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Article ; Online: Atrial fibrillation and heart failure: Factors influencing the choice of oral anticoagulant.

Brown, Louise A E / Boos, Christopher J

2017 Volume 227, Page(s) 863–868

Abstract: Atrial fibrillation (AF) and heart failure (HF) frequently coexist. AF is identified in approximately one third of patients with HF and is linked to increased morbidity and mortality than from either condition alone. AF is relatively more common in HF ... ...

Abstract	Atrial fibrillation (AF) and heart failure (HF) frequently coexist. AF is identified in approximately one third of patients with HF and is linked to increased morbidity and mortality than from either condition alone. AF is relatively more common in HF with preserved ejection fraction (HFpEF) than with reduced ejection fraction (HFrEF). Nevertheless, the risk of stroke and systemic embolism (SSE) is significantly increased with both HF types and the absolute risk is heavily influenced by the presence and severity of associated additional stroke risk factors. The European Society of Cardiology has very recently introduced a third HF subtype entitled HF with mid-range ejection fraction (HFmrEF). At present oral anticoagulation is recommended for all patients with AF and HF, independent of HF type. In addition to warfarin there are currently four non-vitamin K oral anticoagulants (NOACs, previously called novel oral anticoagulants) that have been approved for the prevention of SSE. They consist of one direct thrombin inhibitor, dabigatran and three factor Xa inhibitors: rivaroxaban, apixaban and, most recently, edoxaban. In this review article we present an overview of the evidence to support the use of NOACs for the prevention of SSE in patients with AF and HF and review the influence of HF subtype and co-morbidities on the potential choice of oral anticoagulant.
MeSH term(s)	Administration, Oral ; Anticoagulants/administration & dosage ; Anticoagulants/therapeutic use ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/physiopathology ; Clinical Decision-Making ; Dabigatran/administration & dosage ; Dabigatran/therapeutic use ; Drug Therapy, Combination ; Factor Xa Inhibitors/administration & dosage ; Factor Xa Inhibitors/therapeutic use ; Heart Failure/drug therapy ; Heart Failure/physiopathology ; Humans ; Stroke Volume ; Treatment Outcome ; Warfarin/administration & dosage ; Warfarin/therapeutic use
Chemical Substances	Anticoagulants ; Factor Xa Inhibitors ; Warfarin (5Q7ZVV76EI) ; Dabigatran (I0VM4M70GC)
Language	English
Publishing date	2017-01-15
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2016.09.086
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Article ; Online: Automatic in-line quantitative myocardial perfusion mapping: Processing algorithm and implementation.

Xue, Hui / Brown, Louise A E / Nielles-Vallespin, Sonia / Plein, Sven / Kellman, Peter

Magnetic resonance in medicine

2019 Volume 83, Issue 2, Page(s) 712–730

Abstract: Purpose: Quantitative myocardial perfusion mapping has advantages over qualitative assessment, including the ability to detect global flow reduction. However, it is not clinically available and remains a research tool. Building upon the previously ... ...

