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  1. 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
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  2. Article ; Online: A case report of refractory angina in a patient with diabetes and apical hypertrophic cardiomyopathy.

    Jex, Nicholas / Chowdhary, Amrit / Thirunavukarasu, Sharmaine / Levelt, Eylem

    European heart journal. Case reports

    2022  Volume 6, Issue 8, Page(s) ytac347

    Abstract: Background: Using serial imaging over time, this case reviews the natural history of co-morbid Type two diabetes (T2D) and apical hypertrophic cardiomyopathy (HCM) and assesses the potential combined impact on myocardial structure and perfusion.: Case ...

    Abstract Background: Using serial imaging over time, this case reviews the natural history of co-morbid Type two diabetes (T2D) and apical hypertrophic cardiomyopathy (HCM) and assesses the potential combined impact on myocardial structure and perfusion.
    Case summary: A 59-year-old patient with concomitant T2D and an apical phenotype of HCM was seen over a 11-year period with a significant burden of anginal chest pain. Chest pain was refractory to anti-anginal medical therapy and persisted at on-going follow-up. Multi-modality imaging demonstrated significant deterioration in coronary microvascular function and increased myocardial scar burden despite unobstructed epicardial coronary arteries.
    Discussion: Comorbidity with T2D and apical HCM resulted in a significant increase in myocardial fibrosis and deterioration in coronary microvascular function.
    Language English
    Publishing date 2022-08-16
    Publishing country England
    Document type Case Reports
    ISSN 2514-2119
    ISSN (online) 2514-2119
    DOI 10.1093/ehjcr/ytac347
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  3. Article ; Online: Global microvascular ischaemia following Takotsubo cardiomyopathy with left ventricular function recovery.

    Chowdhary, Amrit / Thirunavukarasu, Sharmaine / Jex, Nick / Levelt, Eylem

    European heart journal. Case reports

    2021  Volume 5, Issue 3, Page(s) ytab093

    Language English
    Publishing date 2021-03-10
    Publishing country England
    Document type Case Reports
    ISSN 2514-2119
    ISSN (online) 2514-2119
    DOI 10.1093/ehjcr/ytab093
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  4. Article ; Online: Multiple Etiologies to Myocardial Injury in COVID-19.

    Gorecka, Miroslawa / Thirunavukarasu, Sharmaine / Levelt, Eylem / Greenwood, John P

    JACC. Case reports

    2021  Volume 3, Issue 6, Page(s) 971–972

    Abstract: In patients with acute myocardial injury secondary to coronavirus disease-2019 (COVID-19), cardiovascular magnetic resonance imaging can identify the underlying pathology. We highlight a case of acute myocardial injury secondary to COVID-19, which ... ...

    Abstract In patients with acute myocardial injury secondary to coronavirus disease-2019 (COVID-19), cardiovascular magnetic resonance imaging can identify the underlying pathology. We highlight a case of acute myocardial injury secondary to COVID-19, which demonstrated both epicardial vessel thrombosis and the recently described phenomenon of microvascular thrombosis. (
    Language English
    Publishing date 2021-06-16
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2666-0849
    ISSN (online) 2666-0849
    DOI 10.1016/j.jaccas.2021.05.003
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  5. Article ; Online: Progressive myocardial dysfunction following COVID-19.

    Gorecka, Miroslawa Maria / Thirunavukarasu, Sharmaine / Levelt, Eylem / Greenwood, John P

    BMJ case reports

    2021  Volume 14, Issue 11

    MeSH term(s) COVID-19 ; Cardiomyopathies ; Humans ; SARS-CoV-2 ; Ventricular Function, Left
    Language English
    Publishing date 2021-11-11
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2021-246291
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  6. Article ; Online: The impact of water exchange on estimates of myocardial extracellular volume calculated using contrast enhanced T

    Sharrack, Noor / Biglands, John D / Broadbent, David A / Kellman, Peter / Chow, Kelvin / Greenwood, John P / Levelt, Eylem / Plein, Sven / Buckley, David L

    Magnetic resonance in medicine

    2023  Volume 91, Issue 4, Page(s) 1637–1644

    Abstract: Purpose: Guidelines recommend measuring myocardial extracellular volume (ECV) using T: Methods: Twenty-five patients with severe AS and 5 healthy controls were recruited. T: Results: Median (range) ECV estimated using the 2SXM model was 25% (21%- ... ...

