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Article: Role of epicardial adipose tissue in diabetic cardiomyopathy through the lens of cardiovascular magnetic resonance imaging - a narrative review.

Kotha, Sindhoora / Plein, Sven / Greenwood, John P / Levelt, Eylem

Therapeutic advances in endocrinology and metabolism

2024 Volume 15, Page(s) 20420188241229540

Abstract: Accumulating evidence suggests that ectopic/visceral adiposity may play a key role in the pathogenesis of nonischaemic cardiovascular diseases associated with type 2 diabetes. Epicardial adipose tissue (EAT) is a complex visceral fat depot, covering 80% ... ...

Abstract	Accumulating evidence suggests that ectopic/visceral adiposity may play a key role in the pathogenesis of nonischaemic cardiovascular diseases associated with type 2 diabetes. Epicardial adipose tissue (EAT) is a complex visceral fat depot, covering 80% of the cardiac surface with anatomical and functional contiguity to the myocardium and coronary arteries. EAT interacts with the biology of the underlying myocardium by secreting a wide range of adipokines. Magnetic resonance imaging (MRI) is the reference modality for structural and functional imaging of the heart. The technique is now also emerging as the reference imaging modality for EAT quantification. With this narrative review, we (a) surveyed contemporary clinical studies that utilized cardiovascular MRI to characterize EAT (studies published 2010-2023); (b) listed the clinical trials monitoring the response to treatment in EAT size as well as myocardial functional and structural parameters and (c) discussed the potential pathophysiological role of EAT in the development of diabetic cardiomyopathy. We concluded that increased EAT quantity and its inflammatory phenotype correlate with early signs of left ventricle dysfunction and may have a role in the pathogenesis of cardiac disease in diabetes with and without coronary artery disease.
Language	English
Publishing date	2024-03-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2554822-0
ISSN	2042-0196 ; 2042-0188
ISSN (online)	2042-0196
ISSN	2042-0188
DOI	10.1177/20420188241229540
Database	MEDical Literature Analysis and Retrieval System OnLINE

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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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Article ; Online: Cardiac Adaptations to Acute Hemodynamic Stress in Function, Perfusion, and Energetics in Type 2 Diabetes With Overweight and Obesity.

Chowdhary, Amrit / Javed, Wasim / Thirunavukarasu, Sharmaine / Jex, Nicholas / Kotha, Sindhoora / Kellman, Peter / Swoboda, Peter / Greenwood, John P / Plein, Sven / Levelt, Eylem

Diabetes care

2022 Volume 45, Issue 12, Page(s) e176–e178

MeSH term(s)	Humans ; Overweight/complications ; Diabetes Mellitus, Type 2 ; Obesity ; Hemodynamics ; Perfusion
Language	English
Publishing date	2022-10-06
Publishing country	United States
Document type	Research Support, Non-U.S. Gov't ; Letter
ZDB-ID	441231-x
ISSN	1935-5548 ; 0149-5992
ISSN (online)	1935-5548
ISSN	0149-5992
DOI	10.2337/dc22-0887
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Zs.A 1434: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Coexistent Diabetes Is Associated With the Presence of Adverse Phenotypic Features in Patients With Hypertrophic Cardiomyopathy.

Jex, Nicholas / Chowdhary, Amrit / Thirunavukarasu, Sharmaine / Procter, Henry / Sengupta, Anshuman / Natarajan, Pavithra / Kotha, Sindhoora / Poenar, Ana-Maria / Swoboda, Peter / Xue, Hui / Cubbon, Richard M / Kellman, Peter / Greenwood, John P / Plein, Sven / Page, Stephen / Levelt, Eylem

Diabetes care

2022 Volume 45, Issue 8, Page(s) 1852–1862

Abstract: Objective: Type 2 diabetes mellitus (T2DM) is associated with worsened clinical outcomes in hypertrophic cardiomyopathy (HCM) patients. We sought to investigate whether HCM patients with T2DM comorbidity exhibit adverse cardiac alterations in myocardial ...

