1, 95%CI 2.5 to 20.6, p<0.001). In conclusion, in nonagenarians with emergent CHB, dual-chamber pacing was associated with improved symptomatic and prognostic outcomes versus singlechamber pacing., Competing Interests: Conflicts of interest None declared., (Copyright © 2024 Medinews (Cardiology) Limited.)
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- 2024
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29. Effect of Sodium-Glucose Cotransporter 2 Inhibitors in Adults With Congenital Heart Disease.
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Neijenhuis RML, MacDonald ST, Zemrak F, Mertens BJA, Dinsdale A, Hunter A, Walker NL, Swan L, Reddy S, Rotmans JI, Jukema JW, Jongbloed MRM, Veldtman GR, and Egorova AD
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Diabetes Mellitus, Type 2 drug therapy, Retrospective Studies, Heart Defects, Congenital drug therapy, Heart Failure drug therapy
- Abstract
Background: Heart failure (HF) is the principal cause of morbidity and mortality in adults with congenital heart disease (ACHD). Robust evidence-based treatment options are lacking., Objectives: This study aims to evaluate the safety, tolerability, and short-term HF-related effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in a real-world ACHD population., Methods: All patients with ACHD treated with SGLT2i in 4 European ACHD centers were included in this retrospective study. Data were collected from 1 year before starting SGLT2i to the most recent follow-up. Data on side effects, discontinuation, mortality, and hospitalizations were collected., Results: In total, 174 patients with ACHD were treated with SGLT2i from April 2016 to July 2023. The mean age was 48.7 ± 15.3 years, 72 (41.4%) were female, and 29 (16.7%) had type 2 diabetes mellitus. Ten (5.7%) patients had mild, 75 (43.1%) moderate, and 89 (51.1%) severe congenital heart disease. HF was the most frequent starting indication (n = 162, 93.1%), followed by type 2 diabetes (n = 11, 6.3%) and chronic kidney disease (n = 1, 0.6%). At median follow-up of 7.7 months (Q1-Q3: 3.9-13.2 months), 18 patients (10.3%) reported side effects, 12 (6.9%) permanently discontinued SGLT2i, and 4 (2.3%) died of SGLT2i-unrelated causes. A significant reduction in the HF hospitalization rate was observed from 6 months before to 6 months after starting SGLT2i (relative rate = 0.30; 95% CI: 0.14-0.62; P = 0.001)., Conclusions: SGLT2i generally seem safe, well-tolerated, and potentially beneficial in patients with ACHD. SGLT2i was associated with a 3-fold reduction in the 6-month HF hospitalization rate. These results warrant prospective randomized investigation of the potential benefits of SGLT2i for patients with ACHD., Competing Interests: Funding Support and Author Disclosures Dr Neijenhuis has received support from the Foundation “De Drie Lichten” (Hilversum, the Netherlands), AstraZeneca, and the Leiden University Medical Center research council Cardio-Vascular cluster Themes for Innovation funding. Dr Zemrak has received speaker fees from Abbott Laboratories. Dr Rotmans has received an unrestricted research grant from AstraZeneca. Dr Jongbloed has received support from the Leiden University Medical Center research council Cardio-Vascular cluster Themes for Innovation funding; and has received a personal grant from the NWO/ZonMw (The Hague, the Netherlands), the Bontius Foundation (Leiden, the Netherlands), and the Rembrandt Institute (Leiden, the Netherlands). Dr Egorova has received support from the Leiden University Medical Center research council Cardio-Vascular cluster Themes for Innovation funding; and has received consultancy and speaker fees from Boston Scientific Corporation and Medtronic Inc. The Department of Cardiology of the Leiden University Medical Center has received unrestricted research and educational grants from Boston Scientific Corporation, Medtronic, and Biotronik. The funders were not involved in study design, collection, analysis, interpretation of data, the writing of this paper, or the decision to submit it for publication. No artificial intelligence programs contributed to the compilation of the submitted manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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30. Sequencing and titrating approach of therapy in heart failure with reduced ejection fraction following the 2021 European Society of Cardiology guidelines: an international cardiology survey.
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Fauvel C, Bonnet G, Mullens W, Giraldo CIS, Mežnar AZ, Barasa A, Tokmakova M, Shchendrygina A, Costa FM, Mapelli M, Zemrak F, Tops LF, Jakus N, Sultan A, Bahouth F, Hadjseyd CE, Salvat M, Anselmino M, Messroghli D, Weberndörfer V, Giverts I, Bochaton T, Courand PY, Berthelot E, Legallois D, Beauvais F, Bauer F, Lamblin N, Damy T, Girerd N, Sebbag L, Pezel T, Cohen-Solal A, Rosano G, Roubille F, and Mewton N
- Subjects
- Humans, Male, Adult, Middle Aged, Female, Stroke Volume, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Adrenergic beta-Antagonists therapeutic use, Mineralocorticoid Receptor Antagonists therapeutic use, Heart Failure drug therapy, Ventricular Dysfunction, Left drug therapy, Cardiology
- Abstract
Aims: In symptomatic patients with heart failure and reduced ejection fraction (HFrEF), recent international guidelines recommend initiating four major therapeutic classes rather than sequential initiation. It remains unclear how this change in guidelines is perceived by practicing cardiologists versus heart failure (HF) specialists., Methods and Results: An independent academic web-based survey was designed by a group of HF specialists and posted by email and through various social networks to a broad community of cardiologists worldwide 1 year after the publication of the latest European HF guidelines. Overall, 615 cardiologists (38 [32-47] years old, 63% male) completed the survey, of which 58% were working in a university hospital and 26% were HF specialists. The threshold to define HFrEF was ≤40% for 61% of the physicians. Preferred drug prescription for the sequential approach was angiotensin-converting enzyme inhibitors or angiotensin receptor-neprilysin inhibitors first (74%), beta-blockers second (55%), mineralocorticoid receptor antagonists third (52%), and sodium-glucose cotransporter 2 inhibitors (53%) fourth. Eighty-four percent of participants felt that starting all four classes was feasible within the initial hospitalization, and 58% felt that titration is less important than introducing a new class. Age, status in training, and specialization in HF field were the principal characteristics that significantly impacted the answers., Conclusion: In a broad international cardiology community, the 'historical approach' to HFrEF therapies remains the preferred sequencing approach. However, accelerated introduction and uptitration are also major treatment goals. Strategy trials in treatment guidance are needed to further change practices., (© 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
- Published
- 2023
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31. Non-invasive characterization of pleural and pericardial effusions using T1 mapping by magnetic resonance imaging.
