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  1. Article ; Online: Exercise cardiovascular magnetic resonance: development, current utility and future applications.

    Craven, Thomas P / Tsao, Connie W / La Gerche, Andre / Simonetti, Orlando P / Greenwood, John P

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

    2020  Volume 22, Issue 1, Page(s) 65

    Abstract: Stress cardiac imaging is the current first line investigation for coronary artery disease diagnosis and decision making and an adjunctive tool in a range of non-ischaemic cardiovascular diseases. Exercise cardiovascular magnetic resonance (Ex-CMR) has ... ...

    Abstract Stress cardiac imaging is the current first line investigation for coronary artery disease diagnosis and decision making and an adjunctive tool in a range of non-ischaemic cardiovascular diseases. Exercise cardiovascular magnetic resonance (Ex-CMR) has developed over the past 25 years to combine the superior image qualities of CMR with the preferred method of exercise stress. Presently, numerous exercise methods exist, from performing stress on an adjacent CMR compatible treadmill to in-scanner exercise, most commonly on a supine cycle ergometer. Cardiac conditions studied by Ex-CMR are broad, commonly investigating ischaemic heart disease and congenital heart disease but extending to pulmonary hypertension and diabetic heart disease. This review presents an in-depth assessment of the various Ex-CMR stress methods and the varied pulse sequence approaches, including those specially designed for Ex-CMR. Current and future developments in image acquisition are highlighted, and will likely lead to a much greater clinical use of Ex-CMR across a range of cardiovascular conditions.
    MeSH term(s) Adult ; Aged ; Bicycling ; Exercise Test ; Female ; Heart Diseases/diagnostic imaging ; Heart Diseases/physiopathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Patient Positioning ; Predictive Value of Tests ; Young Adult
    Language English
    Publishing date 2020-09-10
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review ; Video-Audio Media
    ZDB-ID 1458034-2
    ISSN 1532-429X ; 1097-6647
    ISSN (online) 1532-429X
    ISSN 1097-6647
    DOI 10.1186/s12968-020-00652-w
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  2. Article ; Online: Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus.

    Iqbal, Hansa / Straw, Sam / Craven, Thomas P / Stirling, Katherine / Wheatcroft, Stephen B / Witte, Klaus K

    ESC heart failure

    2020  Volume 7, Issue 5, Page(s) 2032–2041

    Abstract: Aims: Left ventricular (LV) thrombus is increasingly detected in patients with and without ischaemic heart disease due to the increased availability of cardiac magnetic resonance imaging. Risk factors include anterior ST elevation myocardial infarction, ...

    Abstract Aims: Left ventricular (LV) thrombus is increasingly detected in patients with and without ischaemic heart disease due to the increased availability of cardiac magnetic resonance imaging. Risk factors include anterior ST elevation myocardial infarction, delayed reperfusion therapy, and non-ischaemic cardiomyopathy with severe LV systolic dysfunction. We aimed to report the characteristics and outcomes of patients with LV thrombus treated with either vitamin K antagonist (VKA) or direct oral anticoagulants (DOAC) with a view to describing differences in efficacy, specifically, subsequent thromboembolic events, thrombus resolution, and also side effects of therapy including clinically significant bleeding.
    Methods and results: We conducted a retrospective, observational cohort study of patients diagnosed with LV thrombus between 1 December 2012 and 30 June 2018 and treated with either DOAC or VKA. We recorded patient demographics, past medical history, prescribed medications, and baseline investigations. The primary outcomes were rates of thromboembolism and clinically significant bleeding, with secondary outcomes of thrombus resolution on repeat cardiac imaging, repeat hospitalization, and all-cause mortality. During the study period, 84 patients were diagnosed with and managed for LV thrombus. Of these, 62 received VKA and 22 DOAC including 13 prescribed rivaroxaban, eight apixaban, and one dabigatran. Most patients 75 (89%) were male with an average age of 62 ± 14 years. Ischaemic heart disease was the cause of LV impairment in 73 (87%) patients. Baseline characteristics were similar between groups at baseline. Most n = 55 (65%) were co-prescribed a single antiplatelet agent and 32 (38%) received dual-antiplatelet therapy. During an average follow-up of 3.0 ± 1.4 years, there were no statistically significant differences between VKA and DOAC in rates of stroke (2% vs. 0%, P = 0.55), other thromboemboli (2% vs. 0%, P = 0.55), or clinically significant bleeding (10% vs. 0%, P = 0.13). The average interval to cardiac imaging follow-up was 233 ± 251 days and was not different between groups (P = 0.83), and there was no difference in the rate of resolution of thrombus (76% vs. 65% P = 0.33). Rehospitalization (50% vs. 45%: P = 0.53) and all-cause mortality (10% vs. 14%; P = 0.61) were also similar.
    Conclusions: Our data suggest that DOACs are likely to be at least as effective and safe as VKA for stroke prevention in patients with LV thrombus and, despite their lack of a licence for this indication, are therefore likely to represent a reasonable and more convenient option for this setting. The optimal timing and type of anticoagulation for LV thrombus, as well as the role of screening for high-risk patients, should be tested in prospective, randomized trials.
    MeSH term(s) Administration, Oral ; Aged ; Anticoagulants/therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Thrombosis/diagnosis ; Thrombosis/drug therapy ; Vitamin K/therapeutic use
    Chemical Substances Anticoagulants ; Vitamin K (12001-79-5)
    Language English
    Publishing date 2020-06-25
    Publishing country England
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2814355-3
    ISSN 2055-5822 ; 2055-5822
    ISSN (online) 2055-5822
    ISSN 2055-5822
    DOI 10.1002/ehf2.12718
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  3. Article ; Online: 4D Flow Cardiac MR in Primary Mitral Regurgitation.