Abstract	Purpose: Quantitative myocardial perfusion mapping has advantages over qualitative assessment, including the ability to detect global flow reduction. However, it is not clinically available and remains a research tool. Building upon the previously described imaging sequence, this study presents algorithm and implementation of an automated solution for inline perfusion flow mapping with step by step performance characterization. Methods: Proposed workflow consists of motion correction (MOCO), arterial input function blood detection, intensity to gadolinium concentration conversion, and pixel-wise mapping. A distributed kinetics model, blood-tissue exchange model, is implemented, computing pixel-wise maps of myocardial blood flow (mL/min/g), permeability-surface-area product (mL/min/g), blood volume (mL/g), and interstitial volume (mL/g). Results: Thirty healthy subjects (11 men; 26.4 ± 10.4 years) were recruited and underwent adenosine stress perfusion cardiovascular MR. Mean MOCO quality score was 3.6 ± 0.4 for stress and 3.7 ± 0.4 for rest. Myocardial Dice similarity coefficients after MOCO were significantly improved (P < 1e-6), 0.87 ± 0.05 for stress and 0.86 ± 0.06 for rest. Arterial input function peak gadolinium concentration was 4.4 ± 1.3 mmol/L at stress and 5.2 ± 1.5 mmol/L at rest. Mean myocardial blood flow at stress and rest were 2.82 ± 0.47 mL/min/g and 0.68 ± 0.16 mL/min/g, respectively. The permeability-surface-area product was 1.32 ± 0.26 mL/min/g at stress and 1.09 ± 0.21 mL/min/g at rest (P < 1e-3). Blood volume was 12.0 ± 0.8 mL/100 g at stress and 9.7 ± 1.0 mL/100 g at rest (P < 1e-9), indicating good adenosine vasodilation response. Interstitial volume was 20.8 ± 2.5 mL/100 g at stress and 20.3 ± 2.9 mL/100 g at rest (P = 0.50). Conclusions: An inline perfusion flow mapping workflow is proposed and demonstrated on normal volunteers. Initial evaluation demonstrates this fully automated solution for the respiratory MOCO, arterial input function left ventricle mask detection, and pixel-wise mapping, from free-breathing myocardial perfusion imaging.
MeSH term(s)	Adolescent ; Adult ; Algorithms ; Area Under Curve ; Automation ; Contrast Media ; Coronary Circulation ; Female ; Healthy Volunteers ; Heart/diagnostic imaging ; Heart Rate ; Heart Ventricles ; Humans ; Image Interpretation, Computer-Assisted/methods ; Image Processing, Computer-Assisted ; Kinetics ; Magnetic Resonance Imaging ; Male ; Motion ; Myocardial Perfusion Imaging/methods ; Pattern Recognition, Automated ; Young Adult
Chemical Substances	Contrast Media
Language	English
Publishing date	2019-08-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	605774-3
ISSN	1522-2594 ; 0740-3194
ISSN (online)	1522-2594
ISSN	0740-3194
DOI	10.1002/mrm.27954
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Article ; Online: 4D Flow Cardiac MR in Primary Mitral Regurgitation.

Journal of magnetic resonance imaging : JMRI

2024

Abstract: Background: Four-dimensional-flow cardiac MR (4DF-MR) offers advantages in primary mitral regurgitation. The relationship between 4DF-MR-derived mitral regurgitant volume (MR-Rvol) and the post-operative left ventricular (LV) reverse remodeling has not ... ...

Abstract	Background: Four-dimensional-flow cardiac MR (4DF-MR) offers advantages in primary mitral regurgitation. The relationship between 4DF-MR-derived mitral regurgitant volume (MR-Rvol) and the post-operative left ventricular (LV) reverse remodeling has not yet been established. Purpose: To ascertain if the 4DF-MR-derived MR-Rvol correlates with the LV reverse remodeling in primary mitral regurgitation. Study type: Prospective, single-center, two arm, interventional vs. nonintervention observational study. Population: Forty-four patients (male N = 30; median age 68 [59-75]) with at least moderate primary mitral regurgitation; either awaiting mitral valve surgery (repair [MVr], replacement [MVR]) or undergoing "watchful waiting" (WW). Field strength/sequence: 5 T/Balanced steady-state free precession (bSSFP) sequence/Phase contrast imaging/Multishot echo-planar imaging pulse sequence (five shots). Assessment: Patients underwent transthoracic echocardiography (TTE), phase-contrast MR (PMRI), 4DF-MR and 6-minute walk test (6MWT) at baseline, and a follow-up PMRI and 6MWT at 6 months. MR-Rvol was quantified by PMRI, 4DF-MR, and TTE by one observer. The pre-operative MR-Rvol was correlated with the post-operative decrease in the LV end-diastolic volume index (LVEDVi). Statistical tests: Included Student t-test/Mann-Whitney test/Fisher's exact test, Bland-Altman plots, linear regression analysis and receiver operating characteristic curves. Statistical significance was defined as P < 0.05. Results: While Bland-Altman plots demonstrated similar bias between all the modalities, the limits of agreement were narrower between 4DF-MR and PMRI (bias 15; limits of agreement -36 mL to 65 mL), than between 4DF-MR and TTE (bias -8; limits of agreement -106 mL to 90 mL) and PMRI and TTE (bias -23; limits of agreement -105 mL to 59 mL). Linear regression analysis demonstrated a significant association between the MR-Rvol and the post-operative decrease in the LVEDVi, when the MR-Rvol was quantified by PMRI and 4DF-MR, but not by TTE (P = 0.73). 4DF-MR demonstrated the best diagnostic performance for reduction in the post-operative LVEDVi with the largest area under the curve (4DF-MR 0.83; vs. PMRI 0.78; and TTE 0.51; P = 0.89). Data conclusion: This study demonstrates the potential clinical utility of 4DF-MR in the assessment of primary mitral regurgitation. Evidence level: 2 TECHNICAL EFFICACY: Stage 5.
Language	English
Publishing date	2024-02-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1146614-5
ISSN	1522-2586 ; 1053-1807
ISSN (online)	1522-2586
ISSN	1053-1807
DOI	10.1002/jmri.29284
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Zs.A 3648: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Identification of non-ischaemic fibrosis in male veteran endurance athletes, mechanisms and association with premature ventricular beats.