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Rosmini S, Seraphim A, Knott K, Brown JT, Knight DS, Zaman S, Cole G, Sado D, Captur G, Gomes AC, Zemrak F, Treibel TA, Cash L, Culotta V, O'Mahony C, Kellman P, Moon JC, and Manisty C
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- Exudates and Transudates diagnostic imaging, Exudates and Transudates metabolism, Humans, Magnetic Resonance Imaging, Retrospective Studies, Pericardial Effusion diagnostic imaging, Pleural Effusion diagnostic imaging
- Abstract
Aims: Differentiating exudative from transudative effusions is clinically important and is currently performed via biochemical analysis of invasively obtained samples using Light's criteria. Diagnostic performance is however limited. Biochemical composition can be measured with T1 mapping using cardiovascular magnetic resonance (CMR) and hence may offer diagnostic utility for assessment of effusions., Methods and Results: A phantom consisting of serially diluted human albumin solutions (25-200 g/L) was constructed and scanned at 1.5 T to derive the relationship between fluid T1 values and fluid albumin concentration. Native T1 values of pleural and pericardial effusions from 86 patients undergoing clinical CMR studies retrospectively analysed at four tertiary centres. Effusions were classified using Light's criteria where biochemical data was available (n = 55) or clinically in decompensated heart failure patients with presumed transudative effusions (n = 31). Fluid T1 and protein values were inversely correlated both in the phantom (r = -0.992) and clinical samples (r = -0.663, P < 0.0001). T1 values were lower in exudative compared to transudative pleural (3252 ± 207 ms vs. 3596 ± 213 ms, P < 0.0001) and pericardial (2749 ± 373 ms vs. 3337 ± 245 ms, P < 0.0001) effusions. The diagnostic accuracy of T1 mapping for detecting transudates was very good for pleural and excellent for pericardial effusions, respectively [area under the curve 0.88, (95% CI 0.764-0.996), P = 0.001, 79% sensitivity, 89% specificity, and 0.93, (95% CI 0.855-1.000), P < 0.0001, 95% sensitivity; 81% specificity]., Conclusion: Native T1 values of effusions measured using CMR correlate well with protein concentrations and may be helpful for discriminating between transudates and exudates. This may help focus the requirement for invasive diagnostic sampling, avoiding unnecessary intervention in patients with unequivocal transudative effusions., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
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32. Valvular heart disease in the community: the unknown knowns in electronic health record coding.
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Mangan C, Zemrak F, Banerjee A, Bhattacharyya S, Treibel TA, and Lloyd G
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- Humans, Electronic Health Records, Heart Valve Diseases epidemiology
- Published
- 2021
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33. Delayed-onset myocarditis following COVID-19.
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Bajaj R, Sinclair HC, Patel K, Low B, Pericao A, Manisty C, Guttmann O, Zemrak F, Miller O, Longhi P, Proudfoot A, Lams B, Agarwal S, Marelli-Berg FM, Tiberi S, Cutino-Moguel T, Carr-White G, and Mohiddin SA
- Subjects
- Adult, Biomarkers blood, COVID-19 diagnosis, COVID-19 immunology, COVID-19 virology, COVID-19 Nucleic Acid Testing, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Myocarditis blood, Myocarditis diagnosis, Myocarditis mortality, RNA, Viral isolation & purification, SARS-CoV-2 genetics, SARS-CoV-2 isolation & purification, Shock, Cardiogenic blood, Shock, Cardiogenic diagnosis, Shock, Cardiogenic mortality, Systemic Inflammatory Response Syndrome blood, Systemic Inflammatory Response Syndrome diagnosis, Systemic Inflammatory Response Syndrome mortality, Time Factors, Young Adult, COVID-19 complications, Myocarditis immunology, SARS-CoV-2 immunology, Shock, Cardiogenic immunology, Systemic Inflammatory Response Syndrome immunology
- Published
- 2021
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34. Cardiovascular magnetic resonance reference values of mitral and tricuspid annular dimensions: the UK Biobank cohort.
