Publications
115 results found
Halliday BP, Balaban G, Costa CM, et al., 2019, Improving Arrhythmic Risk Stratification in Non-Ischemic Dilated Cardiomyopathy Through the Evaluation of Novel Scar Characteristics Using CMR, Scientific Sessions of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Halliday B, Vassiliou V, Wassall R, et al., 2019, Myocardial Remodelling Following Heart Failure Therapy Withdrawal in Patients With Dilated Cardiomyopathy and Improved Left Ventricular Ejection Fraction Results From TRED-HF, Scientific Sessions of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Jones RE, Hammersley D, Karamasis GV, et al., 2019, Semi-Quantitative CMR Analysis of Left Anterior Descending Territory Ischaemia in Patients With a Right Coronary Artery Chronic Total Occlusion, Scientific Sessions of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Halliday BP, Prasad SK, 2019, The Interstitium in the Hypertrophied Heart, JACC-CARDIOVASCULAR IMAGING, Vol: 12, Pages: 2357-2368, ISSN: 1936-878X
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- Citations: 21
Balaban G, Halliday BP, Bai W, et al., 2019, Scar shape analysis and simulated electrical instabilities in a non-ischemic dilated cardiomyopathy patient cohort., PLoS Computational Biology, Vol: 15, Pages: 1-18, ISSN: 1553-734X
This paper presents a morphological analysis of fibrotic scarring in non-ischemic dilated cardiomyopathy, and its relationship to electrical instabilities which underlie reentrant arrhythmias. Two dimensional electrophysiological simulation models were constructed from a set of 699 late gadolinium enhanced cardiac magnetic resonance images originating from 157 patients. Areas of late gadolinium enhancement (LGE) in each image were assigned one of 10 possible microstructures, which modelled the details of fibrotic scarring an order of magnitude below the MRI scan resolution. A simulated programmed electrical stimulation protocol tested each model for the possibility of generating either a transmural block or a transmural reentry. The outcomes of the simulations were compared against morphological LGE features extracted from the images. Models which blocked or reentered, grouped by microstructure, were significantly different from one another in myocardial-LGE interface length, number of components and entropy, but not in relative area and transmurality. With an unknown microstructure, transmurality alone was the best predictor of block, whereas a combination of interface length, transmurality and number of components was the best predictor of reentry in linear discriminant analysis.
Gulati A, Ismail TF, Ali A, et al., 2019, Microvascular Dysfunction in Dilated Cardiomyopathy A Quantitative Stress Perfusion Cardiovascular Magnetic Resonance Study, JACC-CARDIOVASCULAR IMAGING, Vol: 12, Pages: 1699-1708, ISSN: 1936-878X
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- Citations: 37
Halliday BP, Baksi AJ, Gulati A, et al., 2019, Outcome in dilated cardiomyopathy related to the extent, location and pattern of late gadolinium enhancement, JACC: Cardiovascular Imaging, Vol: 12, Pages: 1645-1655, ISSN: 1936-878X
ObjectivesThis study sought to investigate the association between the extent, location, and pattern of late gadolinium enhancement (LGE) and outcome in a large dilated cardiomyopathy (DCM) cohort.BackgroundThe relationship between LGE and prognosis in DCM is incompletely understood.MethodsWe examined the association between LGE and all-cause mortality and a sudden cardiac death (SCD) composite based on the extent, location, and pattern of LGE in DCM.ResultsOf 874 patients (588 men, median age 52 years) followed for a median of 4.9 years, 300 (34.3%) had nonischemic LGE. Estimated adjusted hazard ratios for patients with an LGE extent of 0 to 2.55%, 2.55% to 5.10%, and >5.10%, respectively, were 1.59 (95% confidence interval [CI]: 0.99 to 2.55), 1.56 (95% CI: 0.96 to 2.54), and 2.31 (95% CI: 1.50 to 3.55) for all-cause mortality, and 2.79 (95% CI: 1.42 to 5.49), 3.86 (95% CI: 2.09 to 7.13), and 4.87 (95% CI: 2.78 to 8.53) for the SCD end-point. There was a marked nonlinear relationship between LGE extent and outcome such that even small amounts of LGE predicted a substantial increase in risk. The presence of septal LGE was associated with increased mortality, but SCD was most associated with the combined presence of septal and free-wall LGE. Predictive models using LGE presence and location were superior to models based on LGE extent or pattern.ConclusionsIn DCM, the presence of septal LGE is associated with a large increase in the risk of death and SCD events, even when the extent is small. SCD risk is greatest with concomitant septal and free-wall LGE. The incremental value of LGE extent beyond small amounts and LGE pattern is limited.
