18 results on '"Muthurangu, Vivek"'
Search Results
2. Pulmonary Hypertension
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Knight, Daniel, Muthurangu, Vivek, Syed, Mushabbar A., editor, and Mohiaddin, Raad H., editor
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- 2023
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3. Modelling Pulmonary Arterial Hypertension: Clinical Concepts, Engineering Applications and an Integrated Medico-engineering Approach
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Torii, Ryo, Muthurangu, Vivek, Butera, Gianfranco, editor, Schievano, Silvia, editor, Biglino, Giovanni, editor, and McElhinney, Doff B., editor
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- 2022
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4. Predictors of outcomes in mild pulmonary hypertension according to 2022 ESC/ERS Guidelines: the EVIDENCE-PAH UK study.
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Karia, Nina, Howard, Luke, Johnson, Martin, Kiely, David G, Lordan, James, McCabe, Colm, Pepke-Zaba, Joanna, Ong, Rose, Preiss, Michael, Knight, Daniel, Muthurangu, Vivek, and Coghlan, J Gerry
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PULMONARY hypertension ,PULMONARY arterial hypertension ,CLINICAL trials ,CARDIAC patients ,CONNECTIVE tissue diseases - Abstract
Background and Aims Interventional studies in pulmonary arterial hypertension completed to date have shown to be effective in symptomatic patients with significantly elevated mean pulmonary artery pressure (mPAP) (≥25 mmHg) and pulmonary vascular resistance (PVR) > 3 Wood Unit (WU). However, in health the mPAP does not exceed 20 mmHg and PVR is 2 WU or lower, at rest. The ESC/ERS guidelines have recently been updated to reflect this. There is limited published data on the nature of these newly defined populations (mPAP 21–24 mmHg and PVR >2–≤3 WU) and the role of comorbidity in determining their natural history. With the change in guidelines, there is a need to understand this population and the impact of the ESC/ERS guidelines in greater detail. Methods A retrospective nationwide evaluation of the role of pulmonary haemodynamics and comorbidity in predicting survival among patients referred to the UK pulmonary hypertension (PH) centres between 2009 and 2017. In total, 2929 patients were included in the study. Patients were stratified by mPAP (<21 mmHg, 21–24 mmHg, and ≥25 mmHg) and PVR (≤2 WU, > 2–≤3 WU, and >3 WU), with 968 (33.0%) in the mPAP <21 mmHg group, 689 (23.5%) in the mPAP 21–24 mmHg group, and 1272 (43.4%) in the mPAP ≥25 mmHg group. Results Survival was negatively correlated with mPAP and PVR in the population as a whole. Survival in patients with mildly elevated mPAP (21–24 mmHg) or PVR (>2–≤3WU) was lower than among those with normal pressures (mPAP <21 mmHg) and normal PVR (PVR ≤ 2WU) independent of comorbid lung and heart disease [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.14–1.61, P =.0004 for mPAP vs. HR 1.28, 95% CI 1.10–1.49, P =.0012 for PVR]. Among patients with mildly elevated mPAP, a mildly elevated PVR remained an independent predictor of survival when adjusted for comorbid lung and heart disease (HR 1.33, 95% CI 1.01–1.75, P =.042 vs. HR 1.4, 95% CI 1.06–1.86, P =.019). 68.2% of patients with a mPAP 21–24 mmHg had evidence of underlying heart or lung disease. Patients with mildly abnormal haemodynamics were not more symptomatic than patients with normal haemodynamics. Excluding patients with heart and lung disease, connective tissue disease was associated with a poorer survival among those with PH. In this subpopulation evaluating those with a mPAP of 21–24 mmHg, survival curves only diverged after 5 years. Conclusions This study supports the change in diagnostic category of the ESC/ERS guidelines in a PH population. The newly included patients have an increased mortality independent of significant lung or heart disease. The majority of patients in this new category have underlying heart or lung disease rather than an isolated pulmonary vasculopathy. Mortality is higher if comorbidity is present. Rigorous phenotyping will be pivotal to determine which patients are at risk of progressive vasculopathic disease and in whom surveillance and recruitment to studies may be of benefit. This study provides an insight into the population defined by the new guidelines. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Pulmonary Hypertension
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Moledina, Shahin, Muthurangu, Vivek, Bogaert, Jan, editor, Dymarkowski, Steven, editor, Taylor, Andrew M., editor, and Muthurangu, Vivek, editor
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- 2012
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6. Cardiovascular magnetic resonance-guided right heart catheterization in a conventional CMR environment – predictors of procedure success and duration in pulmonary artery hypertension
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Knight, Daniel S., Kotecha, Tushar, Martinez-Naharro, Ana, Brown, James T., Bertelli, Michele, Fontana, Marianna, Muthurangu, Vivek, and Coghlan, J. Gerry
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- 2019
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7. Distinct cardiovascular phenotypes are associated with prognosis in systemic sclerosis: a cardiovascular magnetic resonance study.
