Publications
163 results found
Whinnett ZI, Shun-Shin MJ, Tanner M, et al., 2023, Effects of haemodynamically atrio-ventricular optimized His bundle pacing on heart failure symptoms and exercise capacity: the His Optimized Pacing Evaluated for Heart Failure (HOPE-HF) randomized, double-blind, cross-over trial., Eur J Heart Fail, Vol: 25, Pages: 274-283
AIMS: Excessive prolongation of PR interval impairs coupling of atrio-ventricular (AV) contraction, which reduces left ventricular pre-load and stroke volume, and worsens symptoms. His bundle pacing allows AV delay shortening while maintaining normal ventricular activation. HOPE-HF evaluated whether AV optimized His pacing is preferable to no-pacing, in a double-blind cross-over fashion, in patients with heart failure, left ventricular ejection fraction (LVEF) ≤40%, PR interval ≥200 ms and either QRS ≤140 ms or right bundle branch block. METHODS AND RESULTS: Patients had atrial and His bundle leads implanted (and an implantable cardioverter-defibrillator lead if clinically indicated) and were randomized to 6 months of pacing and 6 months of no-pacing utilizing a cross-over design. The primary outcome was peak oxygen uptake during symptom-limited exercise. Quality of life, LVEF and patients' holistic symptomatic preference between arms were secondary outcomes. Overall, 167 patients were randomized: 90% men, 69 ± 10 years, QRS duration 124 ± 26 ms, PR interval 249 ± 59 ms, LVEF 33 ± 9%. Neither peak oxygen uptake (+0.25 ml/kg/min, 95% confidence interval [CI] -0.23 to +0.73, p = 0.3) nor LVEF (+0.5%, 95% CI -0.7 to 1.6, p = 0.4) changed with pacing but Minnesota Living with Heart Failure quality of life improved significantly (-3.7, 95% CI -7.1 to -0.3, p = 0.03). Seventy-six percent of patients preferred His bundle pacing-on and 24% pacing-off (p < 0.0001). CONCLUSION: His bundle pacing did not increase peak oxygen uptake but, under double-blind conditions, significantly improved quality of life and was symptomatically preferred by the clear majority of patients. Ventricular pacing delivered via the His bundle did not adversely impact ventricular function during the
Ahmad Y, Howard JP, Arnold AD, et al., 2023, Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients: a meta-analysis of randomized trials, EUROPEAN HEART JOURNAL, ISSN: 0195-668X
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Madhavan MV, Howard JP, Brener MI, et al., 2023, Long-Term Outcomes of Randomized Controlled Trials Comparing Percutaneous Left Atrial Appendage Closure to Oral Anticoagulation for Nonvalvular Atrial Fibrillation: A Meta-Analysis, Structural Heart, Vol: 7, ISSN: 2474-8706
Background: Oral anticoagulation (OAC) has been considered the standard of care for stroke prophylaxis for patients with nonvalvular atrial fibrillation; however, many individuals are unable or unwilling to take long-term OAC. The safety and efficacy of percutaneous left atrial appendage closure (LAAC) have been controversial, and new trial data have recently emerged. We therefore sought to perform an updated meta-analysis of randomized clinical trials (RCTs) comparing OAC to percutaneous LAAC, focusing on individual clinical endpoints. Methods: We performed a systematic search of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 2000 through December 2021 for all RCTs comparing percutaneous LAAC to OAC in patients with nonvalvular atrial fibrillation. Fixed and random effects meta-analyses of hazard ratios (HRs) were performed using the longest follow-up duration available by intention-to-treat. The prespecified primary endpoint was all-cause mortality. Results: Three RCTs enrolling 1516 patients were identified. The weighted mean follow-up was 54.7 months. LAAC was associated with a reduced risk of all-cause mortality (HR 0.76; 95% confidence interval [CI], 0.59-0.96; p = 0.023), hemorrhagic stroke (HR 0.24; 95% CI, 0.09-0.61; p = 0.003), and major nonprocedural bleeding (HR 0.52; 95% CI, 0.37-0.74; p < 0.001). There was no significant difference between LAAC and OAC for any other endpoints. Conclusions: The available evidence from RCTs suggests LAAC therapy is associated with reduced long-term risk of death compared with OAC. This may be driven by reductions in hemorrhagic stroke and major nonprocedural bleeding. There were no significant differences in the risk of all stroke. Further large-scale clinical trials are needed to validate these findings.