    Abstract Purpose: Guidelines recommend measuring myocardial extracellular volume (ECV) using T
    Methods: Twenty-five patients with severe AS and 5 healthy controls were recruited. T
    Results: Median (range) ECV estimated using the 2SXM model was 25% (21%-39%) for patients and 26% (22%-29%) for controls. ECV estimated in patients using the LM at 10 min following a cumulative contrast dose of 0.15 mmol/kg was 21% (17%-32%) and increased significantly to 22% (19%-35%) at 30 min (p = 0.0001). ECV estimated using the LM was highest following low dose gadobutrol, 25% (19%-38%).
    Conclusion: Current guidelines on contrast agent dose for ECV measurements may lead to underestimated ECV in patients with severe AS because of limited WX. Use of a lower contrast agent dose may mitigate this effect.
    MeSH term(s) Humans ; Contrast Media ; Organometallic Compounds ; Myocardium ; Predictive Value of Tests ; Aortic Valve Stenosis/diagnostic imaging ; Magnetic Resonance Imaging, Cine
    Chemical Substances gadobutrol (1BJ477IO2L) ; Contrast Media ; Organometallic Compounds
    Language English
    Publishing date 2023-12-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605774-3
    ISSN 1522-2594 ; 0740-3194
    ISSN (online) 1522-2594
    ISSN 0740-3194
    DOI 10.1002/mrm.29956
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    Zs.A 1959: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  7. Article ; Online: Aortic stenosis assessment from the 3-chamber cine: Ratio of balanced steady-state-free-precession (bSSFP) blood signal between the aorta and left ventricle predicts severity.

    Vimalesvaran, Kavitha / Zaman, Sameer / Howard, James P / Aziminia, Nikoo / Giannoudi, Marilena / Procter, Henry / Varela, Marta / Uslu, Fatmatulzehra / Ariff, Ben / Linton, Nick / Levelt, Eylem / Bharath, Anil A / Cole, Graham D

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

    2024  Volume 26, Issue 1, Page(s) 100005

    Abstract: Background: Cardiovascular magnetic resonance (CMR) imaging is an important tool for evaluating the severity of aortic stenosis (AS), co-existing aortic disease, and concurrent myocardial abnormalities. Acquiring this additional information requires ... ...

    Abstract Background: Cardiovascular magnetic resonance (CMR) imaging is an important tool for evaluating the severity of aortic stenosis (AS), co-existing aortic disease, and concurrent myocardial abnormalities. Acquiring this additional information requires protocol adaptations and additional scanner time, but is not necessary for the majority of patients who do not have AS. We observed that the relative signal intensity of blood in the ascending aorta on a balanced steady state free precession (bSSFP) 3-chamber cine was often reduced in those with significant aortic stenosis. We investigated whether this effect could be quantified and used to predict AS severity in comparison to existing gold-standard measurements.
    Methods: Multi-centre, multi-vendor retrospective analysis of patients with AS undergoing CMR and transthoracic echocardiography (TTE). Blood signal intensity was measured in a ∼1 cm
    Results: 314 patients (median age 69 [IQR 57-77], 64% male) who had undergone both CMR and TTE were studied; 84 had severe AS, 78 had moderate AS, 66 had mild AS and 86 without AS were studied as a comparator group. The median time between CMR and TTE was 12 weeks (IQR 4-26). The Ao:LV ratio at 1.5 T strongly correlated with peak velocity (r = -0.796, p = 0.001), peak gradient (r = -0.772, p = 0.001) and dimensionless index (r = 0.743, p = 0.001). An Ao:LV ratio of < 0.86 was 84% sensitive and 82% specific for detecting AS of any severity and a ratio of 0.58 was 83% sensitive and 92% specific for severe AS. The ability of Ao:LV ratio to predict AS severity remained for patients with bicuspid aortic valves, dilated aortic root or low indexed stroke volume. The relationship between Ao:LV ratio and AS severity was weaker at 3 T.
    Conclusions: The Ao:LV ratio, derived from bSSFP 3-chamber cine images, shows a good correlation with existing measures of AS severity. It demonstrates utility at 1.5 T and offers an easily calculable metric that can be used at the time of scanning or automated to identify on an adaptive basis which patients benefit from dedicated imaging to assess which patients should have additional sequences to assess AS.
    Language English
    Publishing date 2024-01-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 1458034-2
    ISSN 1532-429X ; 1097-6647
    ISSN (online) 1532-429X
    ISSN 1097-6647
    DOI 10.1016/j.jocmr.2023.100005
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    Zs.A 5045: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  8. Article ; Online: Reply: Ectopic Fat Deposition and Diabetes Mellitus.

    Levelt, Eylem / Neubauer, Stefan

    Journal of the American College of Cardiology

    2016  Volume 68, Issue 23, Page(s) 2595

    MeSH term(s) Diabetes Mellitus, Type 2 ; Humans ; Hypercholesterolemia
    Language English
    Publishing date 2016-12-06
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2016.09.939
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    Zs.A 1846: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 196: Show issues

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  9. Article: Diabetic cardiomyopathy: Pathophysiology, theories and evidence to date.