    Gorecka, Miroslawa / Cole, Charlotte / Bissell, Malenka M / Craven, Thomas P / Chew, Pei G / Dobson, Laura E / Brown, Louise A E / Paton, Maria F / Higgins, David M / Thirunavukarasu, Sharmaine / Sharrack, Noor / Javed, Wasim / Kotha, Sindhoora / Giannoudi, Marilena / Procter, Henry / Parent, Martine / Kidambi, Ananth / Swoboda, Peter P / Plein, Sven /
    Levelt, Eylem / Garg, Pankaj / Greenwood, John P

    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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  4. 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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    Zs.A 5045: Show issues Location:
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  5. 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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  6. Article ; Online: Empagliflozin Treatment Is Associated With Improvements in Cardiac Energetics and Function and Reductions in Myocardial Cellular Volume in Patients With Type 2 Diabetes.

    Thirunavukarasu, Sharmaine / Jex, Nicholas / Chowdhary, Amrit / Hassan, Imtiaz Ul / Straw, Sam / Craven, Thomas P / Gorecka, Miroslawa / Broadbent, David / Swoboda, Peter / Witte, Klaus K / Cubbon, Richard M / Xue, Hui / Kellman, Peter / Greenwood, John P / Plein, Sven / Levelt, Eylem

    Diabetes

    2021  Volume 70, Issue 12, Page(s) 2810–2822

    Abstract: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of major adverse cardiovascular (CV) events and hospitalization for heart failure (HF) in patients with type 2 diabetes (T2D). Using CV MRI (CMR) ... ...

    Abstract Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of major adverse cardiovascular (CV) events and hospitalization for heart failure (HF) in patients with type 2 diabetes (T2D). Using CV MRI (CMR) and
    MeSH term(s) Aged ; Benzhydryl Compounds/pharmacology ; Benzhydryl Compounds/therapeutic use ; Cell Size/drug effects ; Cohort Studies ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/metabolism ; Diabetes Mellitus, Type 2/pathology ; Diabetic Cardiomyopathies/pathology ; Diabetic Cardiomyopathies/prevention & control ; Energy Metabolism/drug effects ; Female ; Glucosides/pharmacology ; Glucosides/therapeutic use ; Heart/drug effects ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Myocardium/metabolism ; Myocardium/pathology ; Myocytes, Cardiac/drug effects ; Myocytes, Cardiac/metabolism ; Myocytes, Cardiac/pathology ; United Kingdom
    Chemical Substances Benzhydryl Compounds ; Glucosides ; empagliflozin (HDC1R2M35U)
    Language English
    Publishing date 2021-10-05
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 80085-5
    ISSN 1939-327X ; 0012-1797
    ISSN (online) 1939-327X
    ISSN 0012-1797
    DOI 10.2337/db21-0270
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  7. 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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  8. Article: Feasibility and reproducibility of a cardiovascular magnetic resonance free-breathing, multi-shot, navigated image acquisition technique for ventricular volume quantification during continuous exercise.