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Ricci F, Aung N, Gallina S, Zemrak F, Fung K, Bisaccia G, Paiva JM, Khanji MY, Mantini C, Palermi S, Lee AM, Piechnik SK, Neubauer S, and Petersen SE
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- Age Factors, Aged, Cross-Sectional Studies, Female, Healthy Volunteers, Humans, Male, Middle Aged, Observer Variation, Predictive Value of Tests, Reference Values, Reproducibility of Results, Sex Factors, United Kingdom, White People, Magnetic Resonance Imaging, Cine, Mitral Valve diagnostic imaging, Tricuspid Valve diagnostic imaging
- Abstract
Background: Mitral valve (MV) and tricuspid valve (TV) apparatus geometry are essential to define mechanisms and etiologies of regurgitation and to inform surgical or transcatheter interventions. Given the increasing use of cardiovascular magnetic resonance (CMR) for the evaluation of valvular heart disease, we aimed to establish CMR-derived age- and sex-specific reference values for mitral annular (MA) and tricuspid annular (TA) dimensions and tethering indices derived from truly healthy Caucasian adults., Methods: 5065 consecutive UK Biobank participants underwent CMR using cine balanced steady-state free precession imaging at 1.5 T. Participants with non-Caucasian ethnicity, prevalent cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Absolute and indexed reference ranges for MA and TA diameters and tethering indices were stratified by gender and age (45-54, 55-64, 65-74 years)., Results: Overall, 721 (14.2%) truly healthy participants aged 45-74 years (54% women) formed the reference cohort. Absolute MA and TA diameters, MV tenting length and MV tenting area, were significantly larger in men. Mean ± standard deviation (SD) end-diastolic and end-systolic MA diameters in the 3-chamber view (anteroposterior diameter) were 2.9 ± 0.4 cm (1.5 ± 0.2 cm/m
2 ) and 3.3 ± 0.4 cm (1.7 ± 0.2 cm/m2 ) in men, and 2.6 ± 0.4 cm (1.6 ± 0.2 cm/m2 ) and 3.0 ± 0.4 cm (1.8 ± 0.2 cm/m2 ) in women, respectively. Mean ± SD end-diastolic and end-systolic TA diameters in the 4-chamber view were 3.2 ± 0.5 cm (1.6 ± 0.3 cm/m2 ) and 3.2 ± 0.5 cm (1.7 ± 0.3 cm/m2 ) in men, and 2.9 ± 0.4 cm (1.7 ± 0.2 cm/m2 ) and 2.8 ± 0.4 cm (1.7 ± 0.3 cm/m2 ) in women, respectively. With advancing age, end-diastolic TA diameter became larger and posterior MV leaflet angle smaller in both sexes. Reproducibility of measurements was good to excellent with an inter-rater intraclass correlation coefficient (ICC) between 0.92 and 0.98 and an intra-rater ICC between 0.90 and 0.97., Conclusions: We described age- and sex-specific reference ranges of MA and TA dimensions and tethering indices in the largest validated healthy Caucasian population. Reference ranges presented in this study may help to improve the distinction between normal and pathological states, prompting the identification of subjects that may benefit from advanced cardiac imaging for annular sizing and planning of valvular interventions.- Published
- 2020
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35. Left Ventricular Hypertrabeculation Is Not Associated With Cardiovascular Morbity or Mortality: Insights From the Eurocmr Registry.
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Zemrak F, Raisi-Estabragh Z, Khanji MY, Mohiddin SA, Bruder O, Wagner A, Lombardi M, Schwitter J, van Rossum AC, Pilz G, Nothnagel D, Steen H, Nagel E, Prasad SK, Deluigi CC, Dill T, Frank H, Schneider S, Mahrholdt H, and Petersen SE
- Abstract
Aim: Left ventricular non-compaction (LVNC) is perceived as a rare high-risk cardiomyopathy characterized by excess left ventricular (LV) trabeculation. However, there is increasing evidence contesting the clinical significance of LV hyper-trabeculation and the existence of LVNC as a distinct cardiomyopathy. The aim of this study is to assess the association of LV trabeculation extent with cardiovascular morbidity and all-cause mortality in patients undergoing clinical cardiac magnetic resonance (CMR) scans across 57 European centers from the EuroCMR registry. Methods and Results: We studied 822 randomly selected cases from the EuroCMR registry. Image acquisition was according to international guidelines. We manually segmented images for LV chamber quantification and measurement of LV trabeculation (as per Petersen criteria). We report the association between LV trabeculation extent and important cardiovascular morbidities (stroke, atrial fibrillation, heart failure) and all-cause mortality prospectively recorded over 404 ± 82 days of follow-up. Maximal non-compaction to compaction ratio (NC/C) was mean (standard deviation) 1.81 ± 0.67, from these, 17% were above the threshold for hyper-trabeculation (NC/C > 2.3). LV trabeculation extent was not associated with increased risk of the defined outcomes (morbidities, mortality, LV CMR indices) in the whole cohort, or in sub-analyses of individuals without ischaemic heart disease, or those with NC/C > 2.3. Conclusion: Among 882 patients undergoing clinical CMR, excess LV trabeculation was not associated with a range of important cardiovascular morbidities or all-cause mortality over ~12 months of prospective follow-up. These findings suggest that LV hyper-trabeculation alone is not an indicator for worse cardiovascular prognosis., (Copyright © 2020 Zemrak, Raisi-Estabragh, Khanji, Mohiddin, Bruder, Wagner, Lombardi, Schwitter, van Rossum, Pilz, Nothnagel, Steen, Nagel, Prasad, Deluigi, Dill, Frank, Schneider, Mahrholdt and Petersen.)
- Published
- 2020
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36. Association Between Recreational Cannabis Use and Cardiac Structure and Function.
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Khanji MY, Jensen MT, Kenawy AA, Raisi-Estabragh Z, Paiva JM, Aung N, Fung K, Lukaschuk E, Zemrak F, Lee AM, Barutcu A, Maclean E, Cooper J, Piechnik SK, Neubauer S, and Petersen SE
- Subjects
- Aged, Female, Heart Diseases diagnostic imaging, Heart Diseases physiopathology, Humans, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Risk Factors, Heart Diseases etiology, Marijuana Abuse complications, Marijuana Smoking adverse effects, Myocardial Contraction, Ventricular Function, Left
- Published
- 2020
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37. The left atrial appendage in humans: structure, physiology, and pathogenesis.
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Karim N, Ho SY, Nicol E, Li W, Zemrak F, Markides V, Reddy V, and Wong T
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- Causality, Humans, Atrial Appendage diagnostic imaging, Atrial Appendage surgery, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation
- Abstract
For many years, the left atrial appendage (LAA) was considered a dormant embryological remnant; however, it is a structurally complex and functional organ that contributes to cardiac haemodynamic changes and volume homeostasis through both its contractile properties and neurohormonal peptide secretion. When dysfunctional, the LAA contributes to thrombogenesis and subsequent increased predisposition to cardioembolic events. Consequently, the LAA has gained much attention as a therapeutic target to lower this risk. In addition, attention has focused on the LAA in its role as an electrical trigger for atrial tachycardia and atrial fibrillation with ablation of the LAA to achieve electrical isolation showing promising results in the maintenance of sinus rhythm. This in-depth review explores the structure, physiology and pathophysiology of the LAA, as well as LAA intervention and their sequelae., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
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38. Prognostic Significance of Left Ventricular Noncompaction: Systematic Review and Meta-Analysis of Observational Studies.