Halliday BP, Cleland JGF, Prasad SK, 2019, When can heart failure treatment be stopped safely? reply, LANCET, Vol: 394, Pages: 217-218, ISSN: 0140-6736
Hammersley D, Halliday BP, Prasad SK, 2019, Can we turn heart failure into heart success by studying myocardial remission?, European Heart Journal, Vol: 40, Pages: 2118-2120, ISSN: 1522-9645
Lota AS, Halliday BP, Hatipoglu S, et al., 2019, Risk prediction in patients with mild dilated cardiomyopathy by cardiovascular magnetic resonance: integrating assessment of myocardial mechanics with tissue characterisation, Publisher: WILEY, Pages: 406-407, ISSN: 1388-9842
Halliday BP, Pennell DJ, 2019, Prediction and prevention of heart failure in high-risk elderly patients, European Heart Journal, Vol: 40, Pages: 539-541, ISSN: 1522-9645
Halliday BP, Wassall R, Lota A, et al., 2019, Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial, The Lancet, Vol: 393, Pages: 61-73, ISSN: 0140-6736
BackgroundPatients with dilated cardiomyopathy whose symptoms and cardiac function have recovered often ask whether their medications can be stopped. The safety of withdrawing treatment in this situation is unknown.MethodsWe did an open-label, pilot, randomised trial to examine the effect of phased withdrawal of heart failure medications in patients with previous dilated cardiomyopathy who were now asymptomatic, whose left ventricular ejection fraction (LVEF) had improved from less than 40% to 50% or greater, whose left ventricular end-diastolic volume (LVEDV) had normalised, and who had an N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) concentration less than 250 ng/L. Patients were recruited from a network of hospitals in the UK, assessed at one centre (Royal Brompton and Harefield NHS Foundation Trust, London, UK), and randomly assigned (1:1) to phased withdrawal or continuation of treatment. After 6 months, patients in the continued treatment group had treatment withdrawn by the same method. The primary endpoint was a relapse of dilated cardiomyopathy within 6 months, defined by a reduction in LVEF of more than 10% and to less than 50%, an increase in LVEDV by more than 10% and to higher than the normal range, a two-fold rise in NT-pro-BNP concentration and to more than 400 ng/L, or clinical evidence of heart failure, at which point treatments were re-established. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02859311.FindingsBetween April 21, 2016, and Aug 22, 2017, 51 patients were enrolled. 25 were randomly assigned to the treatment withdrawal group and 26 to continue treatment. Over the first 6 months, 11 (44%) patients randomly assigned to treatment withdrawal met the primary endpoint of relapse compared with none of those assigned to continue treatment (Kaplan-Meier estimate of event rate 45·7% [95% CI 28·5–67·2]; p=0·0001). After 6 months, 25 (96%) of 2
Halliday BP, Wassail R, Lota AS, et al., 2019, Brief Comment Video to the Recommended Article of the Month, REVISTA PORTUGUESA DE CARDIOLOGIA, Vol: 38, Pages: 71-71, ISSN: 0870-2551
Balaban G, Halliday BP, Costa CM, et al., 2018, Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling, Frontiers in Physiology, Vol: 9, ISSN: 1664-042X
Aims: Patients who present with non-ischemic dilated cardiomyopathy (NIDCM) andenhancement on late gadolinium magnetic resonance imaging (LGE-CMR), are at highrisk of sudden cardiac death (SCD). Further risk stratification of these patients basedon LGE-CMR may be improved through better understanding of fibrosis microstructure.Our aim is to examine variations in fibrosis microstructure based on LGE imaging, andquantify the effect on reentry inducibility and mechanism. Furthermore, we examine therelationship between transmural activation time differences and reentry.Methods and Results: 2D Computational models were created from a single short axisLGE-CMR image, with 401 variations in fibrosis type (interstitial, replacement) and density,as well as presence or absence of reduced conductivity (RC). Transmural activationtimes (TAT) were measured, as well as reentry incidence and mechanism. Reentrieswere inducible above specific density thresholds (0.8, 0.6 for interstitial, replacementfibrosis). RC reduced these thresholds (0.3, 0.4 for interstitial, replacement fibrosis) andincreased reentry incidence (48 no RC vs. 133 with RC). Reentries were classified as rotor,micro-reentry, or macro-reentry and depended on fibrosis micro-structure. Differencesin TAT at coupling intervals 210 and 500ms predicted reentry in the models (sensitivity89%, specificity 93%). A sensitivity analysis of TAT and reentry incidence showed thatthese quantities were robust to small changes in the pacing location.Conclusion: Computational models of fibrosis micro-structure underlying areas ofLGE in NIDCM provide insight into the mechanisms and inducibility of reentry, andtheir dependence upon the type and density of fibrosis. Transmural activation times,measured at the central extent of the scar, can potentially differentiate microstructureswhich support reentry.
