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Background Childhood survival of chronic disease steadily increased over the last decades. However, accumulating evidence suggests that survivors are at risk for early atherosclerosis. The “Cardiovascular Disease in Children with chronic disease” (CDC) study has two aims. First, multimodal assessment of early atherosclerosis was performed in adolescents with chronic inflammatory- and metabolic disorders in order to develop new diagnostic approaches. As fatty streak formation starts in the abdominal aorta, aortic wall thickness (AWT) and pulse wave velocity (PWV) were measured using cardiovascular magnetic resonance imaging (MRI), and compared with traditional carotid intima-media thickness (cIMT) and echocardiography. Second, comprehensive risk profiling was performed, including phenomapping of early risk factors, in order to establish cardiovascular risk profiles in childhood. Methods 113 adolescents aged 12–19 years old were enrolled*. The study population includes adolescents with juvenile idiopathic arthritis (JIA, n=19), cystic fibrosis (CF, n=24), obesity (n=20), corrected coarctation of the aorta (CoA, n=25), and corrected atrial septal defect as control group (ASD, n=25). The aorta was imaged on a 3.0 Tesla MR system using the 3D-T1-BB-VISTA sequence. Aortic PWV was assessed using velocity-encoded MRI. cIMT was measured in three directions for both the right- and left carotid artery using echography. Unbiased hierarchical clustering was performed on phenotypic data (phenomapping), including anthropomorphic-, metabolic-, and inflammatory parameters. Results* Aortic pulse wave velocity on MRI was highest in the obese group compared to controls (p=0.002), yet JIA patients (p=0.015), CoA patients (p=0.029), and CF patients (p=0.044) also showed increased PWV compared to controls. Aortic wall thickness was highest in obese adolescents (p=0.020) and in CF patients (p=0.043). cIMT was only increased in CoA patients (p=0.000). While PWV and AWT showed correlation with inflammatory- and metabolic parameters such as lymphocyte count (PWV, p=0.043), monocyte count (PWV, p=0.002; AWT, p=0.036), CRP (AWT, p=0.032), and QUICKI (PWV, p=0.026), cIMT correlated with systolic blood pressure (p=0.017). Phenomapping of risk factors will further define distinct cardiovascular risk profiles*. Conclusion Multimodal assessment of early atherosclerosis in children with chronic disease reveals differential vascular changes. While traditional cIMT is associated with increased systolic blood pressure in young CoA patients, aortic PWV and aortic wall thickness reflect early systemic inflammatory- and metabolic derangement. Phenomapping traditional risk factors alongside inflammatory- and metabolic parameters bears promise to establish early cardiovascular risk profiles in childhood chronic disease*. *Patient inclusion finishes May 2019, followed by phenomapping of patient characteristics. At the ESC, final data will be presented. Acknowledgement/Funding Wilhelmina Children's Hospital Research Fund, Dutch Topsector Life Sciences and Health TKI fund, Nutricia Research fund. HS was supported by VENI-NWO.

Contains fulltext : 215340.pdf (Publisher’s version ) (Open Access) BACKGROUND: Aortic regurgitation (AR) and subclinical left ventricular (LV) dysfunction expressed by myocardial deformation imaging are common in patients with transposition of the great arteries after the arterial switch operation (ASO). Echocardiographic evaluation is often hampered by reduced acoustic window settings. Cardiovascular magnetic resonance (CMR) imaging provides a robust alternative as it allows for comprehensive assessment of degree of AR and LV function. The purpose of this study is to validate CMR based 4-dimensional flow quantification (4D flow) for degree of AR and feature tracking strain measurements for LV deformation assessment in ASO patients. METHODS: A total of 81 ASO patients (median 20.6 years, IQR 13.5-28.4) underwent CMR for 4D and 2D flow analysis. CMR global longitudinal strain (GLS) feature tracking was compared to echocardiographic (echo) speckle tracking. Agreements between and within tests were expressed as intra-class correlation coefficients (ICC). RESULTS: Eleven ASO patients (13.6%) showed AR > 5% by 4D flow, with good correlation to 2D flow assessment (ICC = 0.85). 4D flow stroke volume of the aortic valve demonstrated good agreement to 2D stroke volume over the mitral valve (internal validation, ICC = 0.85) and multi-slice planimetric LV stroke volume (external validation, ICC = 0.95). 2D flow stroke volume showed slightly less, though still good agreement with 4D flow (ICC = 0.78) and planimetric LV stroke volume (ICC = 0.87). GLS by CMR was normal (- 18.8 +/- 4.4%) and demonstrated good agreement with GLS and segmental analysis by echocardiographic speckle tracking (GLS = - 17.3 +/- 3.1%, ICC of 0.80). CONCLUSIONS: Aortic 4D flow and CMR feature tracking GLS analysis demonstrate good to excellent agreement with 2D flow assessment and echocardiographic speckle tracking, respectively, and can therefore reliably be used for an integrated and comprehensive CMR analysis of aortic valve competence and LV deformation analysis in ASO patients.