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Knight, Daniel S, Karia, Nina, Cole, Alice R, Maclean, Rory H, Brown, James T, Masi, Ambra, Patel, Rishi K, Razvi, Yousuf, Chacko, Liza, Venneri, Lucia, Kotecha, Tushar, Martinez-Naharro, Ana, Kellman, Peter, Scott-Russell, Ann M, Schreiber, Benjamin E, Ong, Voon H, Denton, Christopher P, Fontana, Marianna, Coghlan, J Gerry, and Muthurangu, Vivek
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MORTALITY risk factors ,DECISION trees ,PATIENT aftercare ,HYPERTENSION ,CAUSES of death ,SCIENTIFIC observation ,VENTRICULAR ejection fraction ,SYSTEMIC scleroderma ,MAGNETIC resonance imaging ,RETROSPECTIVE studies ,INDIVIDUALIZED medicine ,RISK assessment ,RIGHT ventricular dysfunction ,DESCRIPTIVE statistics ,CLUSTER analysis (Statistics) ,PREDICTION models ,PHENOTYPES ,CARDIOVASCULAR disease diagnosis ,ALGORITHMS - Abstract
Aims Cardiovascular involvement in systemic sclerosis (SSc) is heterogeneous and ill-defined. This study aimed to: (i) discover cardiac phenotypes in SSc by cardiovascular magnetic resonance (CMR); (ii) provide a CMR-based algorithm for phenotypic classification; and (iii) examine for associations between phenotypes and mortality. Methods and results A retrospective, single-centre, observational study of 260 SSc patients who underwent clinically indicated CMR including native myocardial T1 and T2 mapping from 2016 to 2019 was performed. Agglomerative hierarchical clustering using only CMR variables revealed five clusters of SSc patients with shared CMR characteristics: dilated right hearts with right ventricular failure (RVF); biventricular failure dilatation and dysfunction (BVF); and normal function with average cavity (NF-AC), normal function with small cavity (NF-SC), and normal function with large cavity (NF-LC) sizes. Phenotypes did not co-segregate with clinical or antibody classifications. A CMR-based decision tree for phenotype classification was created. Sixty-three (24%) patients died during a median follow-up period of 3.4 years. After adjustment for age and presence of pulmonary hypertension (PH), independent CMR predictors of all-cause mortality were native T1 (P < 0.001) and right ventricular ejection fraction (RVEF) (P = 0.0032). NF-SC and NF-AC groups had more favourable prognoses (P ≤0.036) than the other three groups which had no differences in prognoses between them (P > 0.14). Hazard ratios (HR) were statistically significant for RVF (HR = 8.9, P < 0.001), BVF (HR = 5.2, P = 0.006), and NF-LC (HR = 4.9, P = 0.002) groups. The NF-LC group remained significantly predictive of mortality after adjusting for RVEF, native T1, and PH diagnosis (P = 0.0046). Conclusion We identified five CMR-defined cardiac SSc phenotypes that did not co-segregate with clinical data and had distinct outcomes, offering opportunities for a more precision-medicine based management approach. [ABSTRACT FROM AUTHOR]
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- 2023
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8. Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study.