Abstract	Objective: Type 2 diabetes mellitus (T2DM) is associated with worsened clinical outcomes in hypertrophic cardiomyopathy (HCM) patients. We sought to investigate whether HCM patients with T2DM comorbidity exhibit adverse cardiac alterations in myocardial energetics, function, perfusion, or tissue characteristics. Research design and methods: A total of 55 participants with concomitant HCM and T2DM (HCM-DM) (n = 20) or isolated HCM (n = 20) and healthy volunteers (HV) (n = 15) underwent 31P-MRS and cardiovascular MRI. The HCM groups were matched for HCM phenotype. Results: Mean ± SD European Society of Cardiology sudden cardiac death risk scores were comparable between the HCM groups (HCM 2.2 ± 1.5%, HCM-DM 1.9 ± 1.2%; P = not significant), and sarcomeric mutations were equally common. HCM-DM patients had the highest median NT-proBNP levels (HV 42 ng/L [interquartile range 35-66], HCM 298 ng/L [157-837], HCM-DM 726 ng/L [213-8,695]; P < 0.0001). Left ventricular (LV) ejection fraction, mass, and wall thickness were similar between the HCM groups. HCM-DM patients displayed a greater degree of fibrosis burden with higher scar percentage and lower global longitudinal strain compared with HCM patients. PCr/ATP (the relative concentrations of phosphocreatine and ATP) was significantly lower in the HCM-DM group than in both HCM and HV (HV 2.17 ± 0.49, HCM 1.93 ± 0.38, HCM-DM 1.54 ± 0.27; P = 0.002). In a similar pattern, stress myocardial blood flow was significantly lower in the HCM-DM group than in both HCM and HV (HV 2.06 ± 0.42 mL/min/g, HCM 1.74 ± 0.44 mL/min/g, HCM-DM 1.39 ± 0.42 mL/min/g; P = 0.002). Conclusions: We show for the first time that HCM-DM patients display greater reductions in myocardial energetics, perfusion, and contractile function and higher myocardial scar burden and serum NT-proBNP levels compared with patients with isolated HCM despite similar LV mass and wall thickness and presence of sarcomeric mutations. These adverse phenotypic features may be important components of the adverse clinical manifestation attributable to a combined presence of HCM and T2DM.
MeSH term(s)	Adenosine Triphosphate ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/genetics ; Cicatrix ; Diabetes Mellitus, Type 2/complications ; Humans ; Phenotype
Chemical Substances	Adenosine Triphosphate (8L70Q75FXE)
Language	English
Publishing date	2022-07-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	441231-x
ISSN	1935-5548 ; 0149-5992
ISSN (online)	1935-5548
ISSN	0149-5992
DOI	10.2337/dc22-0083
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Zs.A 1434: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 365: Show issues

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Article: Dapsone hypersensitivity syndrome with myocarditis.

Pereira, Carmen M / Vaz, Marina / Kotha, Sindhoora / Santosh, N H

The Journal of the Association of Physicians of India

2014 Volume 62, Issue 8, Page(s) 728–731

Abstract: Drug hypersensitivity with myocarditis is known to occur with many drugs especially with antiepileptics, sulpha-compounds and daposne. Dapsone (4, 4 diaminodiphenyl sulphone) induced hypersensitivity is known to occur in about 2% of leprosy patients on ... ...

Abstract	Drug hypersensitivity with myocarditis is known to occur with many drugs especially with antiepileptics, sulpha-compounds and daposne. Dapsone (4, 4 diaminodiphenyl sulphone) induced hypersensitivity is known to occur in about 2% of leprosy patients on treatment and an incidence of 1.66% in non-leprosy patients. We report this rare case of dapsone hypersensitivity syndrome in a girl on dapsone who presented with fever, anaemia, jaundice, skin rash, lymphadenopathy, and hepatomegaly and later developed myocarditis. The drug was withdrawn and the patient was treated with steroids. She improved and was discharged. She relapsed after the corticosteroids were discontinued at home.
MeSH term(s)	Adolescent ; Dapsone/adverse effects ; Drug Hypersensitivity/complications ; Drug Hypersensitivity/etiology ; Female ; Humans ; Myocarditis/etiology
Chemical Substances	Dapsone (8W5C518302)
Language	English
Publishing date	2014-08
Publishing country	India
Document type	Case Reports ; Journal Article
ZDB-ID	800766-4
ISSN	0004-5772
ISSN	0004-5772
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Article: Neurological Manifestations in a Patient of Kikuchi's Disease.