Farooq, Maryum / Brown, Louise A E / Fitzpatrick, Andrew / Broadbent, David A / Wahab, Ali / Klassen, Joel R L / Farley, Jonathan / Saunderson, Christopher E D / Das, Arka / Craven, Thomas / Dall'Armellina, Erica / Levelt, Eylem / Xue, Hui / Kellman, Peter / Greenwood, John P / Plein, Sven / Swoboda, Peter P

Scientific reports

2023 Volume 13, Issue 1, Page(s) 14640

Abstract: Left ventricular fibrosis can be identified by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in some veteran athletes. We aimed to investigate prevalence of ventricular fibrosis in veteran athletes and associations with ... ...

Abstract	Left ventricular fibrosis can be identified by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in some veteran athletes. We aimed to investigate prevalence of ventricular fibrosis in veteran athletes and associations with cardiac arrhythmia. 50 asymptomatic male endurance athletes were recruited. They underwent CMR imaging including volumetric analysis, bright blood (BB) and dark blood (DB) LGE, motion corrected (MOCO) quantitative stress and rest perfusion and T1/T2/extracellular volume mapping. Athletes underwent 12-lead electrocardiogram (ECG) and 24-h ECG. Myocardial fibrosis was identified in 24/50 (48%) athletes. All fibrosis was mid-myocardial in the basal-lateral left ventricular wall. Blood pressure was reduced in athletes without fibrosis compared to controls, but not athletes with fibrosis. Fibrotic areas had longer T2 time (44 ± 4 vs. 40 ± 2 ms, p < 0.0001) and lower rest myocardial blood flow (MBF, 0.5 ± 0.1 vs. 0.6 ± 0.1 ml/g/min, p < 0.0001). On 24-h ECG, athletes with fibrosis had greater burden of premature ventricular beats (0.3 ± 0.6 vs. 0.05 ± 0.2%, p = 0.03), with higher prevalence of ventricular couplets and triplets (33 vs. 8%, p = 0.02). In veteran endurance athletes, myocardial fibrosis is common and associated with an increased burden of ventricular ectopy. Possible mechanisms include inflammation and blood pressure. Further studies are needed to establish whether fibrosis increases risk of malignant arrhythmic events.
MeSH term(s)	Humans ; Male ; Ventricular Premature Complexes ; Contrast Media ; Veterans ; Gadolinium ; Cardiac Conduction System Disease
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2023-09-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-40252-z
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Article ; Online: Cardiac reverse remodeling in primary mitral regurgitation: mitral valve replacement vs. mitral valve repair.

Craven, Thomas P / Chew, Pei G / Dobson, Laura E / Gorecka, Miroslawa / Parent, Martine / Brown, Louise A E / Saunderson, Christopher E D / Das, Arka / Chowdhary, Amrit / Jex, Nicholas / Higgins, David M / Dall'Armellina, Erica / Levelt, Eylem / Schlosshan, Dominik / Swoboda, Peter P / Plein, Sven / Greenwood, John P

Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance

2023 Volume 25, Issue 1, Page(s) 43

Abstract: Background: When feasible, guidelines recommend mitral valve repair (MVr) over mitral valve replacement (MVR) to treat primary mitral regurgitation (MR), based upon historic outcome studies and transthoracic echocardiography (TTE) reverse remodeling ... ...