    Chew, Pei G / Swoboda, Peter P / Ferguson, Carrie / Garg, Pankaj / Cook, Abigail L / Ibeggazene, Said / Brown, Louise A E / Craven, Thomas P / Foley, James R / Fent, Graham J / Saunderson, Christopher E / Higgins, David M / Plein, Sven / Birch, Karen M / Greenwood, John P

    Quantitative imaging in medicine and surgery

    2020  Volume 10, Issue 9, Page(s) 1837–1851

    Abstract: Background: Cardiovascular magnetic resonance (CMR) image acquisition techniques during exercise typically requires either transient cessation of exercise or complex post-processing, potentially compromising clinical utility. We evaluated the ... ...

    Abstract Background: Cardiovascular magnetic resonance (CMR) image acquisition techniques during exercise typically requires either transient cessation of exercise or complex post-processing, potentially compromising clinical utility. We evaluated the feasibility and reproducibility of a navigated image acquisition method for ventricular volumes assessment during continuous physical exercise.
    Methods: Ten healthy volunteers underwent supine cycle ergometer (Lode) exercise CMR on two separate occasions using a free-breathing, multi-shot, navigated, balanced steady-state free precession cine pulse sequence. Images were acquired at 3-stages, baseline and during steady-state exercise at 55% and 75% maximal heart rate (HR
    Results: End-diastolic volume (EDV) of both LV and RV decreased during exercise at 55% and 75% HR
    Conclusions: Exercise CMR using a free-breathing, multi-shot, navigated cine imaging method allows simultaneous assessment of left and right ventricular volumes during
    Language English
    Publishing date 2020-08-19
    Publishing country China
    Document type Journal Article
    ZDB-ID 2653586-5
    ISSN 2223-4306 ; 2223-4292
    ISSN (online) 2223-4306
    ISSN 2223-4292
    DOI 10.21037/qims-20-117
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  9. Article ; Online: Exercise cardiovascular magnetic resonance: feasibility and development of biventricular function and great vessel flow assessment, during continuous exercise accelerated by Compressed SENSE: preliminary results in healthy volunteers.

    Craven, Thomas P / Jex, Nicholas / Chew, Pei G / Higgins, David M / Bissell, Malenka M / Brown, Louise A E / Saunderson, Christopher E D / Das, Arka / Chowdhary, Amrit / Dall'Armellina, Erica / Levelt, Eylem / Swoboda, Peter P / Plein, Sven / Greenwood, John P

    The international journal of cardiovascular imaging

    2020  Volume 37, Issue 2, Page(s) 685–698

    Abstract: Purpose: Exercise cardiovascular magnetic resonance (Ex-CMR) typically requires complex post-processing or transient exercise cessation, decreasing clinical utility. We aimed to demonstrate the feasibility of assessing biventricular volumes and great ... ...