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Brown, James T., Kotecha, Tushar, Steeden, Jennifer A., Fontana, Marianna, Denton, Christopher P., Coghlan, J. Gerry, Knight, Daniel S., and Muthurangu, Vivek
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TISSUE physiology ,CARDIOVASCULAR system radiography ,EXERCISE tests ,EXERCISE tolerance ,CARDIOVASCULAR system physiology ,BLOOD vessels ,OXYGEN ,SKELETAL muscle ,OXYGEN consumption ,CARDIOPULMONARY system ,PULMONARY hypertension ,SYSTEMIC scleroderma ,MAGNETIC resonance imaging ,CONNECTIVE tissue diseases ,ERGOMETRY ,SUPINE position - Abstract
Background: Exercise intolerance in systemic sclerosis (SSc) is typically attributed to cardiopulmonary limitations. However, problems with skeletal muscle oxygen extraction have not been fully investigated. This study used cardiovascular magnetic resonance (CMR)-augmented cardiopulmonary exercise testing (CMR-CPET) to simultaneously measure oxygen consumption and cardiac output. This allowed calculation of arteriovenous oxygen content gradient, a recognized marker of oxygen extraction. We performed CMR-CPET in 4 groups: systemic sclerosis (SSc); systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH); non-connective tissue disease pulmonary hypertension (NC-PAH); and healthy controls. Methods: We performed CMR-CPET in 60 subjects (15 in each group) using a supine ergometer following a ramped exercise protocol until exhaustion. Values for oxygen consumption, cardiac output and oxygen content gradient, as well as ventricular volumes, were obtained at rest and peak-exercise for all subjects. In addition, T1 and T2 maps were acquired at rest, and the most recent clinical measures (hemoglobin, lung function, 6-min walk, cardiac and catheterization) were collected. Results: All patient groups had reduced peak oxygen consumption compared to healthy controls (p < 0.022). The SSc and SSc-PAH groups had reduced peak oxygen content gradient compared to healthy controls (p < 0.03). Conversely, the SSc-PAH and NC-PH patients had reduced peak cardiac output compared to healthy controls and SSc patients (p < 0.006). Higher hemoglobin was associated with higher peak oxygen content gradient (p = 0.025) and higher myocardial T1 was associated with lower peak stroke volume (p = 0.011). Conclusions: Reduced peak oxygen consumption in SSc patients is predominantly driven by reduced oxygen content gradient and in SSc-PAH patients this was amplified by reduced peak cardiac output. Trial registration The study is registered with ClinicalTrials.gov Protocol Registration and Results System (ClinicalTrials.gov ID: 100358). [ABSTRACT FROM AUTHOR]
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- 2021
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9. Accuracy and Reproducibility of Right Ventricular Quantification in Patients with Pressure and Volume Overload Using Single-Beat Three-Dimensional Echocardiography
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Knight, Daniel S., Grasso, Agata E., Quail, Michael A., Muthurangu, Vivek, Taylor, Andrew M., Toumpanakis, Christos, Caplin, Martyn E., Coghlan, J. Gerry, and Davar, Joseph