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Aung N, Doimo S, Ricci F, Sanghvi MM, Pedrosa C, Woodbridge SP, Al-Balah A, Zemrak F, Khanji MY, Munroe PB, Naci H, and Petersen SE
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- Heart Function Tests, Humans, Observational Studies as Topic, Prognosis, Risk Factors, Isolated Noncompaction of the Ventricular Myocardium complications, Isolated Noncompaction of the Ventricular Myocardium diagnostic imaging
- Abstract
Background: Although left ventricular noncompaction (LVNC) has been associated with an increased risk of adverse cardiovascular events, the accurate incidence of cardiovascular morbidity and mortality is unknown. We, therefore, aimed to assess the incidence rate of LVNC-related cardiovascular events., Methods: We systematically searched observational studies reporting the adverse outcomes related to LVNC. The primary end point was cardiovascular mortality., Results: We identified 28 eligible studies enrolling 2501 LVNC patients (mean age, 46 years; male/female ratio, 1.7). After a median follow-up of 2.9 years, the pooled event rate for cardiovascular mortality was 1.92 (95% CI, 1.54-2.30) per 100 person-years. LVNC patients had a similar risk of cardiovascular mortality compared with a dilated cardiomyopathy control group (odds ratio, 1.10 [95% CI, 0.18-6.67]). The incidence rates of all-cause mortality, stroke and systemic emboli, heart failure admission, cardiac transplantation, ventricular arrhythmias, and cardiac device implantation were 2.16, 1.54, 3.53, 1.24, 2.17, and 2.66, respectively, per 100 person-years. Meta-regression and subgroup analyses revealed that left ventricular ejection fraction, not the extent of left ventricular trabeculation, had an important influence on the variability of incidence rates. The risks of thromboembolism and ventricular arrhythmias in LVNC patients were similar to dilated cardiomyopathy patients. However, LVNC patients had a higher incidence of heart failure hospitalization than dilated cardiomyopathy patients., Conclusions: Patients with LVNC carry a similar cardiovascular risk when compared with dilated cardiomyopathy patients. Left ventricular ejection fraction-a conventional indicator of heart failure severity, not the extent of trabeculation-appears to be an important determinant of adverse outcomes in LVNC patients. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42018096313.
- Published
- 2020
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39. Physical activity and left ventricular trabeculation in the UK Biobank community-based cohort study.
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Woodbridge SP, Aung N, Paiva JM, Sanghvi MM, Zemrak F, Fung K, and Petersen SE
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- Aged, Cohort Studies, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, United Kingdom, Cardiomyopathies pathology, Exercise, Heart Ventricles pathology
- Abstract
Objective: Vigorous physical activity (PA) in highly trained athletes has been associated with heightened left ventricular (LV) trabeculation extent. It has therefore been hypothesised that LV trabeculation extent may participate in exercise-induced physiological cardiac remodelling. Our cross-sectional observational study aimed to ascertain whether there is a 'dose-response' relationship between PA and LV trabeculation extent and whether this could be identified at opposite PA extremes., Methods: In a cohort of 1030 individuals from the community-based UK Biobank study (male/female ratio: 0.84, mean age: 61 years), PA was measured via total metabolic equivalent of task (MET) min/week and 7-day average acceleration, and trabeculation extent via maximal non-compaction/compaction ratio (NC/C) in long-axis images of cardiovascular magnetic resonance studies. The relationship between PA and NC/C was assessed by multivariate regression (adjusting for potential confounders) as well as between demographic, anthropometric and LV phenotypic parameters and NC/C., Results: There was no significant linear relationship between PA and NC/C (full adjustment, total MET-min/week: ß=-0.0008, 95% CI -0.039 to -0.037, p=0.97; 7-day average acceleration: ß=-0.047, 95% CI -0.110 to -0.115, p=0.13, per IQR increment in PA), or between extreme PA quintiles (full adjustment, total MET-min/week: ß=-0.026, 95% CI -0.146 to -0.094, p=0.67; 7-day average acceleration: ß=-0.129, 95% CI -0.299 to -0.040, p=0.49), across all adjustment levels. A negative relationship was identified between left ventricular ejection fraction and NC/C, significantly modified by PA (ß difference=-0.006, p=0.03)., Conclusions: In a community-based general population cohort, there was no relationship at, or between, extremes, between PA and NC/C, suggesting that at typical general population PA levels, trabeculation extent is not influenced by PA changes., Competing Interests: Competing interests: SEP provides consultancy to Circle Cardiovascular Imaging Inc, Calgary, Canada. Other authors have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2019
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40. Automated quality control in image segmentation: application to the UK Biobank cardiovascular magnetic resonance imaging study.
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Robinson R, Valindria VV, Bai W, Oktay O, Kainz B, Suzuki H, Sanghvi MM, Aung N, Paiva JM, Zemrak F, Fung K, Lukaschuk E, Lee AM, Carapella V, Kim YJ, Piechnik SK, Neubauer S, Petersen SE, Page C, Matthews PM, Rueckert D, and Glocker B
- Subjects
- Automation, Humans, Predictive Value of Tests, Quality Control, Reproducibility of Results, United Kingdom, Heart diagnostic imaging, Image Interpretation, Computer-Assisted standards, Magnetic Resonance Imaging standards
- Abstract
Background: The trend towards large-scale studies including population imaging poses new challenges in terms of quality control (QC). This is a particular issue when automatic processing tools such as image segmentation methods are employed to derive quantitative measures or biomarkers for further analyses. Manual inspection and visual QC of each segmentation result is not feasible at large scale. However, it is important to be able to automatically detect when a segmentation method fails in order to avoid inclusion of wrong measurements into subsequent analyses which could otherwise lead to incorrect conclusions., Methods: To overcome this challenge, we explore an approach for predicting segmentation quality based on Reverse Classification Accuracy, which enables us to discriminate between successful and failed segmentations on a per-cases basis. We validate this approach on a new, large-scale manually-annotated set of 4800 cardiovascular magnetic resonance (CMR) scans. We then apply our method to a large cohort of 7250 CMR on which we have performed manual QC., Results: We report results used for predicting segmentation quality metrics including Dice Similarity Coefficient (DSC) and surface-distance measures. As initial validation, we present data for 400 scans demonstrating 99% accuracy for classifying low and high quality segmentations using the predicted DSC scores. As further validation we show high correlation between real and predicted scores and 95% classification accuracy on 4800 scans for which manual segmentations were available. We mimic real-world application of the method on 7250 CMR where we show good agreement between predicted quality metrics and manual visual QC scores., Conclusions: We show that Reverse classification accuracy has the potential for accurate and fully automatic segmentation QC on a per-case basis in the context of large-scale population imaging as in the UK Biobank Imaging Study.