Arnold AD, Shun-Shin MJ, Ali N, et al., 2023, Contributions of Atrioventricular Delay Shortening and Ventricular Resynchronization to Hemodynamic Benefits of Biventricular Pacing., JACC Clin Electrophysiol, Vol: 9, Pages: 117-119
Kelshiker MA, Seligman H, Howard JP, et al., 2022, Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis (vol 43, pg 1582, 2022), EUROPEAN HEART JOURNAL, ISSN: 0195-668X
Kaza N, Htun V, Miyazawa A, et al., 2022, Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis, EUROPACE, ISSN: 1099-5129
Howard J, Chow K, Chacko L, et al., 2022, Automated inline myocardial segmentation of joint T1 and T2 mapping using deep learning, Radiology: Artificial Intelligence, Vol: 1, Pages: 1-1, ISSN: 2638-6100
Purpose:To develop an artificial intelligence (AI) solution for automated segmentation and analysis of joint cardiac MRI T1 and T2 short-axis mapping.Materials and Methods:In this retrospective study, a joint T1 and T2 mapping sequence was used to acquire 4240 maps from 807 patients across 2 hospitals (March-November 2020). 509 maps from 94 consecutive patients were assigned to a holdout testing set. A convolutional neural network was trained to segment the endocardial and epicardial contours using an edge probability estimation approach. Training labels were segmented by an expert cardiologist. Predicted contours were processed to yield mapping values for each of the 16 AHA segments. Network segmentation performance and segment-wise measurements on the testing set were compared with two experts on the holdout testing set. The AI model was fully integrated using Gadgetron inline AI to run on MRI scanners.Results:A total of 3899 maps (92%) were deemed artifact-free and suitable for human segmentation. AI segmentation closely matched that of each expert (mean Dice coefficient 0.82 ± [SD] 0.07, 0.86 ± 0.06), comparing favorably with interexpert agreement (0.84 ± 0.06). AI-derived segment-wise values for native T1, postcontrast T1 and T2 mapping correlated with experts (R2 0.96, 0.98, 0.87, respectively versus expert 1; 0.97, 0.99, 0.97 versus expert 2) and fell within the range of interexpert reproducibility (R2 = 0.97, 0.99, 0.90). The AI has since been deployed at two hospitals, enabling automated inline analysis.Conclusion:Automated inline analysis of joint T1 and T2 mapping allows accurate segment-wise tissue characterization, with performance equivalent to human experts.
Simader FA, Howard JP, Ahmad Y, et al., 2022, Catheter ablation improves cardiovascular outcomes in patients with atrial fibrillation and heart failure: a meta-analysis of randomized controlled trials, EUROPACE, ISSN: 1099-5129
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Pathimagaraj R, Foley M, Nowbar A, et al., 2022, A Symptom-Stratified Analysis of the Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina Trial, Publisher: ELSEVIER SCIENCE INC, Pages: B80-B80, ISSN: 0735-1097
Ganesananthan S, Rajkumar C, Foley M, et al., 2022, Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: A substudy of the ORBITA trial, European Heart Journal, Vol: 43, Pages: 3132-3145, ISSN: 0195-668X
AimsOxygen-pulse morphology and gas exchange analysis measured during cardiopulmonary exercise testing (CPET) has been associated with myocardial ischaemia. We examine the relationship between CPET parameters, myocardial ischaemia and anginal symptoms in patients with chronic coronary syndrome. We also determine the ability of these parameters to predict the placebo-controlled response to percutaneous coronary intervention (PCI).Methods and resultsPatients with severe single vessel coronary artery disease were randomised 1:1 to PCI or placebo in the ORBITA trial. Subjects underwent pre-randomisation treadmill CPET, dobutamine stress-echocardiography (DSE) and symptom assessment. These assessments were repeated at the end of a 6-week blinded follow-up period. 195 patients with CPET data were randomised (102 PCI, 93 placebo). Patients in whom an oxygen-pulse plateau was observed during CPET had higher (more ischaemic) DSE score (+0.82 segments; 95%CI, 0.40 to 1.25, P=0.0068) and lower FFR (-0.07; -0.12 to -0.02, P=0.011) compared to those without. At lower (more abnormal) oxygen-pulse slopes, there was a larger improvement of the placebo-controlled effect of PCI on DSE score (oxygen-pulse plateau presence [Pinteraction=0.026] and oxygen-pulse gradient [Pinteraction=0.023]) and Seattle angina physical-limitation score (oxygen-pulse plateau presence [Pinteraction=0.037]). Impaired peak VO2, VE/VCO2 slope, peak oxygen-pulse and oxygen-uptake efficacy slope was significantly associated with higher symptom burden but did not relate to severity of ischaemia or predict response to PCI.ConclusionAlthough selected CPET parameters relate to severity of angina symptoms and quality of life, only an oxygen-pulse plateau detects the severity of myocardial ischaemia and predicts the placebo-controlled efficacy of PCI in patients with single-vessel coronary artery disease.