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Male ,3D, Three-dimensional ,TAPSE, Tricuspid annular plane systolic excursion ,Ventricular Dysfunction, Right ,ROC, Receiver operating characteristic ,Cardiac-Gated Imaging Techniques ,Echocardiography, Three-Dimensional ,ICC, Intraclass correlation coefficient ,RVOT, Right ventricular outflow tract ,COV, Coefficient of variation ,Three-dimensional echocardiography ,2D, Two-dimensional ,Sensitivity and Specificity ,Pulmonary hypertension ,PH, Pulmonary hypertension ,RV, Right ventricular ,Magnetic resonance imaging ,3DE, Three-dimensional echocardiography ,Image Interpretation, Computer-Assisted ,Humans ,Clinical Investigation ,ESV, End-systolic volume ,Carcinoid heart disease ,2DE, Two-dimensional echocardiography ,EDV, End-diastolic volume ,Reproducibility of Results ,Stroke Volume ,Right Ventricular Overload and RV Function ,Middle Aged ,Right ventricular function ,EF, Ejection fraction ,Radiology Nuclear Medicine and imaging ,Feasibility Studies ,CMRI, Cardiac magnetic resonance imaging ,Female ,Cardiology and Cardiovascular Medicine ,SV, Stroke volume - Abstract
Background The right ventricle is a complex structure that is challenging to quantify by two-dimensional (2D) echocardiography. Unlike disk summation three-dimensional (3D) echocardiography (3DE), single-beat 3DE can acquire large volumes at high volume rates in one cardiac cycle, avoiding stitching artifacts or long breath-holds. The aim of this study was to assess the accuracy and test-retest reproducibility of single-beat 3DE for quantifying right ventricular (RV) volumes in adult populations of acquired RV pressure or volume overload, namely, pulmonary hypertension (PH) and carcinoid heart disease, respectively. Three-dimensional and 2D echocardiographic indices were also compared for identifying RV dysfunction in PH. Methods A prospective cross-sectional study was performed in 100 individuals who underwent 2D echocardiography, 3DE, and cardiac magnetic resonance imaging: 49 patients with PH, 20 with carcinoid heart disease, 11 with metastatic carcinoid tumors without cardiac involvement, and 20 healthy volunteers. Two operators performed test-retest acquisition and postprocessing for inter- and intraobserver reproducibility in 20 subjects. Results: RV single-beat 3DE was attainable in 96% of cases, with mean volume rates of 32 to 45 volumes/sec. Bland-Altman analysis of all subjects (presented as mean bias ± 95% limits of agreement) revealed good agreement for end-diastolic volume (−2.3 ± 27.4 mL) and end-systolic volume (5.2 ± 19.0 mL) measured by 3DE and cardiac magnetic resonance imaging, with a tendency to underestimate stroke volume (−7.5 ± 23.6 mL) and ejection fraction (−4.6 ± 13.8%) by 3DE. Subgroup analysis demonstrated a greater bias for volumetric underestimation, particularly in healthy volunteers (end-diastolic volume, −11.9 ± 18.0 mL; stroke volume, −11.2 ± 20.2 mL). Receiver operating characteristic curve analysis showed that 3DE-derived ejection fraction was significantly superior to 2D echocardiographic parameters for identifying RV dysfunction in PH (sensitivity, 94%; specificity, 88%; area under the curve, 0.95; P = .031). There was significant interobserver test-retest bias for RV volume underestimation (end-diastolic volume, −12.5 ± 28.1 mL; stroke volume, −10.6 ± 23.2 mL). Conclusions Single-beat 3DE is feasible and clinically applicable for volumetric quantification in acquired RV pressure or volume overload. It has improved limits of agreement compared with previous disk summation 3D echocardiographic studies and has incremental value over standard 2D echocardiographic measures for identifying RV dysfunction. Despite the ability to obtain and postprocess a full-volume 3D echocardiographic RV data set, the quality of the raw data did influence the accuracy of the data obtained. The technique performs better with dilated rather than nondilated RV cavities, with a learning curve that might affect the test-retest reproducibility for serial RV studies.