    Abstract Purpose: Exercise cardiovascular magnetic resonance (Ex-CMR) typically requires complex post-processing or transient exercise cessation, decreasing clinical utility. We aimed to demonstrate the feasibility of assessing biventricular volumes and great vessel flow during continuous in-scanner Ex-CMR, using vendor provided Compressed SENSE (C-SENSE) sequences and commercial analysis software (Cvi42).
    Methods: 12 healthy volunteers (8-male, age: 35 ± 9 years) underwent continuous supine cycle ergometer (Lode-BV) Ex-CMR (1.5T Philips, Ingenia). Free-breathing, respiratory navigated C-SENSE short-axis cines and aortic/pulmonary phase contrast magnetic resonance (PCMR) sequences were validated against clinical sequences at rest and used during low and moderate intensity Ex-CMR. Optimal PCMR C-SENSE acceleration, C-SENSE-3 (CS3) vs C-SENSE-6 (CS6), was further investigated by image quality scoring. Intra-and inter-operator reproducibility of biventricular and flow indices was performed.
    Results: All CS3 PCMR image quality scores were superior (p < 0.05) to CS6 sequences, except pulmonary PCMR at moderate exercise. Resting stroke volumes from clinical PCMR sequences correlated stronger with CS3 than CS6 sequences. Resting biventricular volumes from CS3 and clinical sequences correlated very strongly (r > 0.93). During Ex-CMR, biventricular end-diastolic volumes (EDV) remained unchanged, except right-ventricular EDV decreasing at moderate exercise. Biventricular ejection-fractions increased at each stage. Exercise biventricular cine and PCMR stroke volumes correlated very strongly (r ≥ 0.9), demonstrating internal validity. Intra-observer reproducibility was excellent, co-efficient of variance (COV) < 10%. Inter-observer reproducibility was excellent, except for resting right-ventricular, and exercise bi-ventricular end-systolic volumes which were good (COV 10-20%).
    Conclusion: Biventricular function, aortic and pulmonary flow assessment during continuous Ex-CMR using CS3 sequences is feasible, reproducible and analysable using commercially available software.
    MeSH term(s) Adult ; Blood Flow Velocity ; Exercise/physiology ; Feasibility Studies ; Female ; Healthy Volunteers ; Heart Ventricles/diagnostic imaging ; Hemodynamics/physiology ; Humans ; Image Processing, Computer-Assisted/methods ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Reference Values ; Reproducibility of Results ; Ventricular Function/physiology ; Young Adult
    Language English
    Publishing date 2020-10-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2055311-0
    ISSN 1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
    ISSN (online) 1875-8312 ; 1573-0743
    ISSN 1569-5794 ; 0167-9899
    DOI 10.1007/s10554-020-02044-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Detrimental Immediate- and Medium-Term Clinical Effects of Right Ventricular Pacing in Patients With Myocardial Fibrosis.

    Saunderson, Christopher E D / Paton, Maria F / Brown, Louise A E / Gierula, John / Chew, Pei G / Das, Arka / Sengupta, Anshuman / Craven, Thomas P / Chowdhary, Amrit / Koshy, Aaron / White, Hazel / Levelt, Eylem / Dall'Armellina, Erica / Garg, Pankaj / Witte, Klaus K / Greenwood, John P / Plein, Sven / Swoboda, Peter P

    Circulation. Cardiovascular imaging

    2021  Volume 14, Issue 5, Page(s) e012256

    Abstract: Background: Long-term right ventricular (RV) pacing leads to heart failure or a decline in left ventricular (LV) function in up to a fifth of patients. We aimed to establish whether patients with focal fibrosis detected on late gadolinium enhancement ... ...

    Abstract Background: Long-term right ventricular (RV) pacing leads to heart failure or a decline in left ventricular (LV) function in up to a fifth of patients. We aimed to establish whether patients with focal fibrosis detected on late gadolinium enhancement cardiovascular magnetic resonance (CMR) have deterioration in LV function after RV pacing.
    Methods: We recruited 84 patients with LV ejection fraction ≥40% into 2 observational CMR studies. Patients (n=34) with a dual-chamber device and preserved atrioventricular conduction underwent CMR in 2 asynchronous pacing modes (atrial asynchronous and dual-chamber asynchronous) to compare intrinsic atrioventricular conduction with forced RV pacing. Patients (n=50) with high-grade atrioventricular block underwent CMR before and 6 months after pacemaker implantation to investigate the medium-term effects of RV pacing.
    Results: The key findings were (1) initiation of RV pacing in patients with fibrosis, compared with those without, was associated with greater immediate changes in both LV end-systolic volume index (5.3±3.5 versus 2.1±2.4 mL/m
    Conclusions: Fibrosis detected on CMR is associated with immediate- and medium-term deterioration in LV function following RV pacing and could be used to identify those at risk of heart failure before pacemaker implantation.
    MeSH term(s) Aged ; Cardiac Pacing, Artificial/methods ; Cardiomyopathies/diagnosis ; Cardiomyopathies/physiopathology ; Cardiomyopathies/therapy ; Electrocardiography ; Fibrosis/diagnosis ; Fibrosis/drug therapy ; Fibrosis/physiopathology ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging, Cine/methods ; Male ; Middle Aged ; Myocardium/pathology ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Ventricular Function, Right/physiology
    Language English
    Publishing date 2021-05-18
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2435045-X
    ISSN 1942-0080 ; 1941-9651
    ISSN (online) 1942-0080
    ISSN 1941-9651
    DOI 10.1161/CIRCIMAGING.120.012256
    Database MEDical Literature Analysis and Retrieval System OnLINE

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