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- 2019
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41. Association Between Ambient Air Pollution and Cardiac Morpho-Functional Phenotypes: Insights From the UK Biobank Population Imaging Study.
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Aung N, Sanghvi MM, Zemrak F, Lee AM, Cooper JA, Paiva JM, Thomson RJ, Fung K, Khanji MY, Lukaschuk E, Carapella V, Kim YJ, Munroe PB, Piechnik SK, Neubauer S, and Petersen SE
- Subjects
- Aged, Air Pollutants toxicity, Biological Specimen Banks, Cardiovascular Diseases diagnostic imaging, Cardiovascular Diseases etiology, Cardiovascular Diseases physiopathology, Cross-Sectional Studies, Databases, Factual, Environmental Exposure, Female, Humans, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Nitrogen Oxides analysis, Particulate Matter toxicity, Phenotype, United Kingdom, Ventricular Function, Left physiology, Ventricular Remodeling, Air Pollutants chemistry, Cardiovascular Diseases diagnosis
- Abstract
Background: Exposure to ambient air pollution is strongly associated with increased cardiovascular morbidity and mortality. Little is known about the influence of air pollutants on cardiac structure and function. We aim to investigate the relationship between chronic past exposure to traffic-related pollutants and the cardiac chamber volume, ejection fraction, and left ventricular remodeling patterns after accounting for potential confounders., Methods: Exposure to ambient air pollutants including particulate matter and nitrogen dioxide was estimated from the Land Use Regression models for the years between 2005 and 2010. Cardiac parameters were measured from cardiovascular magnetic resonance imaging studies of 3920 individuals free from pre-existing cardiovascular disease in the UK Biobank population study. The median (interquartile range) duration between the year of exposure estimate and the imaging visit was 5.2 (0.6) years. We fitted multivariable linear regression models to investigate the relationship between cardiac parameters and traffic-related pollutants after adjusting for various confounders., Results: The studied cohort was 62±7 years old, and 46% were men. In fully adjusted models, particulate matter with an aerodynamic diameter <2.5 μm concentration was significantly associated with larger left ventricular end-diastolic volume and end-systolic volume (effect size = 0.82%, 95% CI, 0.09-1.55%, P =0.027; and effect size = 1.28%, 95% CI, 0.15-2.43%, P =0.027, respectively, per interquartile range increment in particulate matter with an aerodynamic diameter <2.5 μm) and right ventricular end-diastolic volume (effect size = 0.85%, 95% CI, 0.12-1.58%, P =0.023, per interquartile range increment in particulate matter with an aerodynamic diameter <2.5 μm). Likewise, higher nitrogen dioxide concentration was associated with larger biventricular volume. Distance from the major roads was the only metric associated with lower left ventricular mass (effect size = -0.74%, 95% CI, -1.3% to -0.18%, P =0.01, per interquartile range increment). Neither left and right atrial phenotypes nor left ventricular geometric remodeling patterns were influenced by the ambient pollutants., Conclusions: In a large asymptomatic population with no prevalent cardiovascular disease, higher past exposure to particulate matter with an aerodynamic diameter <2.5 μm and nitrogen dioxide was associated with cardiac ventricular dilatation, a marker of adverse remodeling that often precedes heart failure development., Competing Interests: Disclosures Dr Petersen provides consultancy to Circle Cardiovascular Imaging Inc, Calgary, Canada. The other authors report no conflicts.
- Published
- 2018
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42. The impact of menopausal hormone therapy (MHT) on cardiac structure and function: Insights from the UK Biobank imaging enhancement study.
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Sanghvi MM, Aung N, Cooper JA, Paiva JM, Lee AM, Zemrak F, Fung K, Thomson RJ, Lukaschuk E, Carapella V, Kim YJ, Harvey NC, Piechnik SK, Neubauer S, and Petersen SE
- Subjects
- Aging, Comorbidity, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Menopause, Middle Aged, Postmenopause, Risk Factors, Stroke Volume drug effects, United Kingdom epidemiology, Cardiovascular Diseases prevention & control, Heart Atria drug effects, Heart Ventricles drug effects, Hormone Replacement Therapy
- Abstract
Background: The effect of menopausal hormone therapy (MHT)-previously known as hormone replacement therapy-on cardiovascular health remains unclear and controversial. This cross-sectional study examined the impact of MHT on left ventricular (LV) and left atrial (LA) structure and function, alterations in which are markers of subclinical cardiovascular disease, in a population-based cohort., Methods: Post-menopausal women who had never used MHT and those who had used MHT ≥3 years participating in the UK Biobank who had undergone cardiovascular magnetic resonance (CMR) imaging and free of known cardiovascular disease were included. Multivariable linear regression was performed to examine the relationship between cardiac parameters and MHT use ≥3 years. To explore whether MHT use on each of the cardiac outcomes differed by age, multivariable regression models were constructed with a cross-product of age and MHT fitted as an interaction term., Results: Of 1604 post-menopausal women, 513 (32%) had used MHT ≥3 years. In the MHT cohort, median age at menopause was 50 (IQR: 45-52) and median duration of MHT was 8 years. In the non-MHT cohort, median age at menopause was 51 (IQR: 48-53). MHT use was associated with significantly lower LV end-diastolic volume (122.8 ml vs 119.8 ml, effect size = -2.4%, 95% CI: -4.2% to -0.5%; p = 0.013) and LA maximal volume (60.2 ml vs 57.5 ml, effect size = -4.5%, 95% CI: -7.8% to -1.0%; p = 0.012). There was no significant difference in LV mass. MHT use significantly modified the effect between age and CMR parameters; MHT users had greater decrements in LV end-diastolic volume, LV end-systolic volume and LA maximal volume with advancing age., Conclusions: MHT use was not associated with adverse, subclinical changes in cardiac structure and function. Indeed, significantly smaller LV and LA chamber volumes were observed which have been linked to favourable cardiovascular outcomes. These findings represent a novel approach to examining MHT's effect on the cardiovascular system.