Sau A, Ibrahim S, Ahmed A, et al., 2022, Artificial intelligence-enabled electrocardiogram to distinguish cavotricuspid isthmus dependence from other atrial tachycardia mechanisms, European Heart Journal – Digital Health, Vol: 3, Pages: 405-414, ISSN: 2634-3916
Aims:Accurately determining atrial arrhythmia mechanisms from a 12-lead electrocardiogram (ECG) can be challenging. Given the high success rate of cavotricuspid isthmus (CTI) ablation, identification of CTI-dependent typical atrial flutter (AFL) is important for treatment decisions and procedure planning. We sought to train a convolutional neural network (CNN) to classify CTI-dependent AFL vs. non-CTI dependent atrial tachycardia (AT), using data from the invasive electrophysiology (EP) study as the gold standard.Methods and results:We trained a CNN on data from 231 patients undergoing EP studies for atrial tachyarrhythmia. A total of 13 500 five-second 12-lead ECG segments were used for training. Each case was labelled CTI-dependent AFL or non-CTI-dependent AT based on the findings of the EP study. The model performance was evaluated against a test set of 57 patients. A survey of electrophysiologists in Europe was undertaken on the same 57 ECGs. The model had an accuracy of 86% (95% CI 0.77–0.95) compared to median expert electrophysiologist accuracy of 79% (range 70–84%). In the two thirds of test set cases (38/57) where both the model and electrophysiologist consensus were in agreement, the prediction accuracy was 100%. Saliency mapping demonstrated atrial activation was the most important segment of the ECG for determining model output.Conclusion:We describe the first CNN trained to differentiate CTI-dependent AFL from other AT using the ECG. Our model matched and complemented expert electrophysiologist performance. Automated artificial intelligence-enhanced ECG analysis could help guide treatment decisions and plan ablation procedures for patients with organized atrial arrhythmias.
Tayal U, Verdonschot JAJ, Hazebroek MR, et al., 2022, Precision phenotyping of dilated cardiomyopathy using multidimensional data., Journal of the American College of Cardiology, Vol: 79, Pages: 2219-2232, ISSN: 0735-1097
BACKGROUND: Dilated cardiomyopathy (DCM) is a final common manifestation of heterogenous etiologies. Adverse outcomes highlight the need for disease stratification beyond ejection fraction. OBJECTIVES: The purpose of this study was to identify novel, reproducible subphenotypes of DCM using multiparametric data for improved patient stratification. METHODS: Longitudinal, observational UK-derivation (n = 426; median age 54 years; 67% men) and Dutch-validation (n = 239; median age 56 years; 64% men) cohorts of DCM patients (enrolled 2009-2016) with clinical, genetic, cardiovascular magnetic resonance, and proteomic assessments. Machine learning with profile regression identified novel disease subtypes. Penalized multinomial logistic regression was used for validation. Nested Cox models compared novel groupings to conventional risk measures. Primary composite outcome was cardiovascular death, heart failure, or arrhythmia events (median follow-up 4 years). RESULTS: In total, 3 novel DCM subtypes were identified: profibrotic metabolic, mild nonfibrotic, and biventricular impairment. Prognosis differed between subtypes in both the derivation (P < 0.0001) and validation cohorts. The novel profibrotic metabolic subtype had more diabetes, universal myocardial fibrosis, preserved right ventricular function, and elevated creatinine. For clinical application, 5 variables were sufficient for classification (left and right ventricular end-systolic volumes, left atrial volume, myocardial fibrosis, and creatinine). Adding the novel DCM subtype improved the C-statistic from 0.60 to 0.76. Interleukin-4 receptor-alpha was identified as a novel prognostic biomarker in derivation (HR: 3.6; 95% CI: 1.9-6.5; P = 0.00002) and validation cohorts (HR: 1.94; 95% CI: 1.3-2.8; P = 0.00005). CONCLUSIONS: Three reproducible, mechanistically distinct DCM subtypes were identified using widely available clinical and biological data, adding prognostic value to trad
Howard J, Rajasundaram S, 2022, Role of Blinding in N-of-1 Trials, CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, Vol: 15, Pages: 403-404, ISSN: 1941-7705
Nowbar AN, Howard JP, Shun-Shin MJ, et al., 2022, Daily angina documentation versus subsequent recall: development of a symptom smartphone app., Eur Heart J Digit Health, Vol: 3, Pages: 276-283