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- 2015
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10. Accuracy and Test-Retest Reproducibility of Two-Dimensional Knowledge-Based Volumetric Reconstruction of the Right Ventricle in Pulmonary Hypertension
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Knight, Daniel S., Schwaiger, Johannes P., Krupickova, Sylvia, Davar, Joseph, Muthurangu, Vivek, and Coghlan, J. Gerry
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Reproducibility of results ,Male ,Transthoracic echocardiography ,Hypertension, Pulmonary ,Knowledge Bases ,Ventricular Dysfunction, Right ,Right Ventricular Function ,KBR, Knowledge-based reconstruction ,2D, Two-dimensional ,Sensitivity and Specificity ,Pulmonary hypertension ,PH, Pulmonary hypertension ,RV, Right ventricular ,Magnetic resonance imaging ,Imaging, Three-Dimensional ,FAC, Fractional area change ,3DE, Three-dimensional echocardiography ,Humans ,Observer Variation ,2DE, Two-dimensional echocardiography ,Middle Aged ,Radiology Nuclear Medicine and imaging ,Echocardiography ,CMRI, Cardiac magnetic resonance imaging ,Female ,Cardiology and Cardiovascular Medicine - Abstract
Background Right heart function is the key determinant of symptoms and prognosis in pulmonary hypertension (PH), but the right ventricle has a complex geometry that is challenging to quantify by two-dimensional (2D) echocardiography. A novel 2D echocardiographic technique for right ventricular (RV) quantitation involves knowledge-based reconstruction (KBR), a hybrid of 2D echocardiography–acquired coordinates localized in three-dimensional space and connected by reference to a disease-specific RV shape library. The aim of this study was to determine the accuracy of 2D KBR against cardiac magnetic resonance imaging in PH and the test-retest reproducibility of both conventional 2D echocardiographic RV fractional area change (FAC) and 2D KBR. Methods Twenty-eight patients with PH underwent same-day echocardiography and cardiac magnetic resonance imaging. Two operators performed serial RV FAC and 2D KBR acquisition and postprocessing to assess inter- and intraobserver test-retest reproducibility. Results Bland-Altman analysis (mean bias ± 95% limits of agreement) showed good agreement for end-diastolic volume (3.5 ± 25.0 mL), end-systolic volume (0.9 ± 19.9 mL), stroke volume (2.6 ± 23.1 mL), and ejection fraction (0.4 ± 10.2%) measured by 2D KBR and cardiac magnetic resonance imaging. There were no significant interobserver or intraobserver test-retest differences for 2D KBR RV metrics, with acceptable limits of agreement (interobserver end-diastolic volume, −0.9 ± 21.8 mL; end-systolic volume, −1.3 ± 25.8 mL; stroke volume, −0.2 ± 24.2 mL; ejection fraction, 0.7 ± 14.4%). Significant test-retest variability was observed for 2D echocardiographic RV areas and FAC. Conclusions Two-dimensional KBR is an accurate, novel technique for RV volumetric quantification in PH, with superior test-retest reproducibility compared with conventional 2D echocardiographic RV FAC.
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- 2015
11. Right Ventricular Strain: A Better Window Into the Working of the Heart in Pulmonary Hypertension.
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Muthurangu, Vivek
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- 2019
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12. Magnetic Resonance-Augmented Cardiopulmonary Exercise Testing.