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- 2018
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43. Fully-automated left ventricular mass and volume MRI analysis in the UK Biobank population cohort: evaluation of initial results.
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Suinesiaputra A, Sanghvi MM, Aung N, Paiva JM, Zemrak F, Fung K, Lukaschuk E, Lee AM, Carapella V, Kim YJ, Francis J, Piechnik SK, Neubauer S, Greiser A, Jolly MP, Hayes C, Young AA, and Petersen SE
- Subjects
- Aged, Algorithms, Automation, Female, Heart Diseases physiopathology, Humans, Linear Models, Male, Middle Aged, Observer Variation, Predictive Value of Tests, Reproducibility of Results, United Kingdom, Heart Diseases diagnostic imaging, Image Interpretation, Computer-Assisted methods, Magnetic Resonance Imaging, Cine methods, Stroke Volume, Ventricular Function, Left
- Abstract
UK Biobank, a large cohort study, plans to acquire 100,000 cardiac MRI studies by 2020. Although fully-automated left ventricular (LV) analysis was performed in the original acquisition, this was not designed for unsupervised incorporation into epidemiological studies. We sought to evaluate automated LV mass and volume (Siemens syngo InlineVF versions D13A and E11C), against manual analysis in a substantial sub-cohort of UK Biobank participants. Eight readers from two centers, trained to give consistent results, manually analyzed 4874 UK Biobank cases for LV end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and LV mass (LVM). Agreement between manual and InlineVF automated analyses were evaluated using Bland-Altman analysis and the intra-class correlation coefficient (ICC). Tenfold cross-validation was used to establish a linear regression calibration between manual and InlineVF results. InlineVF D13A returned results in 4423 cases, whereas InlineVF E11C returned results in 4775 cases and also reported LVM. Rapid visual assessment of the E11C results found 178 cases (3.7%) with grossly misplaced contours or landmarks. In the remaining 4597 cases, LV function showed good agreement: ESV -6.4 ± 9.0 ml, 0.853 (mean ± SD of the differences, ICC) EDV -3.0 ± 11.6 ml, 0.937; SV 3.4 ± 9.8 ml, 0.855; and EF 3.5 ± 5.1%, 0.586. Although LV mass was consistently overestimated (29.9 ± 17.0 g, 0.534) due to larger epicardial contours on all slices, linear regression could be used to correct the bias and improve accuracy. Automated InlineVF results can be used for case-control studies in UK Biobank, provided visual quality control and linear bias correction are performed. Improvements between InlineVF D13A and InlineVF E11C show the field is rapidly advancing, with further improvements expected in the near future.
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- 2018
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44. Diagnosis and Prognosis in Sudden Cardiac Arrest Survivors Without Coronary Artery Disease: Utility of a Clinical Approach Using Cardiac Magnetic Resonance Imaging.
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Rodrigues P, Joshi A, Williams H, Westwood M, Petersen SE, Zemrak F, Schilling RJ, Kirkby C, Wragg A, Manisty C, and Mohiddin S
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Heart physiopathology, Humans, Male, Middle Aged, Prognosis, Reproducibility of Results, Retrospective Studies, Young Adult, Coronary Artery Disease, Death, Sudden, Cardiac pathology, Heart diagnostic imaging, Magnetic Resonance Imaging methods, Survivors statistics & numerical data
- Abstract
Background: Determining the pathogenesis of sudden cardiac arrest or periarrest without significant coronary artery disease is crucial for management and prognosis. Cardiovascular magnetic resonance (CMR) can detect morphological, functional, or tissue abnormalities, and we sought to evaluate the role of CMR in determining sudden cardiac arrest pathogenesis and prognosis in survivors., Methods and Results: We retrospectively reviewed cardiac investigations and clinical outcomes in consecutive survivors of potentially fatal arrhythmias without coronary artery disease admitted to our institutions from 2008 to 2014. After coronary angiography and echocardiography, all underwent CMR and, when indicated, electrophysiology studies. Major adverse cardiac events (MACE), comprising significant nonfatal ventricular arrhythmia or death, was the primary outcome. Of 164 included subjects (65% men; mean age 48 [18-80] years), CMR contributed to the diagnosis in 80 (49%) and was decisive in 50 cases (30%). Dilated cardiomyopathy (n=27), myocarditis or sarcoidosis (n=22), occult myocardial infarction (n=13), and hypertrophic cardiomyopathy (n=9) were most frequent. Arrhythmic causes were found in 14% while no cause was identified in 36%. MACE occurred in 31% of subjects during a median follow-up of 32 months. MACE associated with presence of a CMR diagnosis, extent of late gadolinium enhancement, and left and right ventricular ejection fractions. Right ventricular ejection fraction was an independent predictor of MACE., Conclusions: CMR identified a likely pathogenesis for sudden cardiac arrest in nearly half of survivors in whom coronary artery disease had been excluded. One in 3 subjects had MACE; risk doubled in those with a CMR diagnosis and some CMR parameters-late gadolinium enhancement, left ventricular ejection fraction, and especially right ventricular ejection fraction-associated with prognosis., (© 2017 American Heart Association, Inc.)