Halliday BP, Wassall R, Lota A, et al., 2018, Withdrawal of Pharmacological Heart Failure Therapy in Recovered Dilated Cardiomyopathy - A Randomised Controlled Trial (TRED-HF), Scientific Sessions of the American-Heart-Association (AHA) / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E761-E761, ISSN: 0009-7322
Halliday BP, Lota AS, Prasad SK, 2018, Sudden death risk markers for patients with left ventricular ejection fractions greater than 40, Trends in Cardiovascular Medicine, Vol: 28, Pages: 516-521, ISSN: 1050-1738
The major burden of sudden cardiac death (SCD) in patients with heart disease occurs in those with a left ventricular ejection fraction > 40%. Although the annual risk of SCD may be lower in these patients compared to those with lower LVEF, their lifetime cumulative risk of SCD may be greater due to a better overall prognosis. It is plausible that those with LVEF > 40% who are at highest risk of life-threatening arrhythmia will benefit from implantable cardioverter defibrillators. Features that identify patients with a LVEF > 40% at high risk of SCD are urgently needed. We review existing studies examining SCD markers in this sub-group and discuss gaps in the current evidence base.
Halliday BP, Gulati A, Ali A, et al., 2018, Sex and age-based differences in the natural history and outcome of dilated cardiomyopathy, European Journal of Heart Failure, Vol: 20, Pages: 1392-1400, ISSN: 1388-9842
Aims: To evaluate the relationship between sex, age and outcome in dilated cardiomyopathy (DCM). Methods & Results: We used proportional hazard modelling to examine the association between sex, age and all-cause mortality in consecutive patients with DCM. Overall, 881 patients (290 women, median age 52 years) were followed for a median of 4.9 years. Women were more likely to present with heart failure (64.0% vs 54.5%; p=0.007) and had more severe symptoms (p<0.001) compared to men. Women had smaller left ventricular end-diastolic volume (125ml/m2 vs 135ml/m2, p<0.001), higher left ventricular ejection fraction (40.2% vs 37.9%, p=0.019) and were less likely to have mid-wall late gadolinium enhancement (23.0% vs 38.9%, p<0.0001). During follow-up 149 (16.9%) patients died, including 41 (4.7%) who died suddenly. After adjustment, all-cause mortality (HR 0.61; 95%CI 0.41:0.92; p=0.018) was lower in women, with similar trends for cardiovascular (HR 0.60; 95%CI 0.35-1.05; p=0.07), non-sudden (HR 0.63; 95%CI 0.39-1.02; p=0.06) and sudden death (HR 0.70, 95%CI 0.30:1.63; p=0.41). All-cause mortality (per 10 yrs: HR 1.36, 95%CI 1.20-1.55; p<0.00001) and non-sudden death (per 10 yrs: HR 1.51, 95%CI 1.26 – 1.82; p<0.00001) increased with age. Cumulative incidence curves confirmed favourable outcomes, particularly in women and those <60 years. Increased all-cause mortality in patients >60 years of age was driven by non-sudden death. Conclusion: Women with DCM have better survival compared to men, which may partly be due to less severe left ventricular dysfunction and a smaller scar burden. There is increased mortality driven by non-sudden death in patients >60 years of age that is less marked in women. Outcomes with contemporary treatment were favourable, with a low incidence of sudden death.