    Athithan, Lavanya / Gulsin, Gaurav S / McCann, Gerald P / Levelt, Eylem

    World journal of diabetes

    2019  Volume 10, Issue 10, Page(s) 490–510

    Abstract: The prevalence of type 2 diabetes (T2D) has increased worldwide and doubled over the last two decades. It features among the top 10 causes of mortality and morbidity in the world. Cardiovascular disease is the leading cause of complications in diabetes ... ...

    Abstract The prevalence of type 2 diabetes (T2D) has increased worldwide and doubled over the last two decades. It features among the top 10 causes of mortality and morbidity in the world. Cardiovascular disease is the leading cause of complications in diabetes and within this, heart failure has been shown to be the leading cause of emergency admissions in the United Kingdom. There are many hypotheses and well-evidenced mechanisms by which diabetic cardiomyopathy as an entity develops. This review aims to give an overview of these mechanisms, with particular emphasis on metabolic inflexibility. T2D is associated with inefficient substrate utilisation, an inability to increase glucose metabolism and dependence on fatty acid oxidation within the diabetic heart resulting in mitochondrial uncoupling, glucotoxicity, lipotoxicity and initially subclinical cardiac dysfunction and finally in overt heart failure. The review also gives a concise update on developments within clinical imaging, specifically cardiac magnetic resonance studies to characterise and phenotype early cardiac dysfunction in T2D. A better understanding of the pathophysiology involved provides a platform for targeted therapy in diabetes to prevent the development of early heart failure with preserved ejection fraction.
    Language English
    Publishing date 2019-10-22
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2583471-X
    ISSN 1948-9358
    ISSN 1948-9358
    DOI 10.4239/wjd.v10.i10.490
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  10. Article: Early prediction of left ventricular function improvement in patients with new-onset heart failure and presumed non-ischaemic aetiology.

    Goh, Ze Ming / Javed, Wasim / Shabi, Mubien / Klassen, Joel R L / Saunderson, Christopher E D / Farley, Jonathan / Spurr, Melanie / Dall'Armellina, Erica / Levelt, Eylem / Greenwood, John / Halliday, Brian / Plein, Sven / Swoboda, Peter

    Open heart

    2023  Volume 10, Issue 2

    Abstract: Objectives: To determine baseline characteristics predictive of left ventricular ejection fraction (LVEF) recovery in patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and presumed non-ischaemic aetiology.: Methods: We ... ...

    Abstract Objectives: To determine baseline characteristics predictive of left ventricular ejection fraction (LVEF) recovery in patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and presumed non-ischaemic aetiology.
    Methods: We prospectively recruited patients who were diagnosed with HFrEF (LVEF ≤40%) on echocardiography and subsequently underwent cardiac MRI. Patients were excluded if they had a known history of coronary artery disease (>70% on invasive coronary angiography), myocardial infarction, coronary revascularisation or anginal symptoms. At cardiac MRI assessment, patients were categorised as either ongoing HFrEF or heart failure with improved ejection fraction (HFimpEF, LVEF >40% with ≥10% of absolute improvement). Clinical characteristics were compared between the groups. Logistic regression was performed to identify variables that were associated with LVEF recovery. Optimal cut-offs in QRISK3 score and baseline LVEF for prediction of LVEF recovery were identified through receiver operating characteristic curve analysis.
    Results: A total of 407 patients were diagnosed with HFrEF, and 139 (34%) attained HFimpEF at cardiac MRI assessment (median 63 days, IQR 41-119 days). Mean age of the patients was 63±12 years, and 260 (63.9%) were male. At multivariate logistic regression, both QRISK3 score (HR 0.978; 95% CI 0.963 to 0.993, p=0.004) and baseline LVEF (HR 1.044; 95% CI 1.015 to 1.073, p=0.002) were independent predictors of HFimpEF. Among patients with baseline LVEF ≤25%, only 22 (21.8%) recovered. In patients with baseline LVEF 25-40%, QRISK3 score >18% was associated with lack of recovery (HR 2.75; 95% CI 1.70 to 4.48, p<0.001). Additionally, QRISK3 score was associated with the presence of ischaemic late gadolinium enhancement (HR 1.035; 95% CI 1.018 to 1.053, p<0.001).
    Conclusions: The QRISK3 score helps identify patients with HFrEF with undiagnosed vascular disease. Patients with either a very low baseline LVEF or a high QRISK3 score have less chance of left ventricular recovery and should be prioritised for early cardiac MRI and close monitoring.
    MeSH term(s) Humans ; Male ; Middle Aged ; Aged ; Female ; Ventricular Function, Left ; Stroke Volume ; Heart Failure/diagnostic imaging ; Heart Failure/etiology ; Contrast Media ; Gadolinium
    Chemical Substances Contrast Media ; Gadolinium (AU0V1LM3JT)
    Language English
    Publishing date 2023-08-17
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2747269-3
    ISSN 2053-3624
    ISSN 2053-3624
    DOI 10.1136/openhrt-2023-002429
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