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- 2017
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45. Evaluation of splenic switch off in a tertiary imaging centre: validation and assessment of utility.
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Hosking A, Koulouroudias M, Zemrak F, Moon JC, Rossi A, Lee A, Barnes MR, Boubertakh R, Pugliese F, Manisty C, and Petersen SE
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- Adenosine, Case-Control Studies, Contrast Media, Coronary Angiography, Exercise Test, False Negative Reactions, Female, Humans, Male, Meglumine, Middle Aged, Organometallic Compounds, Retrospective Studies, Sensitivity and Specificity, Coronary Artery Disease diagnostic imaging, Magnetic Resonance Angiography methods, Spleen blood supply
- Abstract
Aims: Adenosine can induce splenic vasoconstriction (splenic switch-off, SSO). In this study, we aim to evaluate the utility of identifying a lack of SSO for detecting false-negative adenosine stress perfusion cardiac magnetic resonance (CMR) scans., Methods and Results: We visually analysed 492 adenosine stress perfusion CMR scans reported as negative in a cohort of patients with no previous history of coronary artery disease. A lack of SSO was identified in 11%. We quantified the phenomenon by drawing regions of interest on the spleen and comparing intensity between stress and rest scans, the spleen intensity ratio (SIR). Inter-rater agreement for qualitative determination of SSO was κ = 0.81 and inter-class correlation for quantitative determination of SSO was 0.94. The optimal threshold for SIR as an indicator of SSO was 0.40 (sensitivity = 82.5%, specificity = 92.3%, AUC = 0.91). 23 065 CMR scans and 9926 invasive coronary angiogram reports were retrospectively examined to identify patients with negative CMR scans who required coronary intervention in the subsequent 12 months (false negatives). We compared these scans with true positives who had positive adenosine stress perfusion CMR scans followed by coronary intervention. The rate of lack of SSO was 20.7% in the false-negative group versus 13.1% in true positives (P = 0.37)., Conclusion: The lack of SSO is prevalent, easily measureable, and has potential to improve on haemodynamic criteria as a marker of adenosine understress in CMR perfusion scans., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)
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- 2017
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46. Community delivery of semiautomated fractal analysis tool in cardiac mr for trabecular phenotyping.
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Captur G, Radenkovic D, Li C, Liu Y, Aung N, Zemrak F, Tobon-Gomez C, Gao X, Elliott PM, Petersen SE, Bluemke DA, Friedrich MG, and Moon JC
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- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Observer Variation, Reproducibility of Results, Young Adult, Fractals, Heart Ventricles diagnostic imaging, Image Processing, Computer-Assisted methods, Magnetic Resonance Imaging methods
- Abstract
Purpose: To report the development of easy-to-use magnetic resonance imaging (MRI) fractal tools deployed on platforms accessible to all. The trabeculae of the left ventricle vary in health and disease but their measurement is difficult. Fractal analysis of cardiac MR images can measure trabecular complexity as a fractal dimension (FD)., Materials and Methods: This Health Insurance Portability and Accountability Act (HIPAA)-compliant study was approved by the local Institutional Review Board. Participants provided written informed consent. The original MatLab implementation (region-based level set segmentation and box-counting algorithm) was recoded for two platforms (OsiriX and a clinical MR reporting platform [cvi
42 , Circle Cardiovascular Imaging, Calgary, Canada]). For validation, 100 subjects were scanned at 1.5T and 20 imaged twice for interstudy reproducibility. Cines were analyzed by the three tools and FD variability determined. Manual trabecular delineation by an expert reader (R1) provided ground truth contours for validation of segmentation accuracy by point-to-curve (P2C) distance estimates. Manual delineation was repeated by R1 and a second reader (R2) on 15 cases for intra/interobserver variability., Results: FD by OsiriX and the clinical MR reporting platform showed high correlation with MatLab values (correlation coefficients: 0.96 [95% CI: 0.95-0.97] and 0.96 [0.95-0.96]) and high interstudy and intraplatform reproducibility. Semiautomated contours in OsiriX and the clinical MR reporting platform were highly correlated with ground truth contours evidenced by low P2C errors: 0.882 ± 0.76 mm and 0.709 ± 0.617 mm. Validity of ground truth contours was inferred from low P2C errors between readers (R1-R1: 0.798 ± 0.718 mm; R1-R2: 0.804 ± 0.649 mm)., Conclusion: This set of accessible fractal tools that measure trabeculation in the heart have been validated and released to the cardiac MR community (http://j.mp/29xOw3B) to encourage novel clinical applications of fractals in the cardiac imaging domain., Level of Evidence: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1082-1088., (© 2017 International Society for Magnetic Resonance in Medicine.)- Published
- 2017
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47. Hypertrabeculated Left Ventricular Myocardium in Relationship to Myocardial Function and Fibrosis: The Multi-Ethnic Study of Atherosclerosis.