Vaz, Marina / Pereira, Carmen M / Kotha, Sindhoora / Oliveira, Jamina

The Journal of the Association of Physicians of India

2014 Volume 62, Issue 11, Page(s) 57–61

Abstract: Kikuchi's disease is a rare condition that mainly presents in young females along with lymphadenitis. Involvement of the nervous system is rare. We report a young female who presented with fever, headache, vomiting, lymphadenopathy and neurological ... ...

Abstract	Kikuchi's disease is a rare condition that mainly presents in young females along with lymphadenitis. Involvement of the nervous system is rare. We report a young female who presented with fever, headache, vomiting, lymphadenopathy and neurological manifestations in the form of aseptic meningitis, ataxia and paraparesis. Since the disease can be mistaken clinically and histologically for SLE, lymphoma and tuberculosis it is important to differentiate it from these conditions. Also our case emphasizes the importance of recognising this disorder in diagnosing patients with meningitis.
MeSH term(s)	Adolescent ; Ataxia/diagnosis ; Ataxia/etiology ; Biopsy ; Diagnosis, Differential ; Female ; Histiocytic Necrotizing Lymphadenitis/complications ; Histiocytic Necrotizing Lymphadenitis/diagnosis ; Humans ; Lymph Nodes/pathology ; Meningitis, Aseptic/diagnosis ; Meningitis, Aseptic/etiology ; Paraparesis/diagnosis ; Paraparesis/etiology
Language	English
Publishing date	2014-11
Publishing country	India
Document type	Case Reports ; Journal Article
ZDB-ID	800766-4
ISSN	0004-5772
ISSN	0004-5772
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Maternal Cardiac Changes in Women With Obesity and Gestational Diabetes Mellitus.

Diabetes care

2022 Volume 45, Issue 12, Page(s) 3007–3015

Abstract: Objective: We investigated if women with gestational diabetes mellitus (GDM) in the third trimester of pregnancy exhibit adverse cardiac alterations in myocardial energetics, function, or tissue characteristics.: Research design and methods: Thirty- ... ...

Abstract	Objective: We investigated if women with gestational diabetes mellitus (GDM) in the third trimester of pregnancy exhibit adverse cardiac alterations in myocardial energetics, function, or tissue characteristics. Research design and methods: Thirty-eight healthy, pregnant women and 30 women with GDM were recruited. Participants underwent phosphorus MRS and cardiovascular magnetic resonance for assessment of myocardial energetics (phosphocreatine [PCr] to ATP ratio), tissue characteristics, biventricular volumes and ejection fractions, left ventricular (LV) mass, global longitudinal shortening (GLS), and mitral in-flow E-wave to A-wave ratio. Results: Participants were matched for age, gestational age, and ethnicity. The following data are reported as mean ± SD. The women with GDM had higher BMI (27 ± 4 vs. 33 ± 5 kg/m2; P = 0.0001) and systolic (115 ± 11 vs. 121 ± 13 mmHg; P = 0.04) and diastolic (72 ± 7 vs. 76 ± 9 mmHg; P = 0.04) blood pressures. There was no difference in N-terminal pro-brain natriuretic peptide concentrations between the groups. The women with GDM had lower myocardial PCr to ATP ratio (2.2 ± 0.3 vs. 1.9 ± 0.4; P < 0.0001), accompanied by lower LV end-diastolic volumes (76 ± 12 vs. 67 ± 11 mL/m2; P = 0.002) and higher LV mass (90 ± 13 vs. 103 ± 18 g; P = 0.001). Although ventricular ejection fractions were similar, the GLS was reduced in women with GDM (-20% ± 3% vs. -18% ± 3%; P = 0.008). Conclusions: Despite no prior diagnosis of diabetes, women with obesity and GDM manifest impaired myocardial contractility and higher LV mass, associated with reductions in myocardial energetics in late pregnancy compared with lean women with healthy pregnancy. These findings may aid our understanding of the long-term cardiovascular risks associated with GDM.
MeSH term(s)	Female ; Pregnancy ; Humans ; Diabetes, Gestational ; Obesity/complications ; Pregnancy Trimester, Third ; Heart ; Adenosine Triphosphate
Chemical Substances	Adenosine Triphosphate (8L70Q75FXE)
Language	English
Publishing date	2022-09-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	441231-x
ISSN	1935-5548 ; 0149-5992
ISSN (online)	1935-5548
ISSN	0149-5992
DOI	10.2337/dc22-0401
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 1434: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Association Between Type 2 Diabetes and Changes in Myocardial Structure, Contractile Function, Energetics, and Blood Flow Before and After Aortic Valve Replacement in Patients With Severe Aortic Stenosis.

