Background:
Four-dimensional flow cardiac magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology that can be used to quantify mitral regurgitation (MR) volume. Current methods of quantification have demonstrated limitations in accurate analysis, particularly in difficult cases such as complex congenital heart disease. 4D flow CMR methods aim to circumvent these limitations and allow accurate quantification of MR volume even in complex cases. This systematic review aims to summarize the available literature on 4D flow CMR MR quantification methods and examine their ability to accurately classify MR severity.
Methods:
Structured searches were carried out on Medline and EMBASE in December 2018 to identify suitable research outcome studies. The titles and abstracts were screened for relevance, with a third adjudicator utilized when study suitability was uncertain.
Results:
Seven studies met the eligibility criteria and were included in the systematic review. The most widely used 4D flow MRI method was retrospective valve tracking (RVT) which was examined in five papers. The key finding of these papers was that RVT is a reliable and accurate method of regurgitant volume quantification.
Conclusions:
MR quantification through 4D flow MRI is both feasible and accurate. The evidence gathered suggests that for MR assessment, 4D flow MRI is potentially as accurate and reliable to echocardiography and may be complementary to this technique. Further work on MR quantification 4D flow image analysis is needed to determine the most accurate analysis technique and to demonstrate 4D flow MRI as a predictor of clinical outcome.
PROSPERO Registration Number:
CRD42019122837,
http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019122837
ObjectivesTo determine the prognostic value of patterns of right ventricular adaptation in patients with pulmonary arterial hypertension (PAH), assessed using cardiac magnetic resonance (CMR) imaging at baseline and follow-up.MethodsPatients attending the Sheffield Pulmonary Vascular Disease Unit with suspected pulmonary hypertension were recruited into the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral Centre) Registry. With exclusion of congenital heart disease, consecutive patients with PAH were followed up until the date of census or death. Right ventricular end-systolic volume index adjusted for age and sex and ventricular mass index were used to categorise patients into four different volume/mass groups: low-volume-low-mass, low-volume-high-mass, high-volume-low-mass and high-volume-high-mass. The prognostic value of the groups was assessed with one-way analysis of variance and Kaplan-Meier plots. Transition of the groups was studied.ResultsA total of 505 patients with PAH were identified, 239 (47.3%) of whom have died at follow-up (median 4.85 years, IQR 4.05). The mean age of the patients was 59±16 and 161 (32.7%) were male. Low-volume-low-mass was associated with CMR and right heart catheterisation metrics predictive of improved prognosis. There were 124 patients who underwent follow-up CMR (median 1.11 years, IQR 0.78). At both baseline and follow-up, the high-volume-low-mass group had worse prognosis than the low-volume-low-mass group (p<0.001). With PAH therapy, 73.5% of low-volume-low-mass patients remained in this group, whereas only 17.4% of high-volume-low-mass patients transitioned into low-volume-low-mass.ConclusionsRight ventricular adaptation assessed using CMR has prognostic value in patients with PAH. Patients with maladaptive remodelling (high-volume-low-mass) are at high risk of treatment failure.
Racial differences in ALT levels among adults are not evident in children. Obesity, in the absence of metabolic risk factors and other causes of liver disease, is associated with elevated ALT, providing evidence against the concept of healthy obesity in children.
Introduction: Male gender, age, fair skin, ultraviolet radiation and immunosuppression are known risk factors for BCC. However there is limited understanding of the impact of these risk factors with increasing frequency of BCC development. In this study, we sought to investigate the association of gender, age, BCC subtype, distribution and immunosuppressant use with increasing frequency of BCCs. Methods: We performed a retrospective cohort study of 3,392 BCCs biopsied in 1,419 patients between 2005 and 2015 at Stanford Hospital and Clinics. Results: During the 10-year observational period, 53.3% patients were diagnosed with single BCC; 38.8% patients developed 2 to 5 BCCs; 7.8% patients developed 6 or more BCCs (high frequency BCCs or hfBCCs). We found that as the number of BCC increased, the proportion of male patients also significantly increased. Adjusting for age, race, and follow-up duration, male sex was associated with a 1.18 fold-increase in risk of 2 or more BCCs (p ¼ 0.007) and a 2.40-fold increase in risk of 6 or more BCCs (p < 0.001) using logistic regression. Multivariate regression analysis adjusted for age, gender, race, and transplant status also showed that patients with history of azathioprine had 5.22 fold-increase in risk for developing 6 or more BCCs (95% CI 1.31 e 20.81, p ¼ 0.019) compared to single BCC. Mycophenolate, cyclosporine, sirolimus, and tacrolimus did not change the risk of BCC. Conclusion: The data implicates the continued high risk of male gender on the development of numerous BCCs. In addition, azathioprine is associated with increased risk of hfBCCs. Continued clinical surveillance is needed to identify and understand this subset of patients who develop BCC at high frequency.
reduced variation in through-plane peak velocity at different inflow levels versus the mean velocity. Future work is required to determine the effect of addressing the valvular throughplane motion, which may make the averaged mitral inflow assessment a better tool for LV hemodynamics.
acquisition. The velocity encoded images were analysed for the following: mean pulmonary artery pan-systolic velocity (PASV), MPA stroke volume, MPA wall shear stress (WSS) and wall shear rate (WSR). The 4-chamber cine was used to measure end-diastolic right atrial area. Right ventricular volumes were analysed using standard methods. Stepwise multiple regression model of significantly associated parameters (p<0.05) was developed. Results Mean age of the 18 patients was 68.78±7.46 years (44% males). The following CMR metrics demonstrated significant association to the measured mPAP: RA area (r=0.65 p=0.03); MPA mean pan-systolic velocity (r=À0.57 p=0.01); RVEDV (r=0.52 p=0.03); RVEF (r=À0.40 p=0.10); RVESV (r=0.58 p=0.01). In stepwise multiple regression, only two parameters demonstrated independent association to mPAP -RA Area and MPA mean pan-systolic velocity. The predicted mPAP demonstrated good correlation to the measured mPAP (R=0.76, p<0.001). Conclusion(s) Mean pulmonary artery systolic velocity and right atrial area are independently associated with mPAP.Our novel CMR prediction model for mPAP, comprising of these two metrics, demonstrates high association to the measured mPAP by invasive haemodynamic study.
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