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Kawel-Boehm N, McClelland RL, Zemrak F, Captur G, Hundley WG, Liu CY, Moon JC, Petersen SE, Ambale-Venkatesh B, Lima JAC, and Bluemke DA
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- Aged, Aged, 80 and over, Atherosclerosis pathology, Atherosclerosis physiopathology, Cross-Sectional Studies, Female, Fibrosis pathology, Heart physiopathology, Heart Ventricles pathology, Heart Ventricles physiopathology, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Myocardium pathology, United States epidemiology, Atherosclerosis diagnostic imaging, Atherosclerosis epidemiology, Fibrosis diagnostic imaging, Heart diagnostic imaging, Heart Ventricles diagnostic imaging, Racial Groups statistics & numerical data
- Abstract
Purpose To determine if excess greater left ventricle (LV) trabeculation is associated with decreased average regional myocardial function, diffuse fibrosis, or both. Materials and Methods This was a HIPAA-compliant institutional board approved multicenter study, and all participants provided written informed consent. Participants in the Multi-Ethnic Study of Atherosclerosis (MESA) underwent a comprehensive cardiac magnetic resonance (MR) examination. LV trabeculation was measured with the maximal apical fractal dimension (FD), which is a marker of endocardial complexity. Demographic covariates, cardiovascular risk factors, and cardiac MR measurements were compared across quartiles of FD. Associations between FD and peak regional systolic circumferential strain (Ecc) and T1 time, a surrogate for diffuse myocardial fibrosis, were assessed with multivariable linear regression models. Results A total of 1123 subjects (593 [52.8%] female; mean age, 67.1 years ± 8.7 [standard deviation]) underwent FD and Ecc measurement, and 992 (521 [52.5%] female; mean age, 67.1 years ± 8.7) underwent FD and T1 measurement. Mean FD was 1.2 ± 0.07 in both groups, and mean Ecc was -18.3 ± 2.27 in the subjects who underwent FD and Ecc measurement. Global volumes and ejection fraction showed no differences between FD quartiles. However, with increasing FD quartile, Ecc was greater (indicating worse average regional function) (P < .001). After adjustment, greater trabeculation was associated with 21% worse myocardial strain (relative to the mean) per unit change in FD (regression coefficient = 4.0%; P < .001). There was no association between the degree of trabeculation and diffuse fibrosis measured with T1 mapping. Conclusion Average regional LV function was worse in individuals with greater LV trabeculation, supporting the concept of hypertrabeculation being an epiphenomenon of disease.
© RSNA, 2017.- Published
- 2017
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48. LV Noncompaction Cardiomyopathy or Just a Lot of Trabeculations?
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Aung N, Zemrak F, Mohiddin SA, and Petersen SE
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- Adult, Diagnosis, Differential, Female, Heart Ventricles physiopathology, Humans, Isolated Noncompaction of the Ventricular Myocardium physiopathology, Isolated Noncompaction of the Ventricular Myocardium therapy, Male, Middle Aged, Predictive Value of Tests, Systole, Ventricular Function, Left, Heart Ventricles abnormalities, Heart Ventricles diagnostic imaging, Isolated Noncompaction of the Ventricular Myocardium diagnostic imaging, Magnetic Resonance Imaging, Cine
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- 2017
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49. Renin-Angiotensin System Blockade Improves Cardiac Indices in Acromegaly Patients.
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Thomas JDJ, Dattani A, Zemrak F, Burchell T, Akker SA, Kaplan FJL, Khoo B, Aylwin S, Grossman AB, Davies LC, and Korbonits M
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- Adult, Aged, Female, Humans, Male, Middle Aged, Acromegaly diagnostic imaging, Acromegaly drug therapy, Acromegaly physiopathology, Angiotensin Receptor Antagonists administration & dosage, Angiotensin-Converting Enzyme Inhibitors administration & dosage, Heart diagnostic imaging, Heart physiopathology, Magnetic Resonance Imaging, Renin-Angiotensin System drug effects
- Abstract
Blockade of the angiotensin-renin system, with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), has been shown to improve cardiac outcomes following myocardial infarction and delay progression of heart failure. Acromegaly is associated with a disease-specific cardiomyopathy, the pathogenesis of which is poorly understood.The cardiac indices of patients with active acromegaly with no hypertension (Group A, n=4), established hypertension not taking ACEi/ARBs (Group B, n=4) and established hypertension taking ACEi/ARBs (Group C, n=4) were compared using cardiac magnetic imaging.Patients taking ACEi/ARBs had lower end diastolic volume index (EDVi) and end systolic volume index (ESVi) than the other 2 groups ([C] 73.24 vs. [A] 97.92 vs. [B] 101.03 ml/m
2 , ANOVA p=0.034, B vs. C p<0.01). Groups A and B had EDVi and ESVi values at the top of published reference range values; Group C had values in the middle of the range.Acromegaly patients on ACEi/ARBs for hypertension demonstrate improved cardiac indices compared to acromegaly patients with hypertension not taking these medications. Further studies are needed to determine if these drugs have a beneficial cardiac effect in acromegaly in the absence of demonstrable hypertension., Competing Interests: Conflict of Interest: None., (© Georg Thieme Verlag KG Stuttgart · New York.)- Published
- 2017
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50. Key Questions Relating to Left Ventricular Noncompaction Cardiomyopathy: Is the Emperor Still Wearing Any Clothes?
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Anderson RH, Jensen B, Mohun TJ, Petersen SE, Aung N, Zemrak F, Planken RN, and MacIver DH
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- Animals, Heart Ventricles physiopathology, Humans, Diagnostic Imaging methods, Heart Ventricles diagnostic imaging, Isolated Noncompaction of the Ventricular Myocardium diagnosis, Isolated Noncompaction of the Ventricular Myocardium etiology, Isolated Noncompaction of the Ventricular Myocardium physiopathology, Ventricular Function, Left physiology
- Abstract
The evidence is increasing that left ventricular noncompaction cardiomyopathy as it is currently defined does not represent a failure of compaction of pre-existing trabecular myocardium found during embryonic development to form the compact component of the ventricular walls. Neither is there evidence of which we are aware to favour the notion that the entity is a return to a phenotype seen in cold-blooded animals. It is also known that when seen in adults, the presence of excessive ventricular trabeculations does not portend a poor prognosis when the ejection fraction is normal, with the risks of complications such as arrhythmia and stroke being rare in this setting. It is also the case that images of "noncompaction" as provided from children or autopsy studies are quite different from the features observed clinically in asymptomatic adults with excessive trabeculation. Our review suggests that the presence of an excessively trabeculated left ventricular wall is not in itself a clinical entity. It is equally possible that the excessive trabeculation is no more than a bystander in the presence of additional lesions such as dilated cardiomyopathy, with the additional lesions being responsible for the reduced ejection fraction bringing a given patient to clinical attention. We, therefore, argue that the term "noncompaction cardiomyopathy" is misleading, because there is neither failure of compaction nor a cardiomyopathic process in most individuals that fulfill widely used diagnostic criteria., (Copyright © 2017 Canadian Cardiovascular Society. All rights reserved.)
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- 2017
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