Abstract	Background: When feasible, guidelines recommend mitral valve repair (MVr) over mitral valve replacement (MVR) to treat primary mitral regurgitation (MR), based upon historic outcome studies and transthoracic echocardiography (TTE) reverse remodeling studies. Cardiovascular magnetic resonance (CMR) offers reference standard biventricular assessment with superior MR quantification compared to TTE. Using serial CMR in primary MR patients, we aimed to investigate cardiac reverse remodeling and residual MR post-MVr vs MVR with chordal preservation. Methods: 83 patients with ≥ moderate-severe MR on TTE were prospectively recruited. 6-min walk tests (6MWT) and CMR imaging including cine imaging, aortic/pulmonary through-plane phase contrast imaging, T1 maps and late-gadolinium-enhanced (LGE) imaging were performed at baseline and 6 months after mitral surgery or watchful waiting (control group). Results: 72 patients completed follow-up (Controls = 20, MVr = 30 and MVR = 22). Surgical groups demonstrated comparable baseline cardiac indices and co-morbidities. At 6-months, MVr and MVR groups demonstrated comparable improvements in 6MWT distances (+ 57 ± 54 m vs + 64 ± 76 m respectively, p = 1), reduced indexed left ventricular end-diastolic volumes (LVEDVi; - 29 ± 21 ml/m Conclusion: In primary MR, MVR with chordal preservation may offer comparable cardiac reverse remodeling and functional benefits at 6-months when compared to MVr. Larger, multicenter CMR studies are required, which if the findings are confirmed could impact future surgical practice.
MeSH term(s)	Humans ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery ; Mitral Valve Insufficiency/pathology ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery ; Stroke Volume ; Predictive Value of Tests ; Ventricular Function, Right ; Fibrosis
Language	English
Publishing date	2023-07-27
Publishing country	England
Document type	Multicenter Study ; Journal Article
ZDB-ID	1458034-2
ISSN	1532-429X ; 1097-6647
ISSN (online)	1532-429X
ISSN	1097-6647
DOI	10.1186/s12968-023-00946-9
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Article ; Online: A comparison of standard and high dose adenosine protocols in routine vasodilator stress cardiovascular magnetic resonance: dosage affects hyperaemic myocardial blood flow in patients with severe left ventricular systolic impairment.

Brown, Louise A E / Saunderson, Christopher E D / Das, Arka / Craven, Thomas / Levelt, Eylem / Knott, Kristopher D / Dall'Armellina, Erica / Xue, Hui / Moon, James C / Greenwood, John P / Kellman, Peter / Swoboda, Peter P / Plein, Sven

Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance

2021 Volume 23, Issue 1, Page(s) 37

Abstract: Background: Adenosine stress perfusion cardiovascular magnetic resonance (CMR) is commonly used in the assessment of patients with suspected ischaemia. Accepted protocols recommend administration of adenosine at a dose of 140 µg/kg/min increased up to ... ...

Abstract	Background: Adenosine stress perfusion cardiovascular magnetic resonance (CMR) is commonly used in the assessment of patients with suspected ischaemia. Accepted protocols recommend administration of adenosine at a dose of 140 µg/kg/min increased up to 210 µg/kg/min if required. Conventionally, adequate stress has been assessed using change in heart rate, however, recent studies have suggested that these peripheral measurements may not reflect hyperaemia and can be blunted, in particular, in patients with heart failure. This study looked to compare stress myocardial blood flow (MBF) and haemodynamic response with different dosing regimens of adenosine during stress perfusion CMR in patients and healthy controls. Methods: 20 healthy adult subjects were recruited as controls to compare 3 adenosine perfusion protocols: standard dose (140 µg/kg/min for 4 min), high dose (210 µg/kg/min for 4 min) and long dose (140 µg/kg/min for 8 min). 60 patients with either known or suspected coronary artery disease (CAD) or with heart failure and different degrees of left ventricular (LV) dysfunction underwent adenosine stress with standard and high dose adenosine within the same scan. All studies were carried out on a 3 T CMR scanner. Quantitative global myocardial perfusion and haemodynamic response were compared between doses. Results: In healthy controls, no significant difference was seen in stress MBF between the 3 protocols. In patients with known or suspected CAD, and those with heart failure and mild systolic impairment (LV ejection fraction (LVEF) ≥ 40%) no significant difference was seen in stress MBF between standard and high dose adenosine. In those with LVEF < 40%, there was a significantly higher stress MBF following high dose adenosine compared to standard dose (1.33 ± 0.46 vs 1.10 ± 0.47 ml/g/min, p = 0.004). Non-responders to standard dose adenosine (defined by an increase in heart rate (HR) < 10 bpm) had a significantly higher stress HR following high dose (75 ± 12 vs 70 ± 14 bpm, p = 0.034), but showed no significant difference in stress MBF. Conclusions: Increasing adenosine dose from 140 to 210 µg/kg/min leads to increased stress MBF in patients with significantly impaired LV systolic function. Adenosine dose in clinical perfusion assessment may need to be increased in these patients.
MeSH term(s)	Adenosine/administration & dosage ; Aged ; Case-Control Studies ; Coronary Circulation ; Female ; Humans ; Hyperemia/physiopathology ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Myocardial Perfusion Imaging ; Predictive Value of Tests ; Reproducibility of Results ; Severity of Illness Index ; Stroke Volume ; Systole ; Vasodilator Agents/administration & dosage ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Function, Left
Chemical Substances	Vasodilator Agents ; Adenosine (K72T3FS567)
Language	English
Publishing date	2021-03-18
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1458034-2
ISSN	1532-429X ; 1097-6647
ISSN (online)	1532-429X
ISSN	1097-6647
DOI	10.1186/s12968-021-00714-7
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Article ; Online: Cardiovascular magnetic resonance phenotyping of heart failure with mildly reduced ejection fraction.