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Barber, Nathaniel J., Ako, Emmanuel O., Kowalik, Gregorz T., Cheang, Mun H., Pandya, Bejal, Steeden, Jennifer A., Moledina, Shahin, and Muthurangu, Vivek
- Abstract
Background-Conventional cardiopulmonary exercise testing can objectively measure exercise intolerance but cannot provide comprehensive evaluation of physiology. This requires additional assessment of cardiac output and arteriovenous oxygen content difference. We developed magnetic resonance (MR)-augmented cardiopulmonary exercise testing to achieve this goal and assessed children with right heart disease. Methods and Results-Healthy controls (n=10) and children with pulmonary arterial hypertension (PAH; n=10) and repaired tetralogy of Fallot (n=10) underwent MR-augmented cardiopulmonary exercise testing. All exercises were performed on an MR-compatible ergometer, and oxygen uptake was continuously acquired using a modified metabolic cart. Simultaneous cardiac output was measured using a real-time MR flow sequence and combined with oxygen uptake to calculate arteriovenous oxygen content difference. Peak oxygen uptake was significantly lower in the PAH group (12.6±1.31 mL/kg per minute; P=0.01) and trended toward lower in the tetralogy of Fallot group (13.5±1.29 mL/kg per minute; P=0.06) compared with controls (16.7±1.37 mL/kg per minute). Although tetralogy of Fallot patients had the largest increase in cardiac output, they had lower resting (3±1.2 L/min per m2) and peak (5.3±1.2 L/min per m2) values compared with controls (resting 4.3±1.2 L/min per m2 and peak 6.6±1.2 L/min per m2) and PAH patients (resting 4.5±1.1 L/min per m2 and peak 5.9±1.1 L/min per m2). Both the PAH and tetralogy of Fallot patients had blunted exercise-induced increases in arteriovenous oxygen content difference. However, only the PAH patients had significantly reduced peak values (6.9±1.3 mlO
2 /100 mL) compared with controls (8.4±1.4 mlO2/100 mL; P=0.005). Conclusions-MR-augmented cardiopulmonary exercise testing is feasible in both healthy children and children with cardiac disease. Using this novel technique, we have demonstrated abnormal exercise patterns in oxygen uptake, cardiac output, and arteriovenous oxygen content difference. [ABSTRACT FROM AUTHOR]- Published
- 2016
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13. Cardiac MR and CT imaging in children with suspected or confirmed pulmonary hypertension/pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK.
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Latus, Heiner, Kuehne, Titus, Beerbaum, Philipp, Apitz, Christian, Hansmann, Georg, Muthurangu, Vivek, and Moledina, Shahin
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PULMONARY hypertension diagnosis ,PULMONARY hypertension treatment ,CARDIAC magnetic resonance imaging ,COMPUTED tomography ,PEDIATRICS ,PATIENTS ,HEART ventricle diseases ,COMPARATIVE studies ,CONSENSUS (Social sciences) ,RIGHT heart ventricle ,HEART ventricles ,HEMODYNAMICS ,MAGNETIC resonance imaging ,RESEARCH methodology ,MEDICAL cooperation ,PULMONARY artery ,PULMONARY circulation ,PULMONARY hypertension ,RESEARCH ,EVALUATION research ,PHYSIOLOGY - Abstract
Childhood pulmonary hypertension (PH) is a heterogenous disease associated with considerable morbidity and mortality. Invasive assessment of haemodynamics is crucial for accurate diagnosis and guidance of medical therapy. However, adequate imaging is increasingly important in children with PH to evaluate the right heart and the pulmonary vasculature. Cardiac MR (CMR) and computed tomography (CT) represent important non-invasive imaging modalities that may enable comprehensive assessment of right ventricular (RV) function and pulmonary haemodynamics. Here, we present graded consensus recommendations for the evaluation of children with PH by CMR and CT. The article provides a structured approach for the use of CMR and CT imaging, emphasises non-invasive variables of RV function, myocardial tissue and afterload parameters that may be useful for initial diagnosis and monitoring. Furthermore, assessment of pulmonary perfusion and characterisation of the lung parenchyma provides structural information about processes that may cause or be due to PH. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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14. Left ventricular diastolic dysfunction in pulmonary hypertension predicts functional capacity and clinical worsening: a tissue phase mapping study.