Loudon B, Ntatsaki E, Newsome S, et al., 2018, Osteoprotegerin and myocardial fibrosis in patients with aortic stenosis, Scientific Reports, Vol: 8, ISSN: 2045-2322
Left ventricular myocardial fibrosis in patients with aortic stenosis (AS) confers worse prognosis. Plasma osteoprotegerin (OPG), a cytokine from the TNF receptor family, correlates with the degree of valve calcification in AS, reflecting the activity of the tissue RANKL/RANK/OPG (receptor activator of nuclear factor κΒ ligand/RANK/osteoprotegerin) axis, and is associated with poorer outcomes in AS. Its association with myocardial fibrosis is unknown. We hypothesised that OPG levels would reflect the extent of myocardial fibrosis in AS. We included 110 consecutive patients with AS who had undergone late-gadolinium contrast enhanced cardiovascular magnetic resonance (LGE-CMR). Patients were characterised according to pattern of fibrosis (no fibrosis, midwall fibrosis, or chronic myocardial infarction fibrosis). Serum OPG was measured with ELISA and compared between groups defined by valve stenosis severity. Some 36 patients had no fibrosis, 38 had midwall fibrosis, and 36 had chronic infarction. Patients with midwall fibrosis did not have higher levels of OPG compared to those without fibrosis (6.78 vs. 5.25 pmol/L, p = 0.12). There was no difference between those with midwall or chronic myocardial infarction fibrosis (6.78 vs. 6.97 pmol/L, p = 0.27). However, OPG levels in patients with chronic myocardial infarction fibrosis were significantly higher than those without fibrosis (p = 0.005).
Gulati A, Japp AG, Raza S, et al., 2018, Absence of myocardial fibrosis predicts favorable long-term survival in new-onset heart failure a cardiovascular magnetic resonance study, Circulation: Cardiovascular Imaging, Vol: 11, ISSN: 1941-9651
Background:Myocardial fibrosis, identified by late gadolinium enhancement cardiovascular magnetic resonance, predicts outcomes in chronic heart failure (HF). Its prognostic significance in new-onset HF and reduced left ventricular ejection fraction (LVEF) is unclear. We investigated whether the pattern and extent of fibrosis predict survival in new-onset HF and reduced LVEF of initially uncertain pathogenesis.Methods and Results:Of 120 consecutive patients with new-onset (<6 months) HF and reduced LVEF, 31 (26%) had infarct fibrosis, 25 (21%) had midwall fibrosis, and 64 (53%) had no fibrosis. During median follow-up of 8.9 years, 33 (28%) patients died. Patients with infarct fibrosis (hazard ratios [HR], 3.32; 95% CI, 1.46–7.58; P=0.004) or midwall fibrosis (HR, 2.99; 95% CI, 1.24–7.19; P=0.014) were more likely to die compared with those without fibrosis. On multivariable analysis, the pattern and extent of fibrosis were both associated with all-cause mortality (by fibrosis pattern: infarct: HR, 2.60; 95% CI, 1.08–6.27; P=0.033; midwall: HR, 2.64; 95% CI, 1.08–6.47; P=0.034; by fibrosis extent per 1%: HR, 1.07; 95% CI, 1.03–1.12; P<0.001). Fibrosis pattern also predicted composites of cardiovascular mortality or aborted sudden cardiac death (infarct: HR, 3.45; 95% CI, 1.20–9.90; P=0.022; midwall: HR, 6.59; 95% CI, 2.26–19.22; P<0.001), and all-cause mortality, HF hospitalization, or aborted sudden cardiac death (infarct: HR, 2.69; 95% CI, 1.26–5.76; P=0.011; midwall fibrosis: HR, 2.97; 95% CI, 1.37–6.45; P=0.006). Addition of fibrosis pattern to LVEF improved risk prediction for all-cause mortality (LVEF versus LVEF+fibrosis C statistic: 0.66 versus 0.71; P=0.033). Importantly, the absence of fibrosis heralded a favorable prognosis with an 85% survival rate over the duration of follow-up.Conclusions:The pattern and extent of myocardial fibrosis predict adverse outcomes in new-onset HF and reduced LVEF.
Tayal U, Halliday B, Prasad S, 2018, Role of CMR in Dilated Cardiomyopathy, Cardiovascular Magnetic Resonance A Companion to Braunwald's Heart Disease, Publisher: Churchill Livingstone, ISBN: 9780323415613
Complemented by: Braunwald's heart disease / edited by Douglas P. Zipes, Peter Libby, Robert O. Bonow, Douglas L. Mann, and Gordon F. Tomaselli. 11th ed. 2018.