Brown, Louise A E / Wahab, Ali / Ikongo, Eunice / Saunderson, Chirstopher E D / Jex, Nicholas / Thirunavukarasu, Sharmaine / Chowdhary, Amrit / Das, Arka / Craven, Thomas P / Levelt, Eylem / Dall'Armellina, Erica / Knott, Kristopher D / Greenwood, John P / Moon, James C / Xue, Hui / Kellman, Peter / Plein, Sven / Swoboda, Peter P

European heart journal. Cardiovascular Imaging

2022 Volume 24, Issue 1, Page(s) 38–45

Abstract: Aims: The 2016 European Society of Cardiology Heart Failure Guidelines defined a new category: heart failure with mid-range ejection fraction (HFmrEF) of 40-49%. This new category was highlighted as having limited evidence and research was advocated ... ...

Abstract	Aims: The 2016 European Society of Cardiology Heart Failure Guidelines defined a new category: heart failure with mid-range ejection fraction (HFmrEF) of 40-49%. This new category was highlighted as having limited evidence and research was advocated into underlying characteristics, pathophysiology, and diagnosis. We used multi-parametric cardiovascular magnetic resonance (CMR) to define the cardiac phenotype of presumed non-ischaemic HFmrEF. Methods and results: Patients (N = 300, 62.7 ± 13 years, 63% males) with a clinical diagnosis of heart failure with no angina symptoms, history of myocardial infarction, or coronary intervention were prospectively recruited. Patients underwent clinical assessment and CMR including T1 mapping, extracellular volume (ECV) mapping, late gadolinium enhancement, and measurement of myocardial blood flow at rest and maximal hyperaemia. Of 273 patients in the final analysis, 93 (34%) patients were categorized as HFmrEF, 46 (17%) as heart failure with preserved ejection fraction (HFpEF), and 134 (49%) as heart failure with reduced ejection fraction (HFrEF). Nineteen (20%) patients with HFmrEF had evidence of occult ischaemic heart disease. Diffuse fibrosis and hyperaemic myocardial blood flow were similar in HFmrEF and HFpEF, but HFmrEF showed significantly lower native T1 (1311 ± 32 vs. 1340 ± 45 ms, P < 0.001), ECV (24.6 ± 3.2 vs. 26.3 ± 3.1%, P < 0.001), and higher myocardial perfusion reserve (2.75 ± 0.84 vs. 2.28 ± 0.84, P < 0.001) compared with HFrEF. Conclusion: Patients with HFmrEF share most phenotypic characteristics with HFpEF, including the degree of microvascular impairment and fibrosis, but have a high prevalence of occult ischaemic heart disease similar to HFrEF. Further work is needed to confirm how the phenotype of HFmrEF responds to medical therapy.
MeSH term(s)	Male ; Female ; Humans ; Heart Failure ; Stroke Volume/physiology ; Contrast Media ; Prognosis ; Gadolinium ; Coronary Artery Disease ; Magnetic Resonance Spectroscopy ; Fibrosis
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2022-10-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2638345-7
ISSN	2047-2412 ; 2047-2404
ISSN (online)	2047-2412
ISSN	2047-2404
DOI	10.1093/ehjci/jeac204
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Book ; Online: Automatic In-line Quantitative Myocardial Perfusion Mapping

Xue, Hui / Brown, Louise A. E. / Nielles-Vallespin, Sonia / Plein, Sven / Kellman, Peter

processing algorithm and implementation

2019

Abstract: Quantitative myocardial perfusion mapping has advantages over qualitative assessment, including the ability to detect global flow reduction. However, it is not clinically available and remains as a research tool. Building upon the previously described ... ...