Jex, Nicholas / Greenwood, John P / Cubbon, Richard M / Rider, Oliver J / Chowdhary, Amrit / Thirunavukarasu, Sharmaine / Kotha, Sindhoora / Giannoudi, Marilena / McGrane, Anna / Maccannell, Amanda / Conning-Rowland, Marcella / Straw, Sam / Procter, Henry / Papaspyros, Sotiris / Evans, Betsy / Javangula, Kalyana / Ferrara, Antonella / Elmahdy, Walid / Kaul, Pankaj /

Xue, Hui / Swoboda, Peter / Kellman, Peter / Valkovič, Ladislav / Roberts, Lee / Beech, David / Kearney, Mark T / Plein, Sven / Dweck, Marc R / Levelt, Eylem

Circulation

2023 Volume 148, Issue 15, Page(s) 1138–1153

Abstract: Background: Type 2 diabetes (T2D) is associated with an increased risk of left ventricular dysfunction after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). Persistent impairments in myocardial energetics and myocardial ... ...

Abstract	Background: Type 2 diabetes (T2D) is associated with an increased risk of left ventricular dysfunction after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). Persistent impairments in myocardial energetics and myocardial blood flow (MBF) may underpin this observation. Using phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance, this study tested the hypothesis that patients with severe AS and T2D (AS-T2D) would have impaired myocardial energetics as reflected by the phosphocreatine to ATP ratio (PCr/ATP) and vasodilator stress MBF compared with patients with AS without T2D (AS-noT2D), and that these differences would persist after AVR. Methods: Ninety-five patients with severe AS without coronary artery disease awaiting AVR (30 AS-T2D and 65 AS-noT2D) were recruited (mean, 71 years of age [95% CI, 69, 73]; 34 [37%] women). Thirty demographically matched healthy volunteers (HVs) and 30 patients with T2D without AS (T2D controls) were controls. One month before and 6 months after AVR, cardiac PCr/ATP, adenosine stress MBF, global longitudinal strain, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and 6-minute walk distance were assessed in patients with AS. T2D controls underwent identical assessments at baseline and 6-month follow-up. HVs were assessed once and did not undergo 6-minute walk testing. Results: Compared with HVs, patients with AS (AS-T2D and AS-noT2D combined) showed impairment in PCr/ATP (mean [95% CI]; HVs, 2.15 [1.89, 2.34]; AS, 1.66 [1.56, 1.75]; Conclusions: Among patients with severe AS, those with T2D demonstrate persistent abnormalities in myocardial PCr/ATP, vasodilator stress MBF, and cardiac contractile function after AVR; AVR effectively normalizes myocardial PCr/ATP, vasodilator stress MBF, and cardiac contractile function in patients without T2D.
MeSH term(s)	Humans ; Female ; Male ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Diabetes Mellitus, Type 2/complications ; Ventricular Function, Left/physiology ; Aortic Valve Stenosis ; Vasodilator Agents ; Adenosine Triphosphate ; Heart Valve Prosthesis Implantation/adverse effects
Chemical Substances	Vasodilator Agents ; Adenosine Triphosphate (8L70Q75FXE)
Language	English
Publishing date	2023-09-25
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.122.063444
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