Halliday BP, Baksi AJ, Izgi C, et al., 2018, Improving risk stratification for sudden cardiac death in dilated cardiomyopathy using late gadolinium enhancement cardiovascular magnetic resonance, Heart Failure 2018, Publisher: WILEY, Pages: 184-184, ISSN: 1388-9842
Halliday BP, Wassall R, Khalique Z, et al., 2018, Comprehensive phenoptyping of patients with dilated cardiomyopathy and recovered ejection fraction, Heart Failure 2018, Publisher: WILEY, Pages: 185-185, ISSN: 1388-9842
Lota A, Fazal S, Wassall R, et al., 2018, NATIONAL TRENDS IN THE EPIDEMIOLOGY OF HOSPITAL ADMISSIONS FOR ACUTE MYOCARDITIS: INSIGHTS FROM THE UK NATIONAL HEALTH SERVICE, 67th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 875-875, ISSN: 0735-1097
Halliday B, Gulati A, Ali A, et al., 2018, SEX DIFFERENCES IN THE NATURAL HISTORY AND OUTCOME OF DILATED CARDIOMYOPATHY, 67th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 704-704, ISSN: 0735-1097
Lota A, Tsao A, Al-Balah A, et al., 2018, PROGNOSTIC SIGNIFICANCE OF NON-ISCHAEMIC MYOCARDIAL FIBROSIS IN PATIENTS WITH NORMAL LV SIZE AND FUNCTION: A LARGE CMR REGISTRY STUDY, 67th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 436-436, ISSN: 0735-1097
Halliday B, Baksi A, Gulati A, et al., 2018, DEFINING THE RELATIONSHIP BETWEEN THE EXTENT OF MID-WALL LATE GADOLINIUM ENHANCEMENT AND ADVERSE HEART FAILURE EVENTS IN PATIENTS WITH DILATED CARDIOMYOPATHY, 67th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 1473-1473, ISSN: 0735-1097
Lota AS, Halliday BP, Vassiliou VS, 2018, Latrogenic myocarditis-biomarkers, cardiovascular MRI and the need for early diagnosis, Oxford Medical Case Reports, Vol: 2018, Pages: omx096-omx096, ISSN: 2053-8855
Halliday BP, Tayal U, Prasad S, 2018, Role of Cardiovascular Magnetic Resonance in Dilated Cardiomyopathy, Cardiovascular Magnetic Resonance: A Companion to Braunwald’s Heart Disease, Pages: 383.e4-390.e4, ISBN: 9780323415613
Dilated cardiomyopathy (DCM) is defined as a disease of the myocardium characterized by left ventricular dilatation and systolic impairment that cannot be exclusively explained by abnormal loading conditions (such as hypertension or valvular heart disease) or coronary artery disease. The true prevalence is debated because of a lack of large contemporary population studies. The original Olmsted County study, performed between 1975 and 1984, estimated the prevalence to be in the region of 1 in 2700 individuals. However, the calculated prevalence of hypertrophic cardiomyopathy in the same study has since been shown to be a gross underestimate, possibly explained by the fact that echocardiography was still a developing technique. Recent reports have estimated the prevalence to be closer to 1 in 400 people in the United States. Nevertheless, DCM is a commonly encountered condition, representing the most frequent indication for cardiac transplantation and a common cause of heart failure and sudden cardiac death. Despite therapeutic advances, 3-year treated mortality rates are estimated to be 12% to 20%. Definitive early investigation giving a prompt and accurate diagnosis is therefore essential for the expedient introduction of targeted therapy. We will discuss the benefits of cardiovascular magnetic resonance in the investigation of DCM after a brief overview of our current understanding of the disease.
Balaban G, Halliday BP, Costa CM, et al., 2018, The Effects of Non-ischemic Fibrosis Texture and Density on Mechanisms of Reentry, 45th Computing in Cardiology Conference (CinC), Publisher: IEEE, ISSN: 2325-8861
Halliday BP, Pennell DJ, Prasad SK, 2017, Response by Halliday et al to letter regarding article, "Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction", Circulation, Vol: 137, Pages: 101-102, ISSN: 0009-7322
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