Background: Diabetic cardiomyopathy is hallmarked by impaired left ventricular relaxation and increased left ventricular filling pressure (E/Ea). Liraglutide is an antidiabetic agent with cardioprotective effect. The aim of this study was to test liraglutide's efficacy to improve diabetic cardiomyopathy in diabetes mellitus type 2 (DM2) patients. Methods: A 26 week double-blind, placebo-controlled trial was performed. DM2 patients without prior cardiovascular disease were randomly assigned to liraglutide 1.8mg (LIRA) or placebo (PLB) added to standard care. Primary outcome measures were LV diastolic and systolic function assessed with MRI. Diastolic function indices were: early (E) and late (A) transmitral peak flow rate, E/A ratio, early decelaration peak (Edec), peak mitral annular septal velocity (Ea) and E/Ea. Systolic function indices were: stroke volume (SV), ejection fraction (EF), cardiac output (CO), cardiac index (CI) and peak ejection rate (PER). Intention-to-treat analysis of between group differences was performed using ANCOVA. Mean estimated treatment differences (95% confidence intervals) are reported. Findings: 23 patients were randomised to LIRA and 26 to PLB. As compared with PLB, LIRA significantly reduced E (-56 ml/s (-91 to -21)), E/A ratio (-0·17 (-0·27 to -0·06)), Edec (-0·9 ml/s2*10-3 (-1·3 to -0·2)) and E/Ea (-1·8 (-3·0 to -0·6)), without affecting A (3 ml/s (-35 to 41)) and Ea (0·4 cm/s (-0·9 to 1·4)). LIRA reduced SV (-9 ml (-16 to -2)) and EF (-3% (-6 to -0·1)), but did not change CO (-0·4 L/min (-0·9 to 0·2)), CI (-0·1 L/min/m2 (-0·4 to 0·1)) and PER (-46 ml/s (-95 to 3)), as compared to PLB. Interpretation: In DM2 patients without prior cardiovascular disease, liraglutide improved E/Ea. Systolic function reduced and remained within normal range. Future studies are needed to investigate if liraglutide-induced left ventricular unloading can slow progression of diabetic cardiomyopathy into symptomatic stages. Trial Registration Number: The trial was registered with ClinicalTrials.gov, number NCT01761318 Funding: MAGNA VICTORIA Competing Declaration of Interest: All authors have no conflict of interest. Ethical Approval Statement: The trial was approved by the local ethics committee and performed in accordance with the principles of the revised Declaration of Helsinki. Written informed consent was obtained from all participants before study entry.

ObjectivesIn acute type B aortic dissection (ABAD) a patent false lumen portends a poor outcome. Patent branch vessels originating from the false lumen in a type B aortic dissection are assumed to contribute to persistent blood flow and patent false lumen. Therefore, the morphologic changes of the false lumen generated by different outflow rates in an in vitro model were investigated.MethodsAn artificial dissection was created in two ex vivo porcine aortas. A thin cannula was placed in the false lumen, simulating a branch vessel originating from it. The aorta was positioned in a validated in vitro circulatory system with physiological pulsatile flow (1,500–2,700mL/minute) and pressure characteristics (130/70 mmHg). The cannula was attached to a small silicone tube with an adjustable valve mechanism. Three different valve settings were used for creating outflow from the false lumen (fully closed, opened at 50%, and fully opened at 100%). Measurements of lumen areas and flow rates were assessed with time-resolved magnetic resonance imaging. In order to study reproducibility, the experiment was performed twice in two different porcine aortas with a similar morphology.ResultsIncreasing antegrade outflow through the branch vessel of the false lumen resulted in a significant (p

Thoracic aortic aneurysm (TAA) is potentially life-threatening and requires close follow-up to prevent aortic dissection. Aortic stiffness and size are considered to be coupled. Regional aortic stiffness in patients with TAA is unknown. We aimed to evaluate coupling between regional pulse wave velocity (PWV), a marker of vascular stiffness, and aortic diameter in TAA patients.In 40 TAA patients (59 ± 13 years, 28 male), regional aortic diameters and regional PWV were assessed by 1.5 T MRI. The incidence of increased diameter and PWV were determined for five aortic segments (S1, ascending aorta; S2, aortic arch; S3, thoracic descending aorta; S4, suprarenal and S5, infrarenal abdominal aorta). In addition, coupling between regional PWV testing and aortic dilatation was evaluated and specificity and sensitivity were assessed.Aortic diameter was 44 ± 5 mm for the aortic root and 39 ± 5 mm for the ascending aorta. PWV was increased in 36 (19 %) aortic segments. Aortic diameter was increased in 28 (14 %) segments. Specificity of regional PWV testing for the prediction of increased regional diameter was ≥ 84 % in the descending thoracic to abdominal aorta and ≥ 68 % in the ascending aorta and aortic arch.Normal regional PWV is related to absence of increased diameter, with high specificity in the descending thoracic to abdominal aorta and moderate results in the ascending aorta and aortic arch.