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Knight, Daniel S., Steeden, Jennifer A., Moledina, Shahin, Jones, Alexander, Coghlan, J. Gerry, and Muthurangu, Vivek
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BIOPHYSICS ,HEART ventricle diseases ,STATISTICAL correlation ,DIASTOLE (Cardiac cycle) ,FISHER exact test ,LEFT heart ventricle ,MAGNETIC resonance imaging ,MYOCARDIUM ,PULMONARY hypertension ,RESEARCH funding ,SCIENTIFIC apparatus & instruments ,STATISTICS ,T-test (Statistics) ,DATA analysis ,PROPORTIONAL hazards models ,DISEASE progression ,DATA analysis software ,FUNCTIONAL assessment ,DESCRIPTIVE statistics ,STROKE volume (Cardiac output) ,MANN Whitney U Test ,KRUSKAL-Wallis Test ,VENTRICULAR ejection fraction ,DISEASE complications ,DIAGNOSIS - Abstract
Background: The function of the right and left ventricles is intimately related through a shared septum and pericardium. Therefore, right ventricular (RV) disease in pulmonary hypertension (PH) can result in abnormal left ventricular (LV) myocardial mechanics. To assess this, we implemented novel cardiovascular magnetic resonance (CMR) tissue phase mapping (TPM) to assess radial, longitudinal and tangential LV myocardial velocities in patients with PH. Methods: Respiratory self-gated TPM was performed using a rotating golden-angle spiral acquisition with retrospective cardiac gating. TPM of a mid ventricular slice was acquired in 40 PH patients and 20 age- and sex-matched healthy controls. Endocardial and epicardial LV borders were manually defined, and myocardial velocities calculated using in-house software. Patients without proximal CTEPH (chronic thromboembolic PH) and not receiving intravenous prostacyclin therapy (n = 34) were followed up until the primary outcome of disease progression (death, transplantation, or progression to intravenous therapy) or the end of the study. Physicians who determined disease progression were blinded to CMR data. Conventional ventricular volumetric indices and novel TPM metrics were analyzed for prediction of 6-min walk distance (6MWD) and disease progression. Results: Peak longitudinal (p<0.0001) and radial (p = 0.001) early diastolic (E) wave velocities were significantly lower in PH patients compared with healthy volunteers. Reversal of tangential E waves was observed in all patients and was highly discriminative for the presence of PH (p < 0.0001). The global radial E wave (β = 0.41, p = 0.017) and lateral wall radial systolic (S) wave velocities (β = 0.33, p = 0.028) were the only independent predictors of 6MWD in a model including RV ejection fraction (RVEF) and LV stroke volume. Over a median follow-up period of 20 months (IQR 7.9 months), 8 patients commenced intravenous therapy and 1 died. Global longitudinal E wave was the only independent predictor of clinical worsening (6.3x increased risk, p = 0.009) in a model including RVEF and septal curvature. Conclusions: TPM metrics of LV diastolic function are significantly abnormal in PH. More importantly, abnormal LV E wave velocities are the only independent predictors of functional capacity and clinical worsening in a model that includes conventional metrics of biventricular function. [ABSTRACT FROM AUTHOR]
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- 2015
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15. Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension.
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Quail, Michael A., Knight, Daniel S., Steeden, Jennifer A., Taelman, Liesbeth, Moledina, Shahin, Taylor, Andrew M., Segers, Patrick, Coghlan, J. Gerry, and Muthurangu, Vivek
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PULMONARY hypertension diagnosis ,NONINVASIVE diagnostic tests ,PULMONARY artery physiology ,BIOMARKERS ,MAGNETIC resonance imaging - Abstract
Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35% CTEPH and 75% female) and 10 healthy controls (60% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls (P = 6e
-8 ). The area under the BCW was associated with a sensitivity of 100% [95% confidence interval (CI) 63-100%] and specificity of 91% (95% CI 75-98%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH. [ABSTRACT FROM AUTHOR]- Published
- 2015
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16. Fractal branching quantifies vascular changes and predicts survival in pulmonary hypertension: a proof of principle study.