Abstract	Quantitative myocardial perfusion mapping has advantages over qualitative assessment, including the ability to detect global flow reduction. However, it is not clinically available and remains as a research tool. Building upon the previously described imaging sequence, this paper presents algorithm and implementation of an automated solution for inline perfusion flow mapping with step by step performance characterization. An inline perfusion flow mapping workflow is proposed and demonstrated on normal volunteers. Initial evaluation demonstrates the fully automated proposed solution for the respiratory motion correction, AIF LV mask detection and pixel-wise mapping, from free-breathing myocardial perfusion imaging.
Keywords	Electrical Engineering and Systems Science - Image and Video Processing ; Physics - Medical Physics ; Quantitative Biology - Quantitative Methods
Publishing date	2019-10-15
Publishing country	us
Document type	Book ; Online
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Article ; Online: Automated Inline Analysis of Myocardial Perfusion MRI with Deep Learning.

Xue, Hui / Davies, Rhodri H / Brown, Louise A E / Knott, Kristopher D / Kotecha, Tushar / Fontana, Marianna / Plein, Sven / Moon, James C / Kellman, Peter

Radiology. Artificial intelligence

2020 Volume 2, Issue 6, Page(s) e200009

Abstract: Purpose: To develop a deep neural network-based computational workflow for inline myocardial perfusion analysis that automatically delineates the myocardium, which improves the clinical workflow and offers a "one-click" solution.: Materials and ... ...

Abstract	Purpose: To develop a deep neural network-based computational workflow for inline myocardial perfusion analysis that automatically delineates the myocardium, which improves the clinical workflow and offers a "one-click" solution. Materials and methods: In this retrospective study, consecutive adenosine stress and rest perfusion scans were acquired from three hospitals between October 1, 2018 and February 27, 2019. The training and validation set included 1825 perfusion series from 1034 patients (mean age, 60.6 years ± 14.2 [standard deviation]). The independent test set included 200 scans from 105 patients (mean age, 59.1 years ± 12.5). A convolutional neural network (CNN) model was trained to segment the left ventricular cavity, myocardium, and right ventricle by processing an incoming time series of perfusion images. Model outputs were compared with manual ground truth for accuracy of segmentation and flow measures derived on a global and per-sector basis with Results: The mean Dice ratio of automatic and manual segmentation was 0.93 ± 0.04. The CNN performed similarly to manual segmentation and flow measures for mean stress myocardial blood flow (MBF; 2.25 mL/min/g ± 0.59 vs 2.24 mL/min/g ± 0.59, Conclusion: The described CNN was capable of cardiac perfusion mapping and integrated an automated inline implementation on the MR scanner, enabling one-click analysis and reporting in a manner comparable to manual assessment.
Language	English
Publishing date	2020-10-21
Publishing country	United States
Document type	Journal Article
ISSN	2638-6100
ISSN (online)	2638-6100
DOI	10.1148/ryai.2020200009
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Article ; Online: Acute Microstructural Changes after ST-Segment Elevation Myocardial Infarction Assessed with Diffusion Tensor Imaging.

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

Radiology

2021 Volume 299, Issue 1, Page(s) 86–96

Abstract: Background Cardiac diffusion tensor imaging (cDTI) allows for in vivo characterization of myocardial microstructure. In cDTI, mean diffusivity and fractional anisotropy (FA)-markers of magnitude and anisotropy of diffusion of water molecules-are known to ...

Abstract	Background Cardiac diffusion tensor imaging (cDTI) allows for in vivo characterization of myocardial microstructure. In cDTI, mean diffusivity and fractional anisotropy (FA)-markers of magnitude and anisotropy of diffusion of water molecules-are known to change after myocardial infarction. However, little is known about regional changes in helix angle (HA) and secondary eigenvector angle (E2A), which reflects orientations of laminar sheetlets, and their association with long-term recovery of left ventricular ejection fraction (LVEF). Purpose To assess serial changes in cDTI biomarkers in participants following ST-segment elevation myocardial infarction (STEMI) and to determine their associations with long-term left ventricular remodeling. Materials and Methods In this prospective study, 30 participants underwent cardiac MRI (3 T) after STEMI at 5 days and 3 months after reperfusion (National Institute of Health Research study no. 33963 and Research Ethics no. REC17/YH/0062). Spin-echo cDTI with second-order motion-compensation (approximate duration, 13 minutes; three sections; 18 noncollinear diffusion-weighted scans with
MeSH term(s)	Anisotropy ; Diffusion Magnetic Resonance Imaging/methods ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; ST Elevation Myocardial Infarction/diagnostic imaging ; ST Elevation Myocardial Infarction/pathology ; Ventricular Remodeling
Language	English
Publishing date	2021-02-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80324-8
ISSN	1527-1315 ; 0033-8419
ISSN (online)	1527-1315
ISSN	0033-8419
DOI	10.1148/radiol.2021203208
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