Objective Atherosclerotic large vessel disease is potentially involved in the pathogenesis of cerebral small vessel disease related to occurrence of white matter lesions (WMLs) in the brain. We aimed to assess morphological and functional carotid vessel wall properties in relation to WML using magnetic resonance imaging (MRI) in myocardial infarction (MI) patients. Materials and methods A total of 20 MI patients (90 % male, 61 ± 11 years) underwent carotid artery and brain MRI. Carotid vessel wall thickness (VWT) was assessed, by detecting lumen and outer wall contours. Carotid pulse wave velocity (PWV), a measure of elasticity, was determined using the transit-time method. Patients were divided according to the median VWT into two groups. Brain MRI allowed for the WML score. Results Mean VWT was 1.41 ± 0.29 mm and mean carotid PWV was 7.0 ± 2.2 m/s. A significant correlation (Pearson r = 0.45, p = 0.046) between VWT and PWV was observed. Furthermore, in the group of high VWT, the median WML score was higher as compared with the group with lower VWT (4.0 vs 3.0, p = 0.035). Conclusions Carotid artery morphological and functional alterations are correlated in MI patients. Patients with high VWT showed a higher amount of periventricular WMLs. These findings support the hypothesis that atherosclerotic large vessel disease is potentially involved in the pathogenesis of cerebral small vessel disease.

Background-—Accurate assessment of mechanical properties of the proximal aorta is a requisite first step for elucidating the pathophysiology of isolated systolic hypertension. During systole, substantial proximal aortic axial displacement produces longitudinal strain, which we hypothesize causes variable underestimation of ascending aortic circumferential strain compared to values in the longitudinally constrained descending aorta.

In this study, a scanning protocol was developed to image the arterial bed of the pelvis and both legs along their entire length in patients with peripheral arterial disease, using standard hard-and software. Three adjacent stations are acquired consecutively, with some small overlap; per station; one Gadolinium contrast bolus is administered. The scanning protocol was optimized in an in vitro phantom study. The optimal flip angle was found to be 50°. Also, the optimal scan delay was chosen to be equal to the arrival time of the contrast bolus thereby minimizing artifacts. Three contrast bolus injections showed sufficient enhancement of the vessels after image subtraction. Finally, stenosis quantification by manual caliper was performed by five observers in the MRA images and correlated with the percent diameter reduction determined by quantitative angiography from corresponding X-ray images. The results of the MRA measurements were reproducible and intra- and inter-observer variabilities were statistically non-significant (p = 0.54 and p = 0.12, respectively). Stenosis quantification performed by four observers showed a good correlation with the X-ray derived values (r p > 0.90, p < 0.02); the results from one observer were not significantly correlated. Five patients with proven peripheral disease were investigated with this new MRA scanning protocol. The images were of good quality which allowed adequate clinical evaluation; the original diagnoses obtained from X-ray examinations, were confirmed with MRA. In conclusion, peripheral arterial disease can be evaluated adequately with this MR scanning protocol.

Background: Aortic wall pathology and concomitant aortic dilatation have been described in tetralogy of Fallot (TOF) patients, which may negatively affect aortic valve and left ventricular systolic function. Objective: To assess aortic dimensions, aortic elasticity, aortic valve competence and biventricular function in repaired TOF patients after pulmonary valve replacement (PVR) using magnetic resonance imaging (MRI). Methods: MRI was performed in 16 patients with TOF after PVR (10 male; mean age 31 years (SD 15)) and 16 age and gender-matched healthy subjects. Results: TOF patients showed aortic root dilatation (mean difference 7.8-8.8 mm, p

OBJECTIVE: To assess pulmonary flow dynamics and right ventricular (RV) function in patients without significant anatomical narrowing of the pulmonary arteries late after the arterial switch operation (ASO) by using magnetic resonance imaging (MRI). METHODS: 17 patients (mean (SD), 16.5 (3.6) years after ASO) and 17 matched healthy subjects were included. MRI was used to assess flow across the pulmonary trunk, RV systolic and diastolic function, and RV mass. RESULTS: Increased peak flow velocity (>1.5 m/s) was found across the pulmonary trunk in 14 of 17 patients. Increased RV mass was found in ASO patients: 14.9 (3.4) vs 10.0 (2.6) g/m2 in normal subjects (p

The paper presents a segmentation method based on 3D cylindrical B-spline model. Proposed method was applied to 5 patient MRA studies of carotid arteries and 1 phantom dataset. Carotid bifurcation was segmented as two independent, overlapping branches. The presented method was evaluated against observer drawn contours and phantom model. Statistical assessment of vessel lumen area showed 10.4% systematic underestimation and good precision (SD = 9.2 vs. SDinterobs= 11.8) of presented method in comparison to the observer's results

This paper describes a new method to segment vascular structures in 3D MRA data, based on the Wavefront Propagation algorithm. The center lumen line and the vessel boundary are detected automatically. Our 3D visualization and interaction platform will be prestended, which is used to aid the phycisian in the analysis of the MRA data. The results are compared to conventional X-ray DSA which is considered the current gold-standard. Provided that the diameter of the vessel is larger than 3 voxels, our method has similar result as X-ray DSA.