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Moledina, Shahin, de Bruyn, Annemijn, Schievano, Silvia, Owens, Catherine M., Young, Carol, Haworth, Sheila G., Taylor, Andrew M., Schulze-Neick, Ingram, and Muthurangu, Vivek
- Subjects
PULMONARY hypertension ,FRACTALS ,DISEASE progression ,PULMONARY blood vessels ,RETROSPECTIVE studies - Abstract
Objectives To develop a non-invasive method of assessing disease severity in pulmonary hypertension by quantifying the overall degree of vascular pruning using fractal geometry. Design A retrospective analysis of ECG-gated CT pulmonary angiograms. Setting A single national referral centre for the investigation and treatment of children with pulmonary hypertension. Patients Consecutive CT pulmonary angiograms in children and young adults (mean age 10.3 years, range 0.7e19.1) with pulmonary arterial hypertension assessed between January 2007 and April 2009. Main outcome measures The fractal dimension (FD) of skeletonised CT pulmonary angiograms was calculated using the box counting method. The FD was compared with pulmonary vascular resistance, the percentage of predicted 6-min walk distance, WHO functional class and survival. Results Diagnostic plots confirmed that the pulmonary artery angiograms were all fractal. The FD correlated negatively with the pulmonary vascular resistance index (r=-0.55, p=0.01, n=21) and with WHO functional class (p<0.01, n=31) while it correlated positively with the percentage of predicted 6-min walk distance (r=0.43, p=0.04, n=24). A lower FD was associated with poorer survival (HR 5.6; 95% CI 1.2 to 25; p=0.027) for every SD reduction in FD. Conclusion The FD derived from CT can be used to quantify vascular changes in pulmonary hypertension. This non-invasive technique may be useful in monitoring disease progression and response to therapy. [ABSTRACT FROM AUTHOR]
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- 2011
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17. Measurement of total pulmonary arterial compliance using invasive pressure monitoring and MR flow quantification during MR-guided cardiac catheterization.
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Muthurangu, Vivek, Atkinson, David, Sermesant, Maxime, Miquel, Marc F., Hegde, Sanjeet, Johnson, Robert, Andriantsimiavona, Rado, Taylor, Andrew M., Baker, Edward, Tulloh, Robert, Hill, Derek, and Razavi, Reza S.
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PULMONARY artery , *CARDIAC catheterization , *HEART disease diagnosis , *HYPERTENSION , *MAGNETIC resonance imaging , *CONGENITAL heart disease - Abstract
Pulmonary hypertensive disease is assessed by quantification of pulmonary vascular resistance. Pulmonary total arterial compliance is also an indicator of pulmonary hypertensive disease. However, because of difficulties in measuring compliance, it is rarely used. We describe a method of measuring pulmonary arterial compliance utilizing magnetic resonance (MR) flow data and invasive pressure measurements. Seventeen patients with suspected pulmonary hypertension or congenital heart disease requiring preoperative assessment underwent MR-guided cardiac catheterization. Invasive manometry was used to measure pulmonary arterial pressure, and phase-contrast MR was used to measure flow at baseline and at 20 ppm nitric oxide (NO). Total arterial compliance was calculated using the pulse pressure method (parameter optimization of the 2-element windkessel model) and the ratio of stroke volume to pulse pressure. There was good agreement between the two estimates of compliance (r = 0.98, P < 0.001). However, there was a systematic bias between the ratio of stroke volume to pulse pressure and the pulse pressure method (bias = 61%, upper level of agreement = 84%, lower level of agreement = 38%). In response to 20 ppm NO, there was a statistically significant fall in resistance, systolic pressure, and pulse pressure. In seven patients, total arterial compliance increased >10% in response to 20 ppm NO. As a population, the increase did not reach statistical significance. There was an inverse relation between compliance and resistance (r = 0.89, P < 0.001) and between compliance and mean pulmonary arterial pressure (r = 0.72, P < 0.001). We have demonstrated the feasibility of quantifying total arterial compliance using an MR method. [ABSTRACT FROM AUTHOR]
- Published
- 2005
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18. An Unwelcome Embrace.
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Quail, Michael A. and Muthurangu, Vivek
- Published
- 2017
- Full Text
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