AIMS: The traditional approach to documenting angina outcomes in clinical trials is to ask the patient to recall their symptoms at the end of a month. With the ubiquitous availability of smartphones and tablets, daily contemporaneous documentation might be possible. METHODS AND RESULTS: The ORBITA-2 symptom smartphone app was developed with a user-centred iterative design and testing cycle involving a focus group of previous ORBITA participants. The feasibility and acceptability were assessed in an internal pilot of participants in the ongoing ORBITA-2 trial. Seven days of app entries by ORBITA-2 participants were compared with subsequent participant recall at the end of the 7-day period. The design focus group tested a prototype app. They reported that the final version captured their symptoms and was easy to use. In the completion assessment group, 141 of 142 (99%) completed the app in full and 47 of 141 (33%) without reminders. In the recall assessment group, 29 of 29 (100%) participants said they could recall the previous day's symptoms, and 82% of them recalled correctly. For 2 days previously, 88% said they could recall and of those, 87% recalled correctly. The proportion saying they could recall their symptoms fell progressively thereafter: 89, 67, 61, 50%, and at 7 days, 55% (P < 0.001 for trend). The proportion of recalling correctly also fell progressively to 55% at 7 days (P = 0.04 for trend). CONCLUSION: Episode counts of angina are difficult to recall after a few days. For trials such as ORBITA-2 focusing on angina, daily symptom collection via a smartphone app will increase the validity of the results.
Howard J, Francis D, 2022, Machine learning with convolutional neural networks for clinical cardiologists, Heart, Vol: 108, Pages: 973-981, ISSN: 1355-6037
Kelshiker M, Seligman H, Howard JAMES, et al., 2022, Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis, European Heart Journal, Vol: 43, Pages: 1582-1593, ISSN: 0195-668X
Aims: This meta-analysis aims to quantify the association of reduced coronary flow with all3 cause mortality and major adverse cardiovascular events (MACE) across a broad range of patient groups and pathologies. Methods and Results: We systematically identified all studies between 1st January 2000 and1st August 2020, where coronary flow was measured and clinical outcomes were reported. The endpoints were all-cause mortality and MACE. Estimates of effect were calculated from published hazard ratios using a random-effects model. 79 studies, including 59,740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality (HR 3.78, 95% CI 2.39-5.97) and a higher incidence of MACE (HR 3.42, 95% CI 2.92-3.99). Each 0.1-unit reduction in CFR was associated with a proportional increase in mortality (per 0.1 CFR unit HR 1.16, 95% CI 1.04-1.29) and MACE (per 0.1 CFR unit HR 1.08, 95% CI 1.04-1.11)). In patients with isolated coronary microvascular dysfunction, an abnormal CFR was associated with a higher incidence of mortality (HR 5.44, 95% CI 3.78-7.83) and MACE (HR 3.56, 95% CI 2.14-5.90). Abnormal CFR was also associated with a higher incidence of MACE in patients with acute coronary syndromes (HR 3.76, 95% CI 2.35-6.00), heart failure (HR 6.38, 95% CI 1.95-20.90), heart transplant (HR 3.32, 95% CI 2.34-4.71) and diabetes mellitus (HR 7.47, 95% CI 3.37-16.55). Conclusions: Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice to target aggressive vascular risk modification for individuals at higher risk
Kelshiker MA, Seligman H, Howard JP, et al., 2022, Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis., Eur Heart J, Vol: 43, Pages: 1582-1593
AIMS: This meta-analysis aims to quantify the association of reduced coronary flow with all-cause mortality and major adverse cardiovascular events (MACE) across a broad range of patient groups and pathologies. METHODS AND RESULTS: We systematically identified all studies between 1 January 2000 and 1 August 2020, where coronary flow was measured and clinical outcomes were reported. The endpoints were all-cause mortality and MACE. Estimates of effect were calculated from published hazard ratios (HRs) using a random-effects model. Seventy-nine studies with a total of 59 740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality [HR: 3.78, 95% confidence interval (CI): 2.39-5.97] and a higher incidence of MACE (HR 3.42, 95% CI: 2.92-3.99). Each 0.1 unit reduction in CFR was associated with a proportional increase in mortality (per 0.1 CFR unit HR: 1.16, 95% CI: 1.04-1.29) and MACE (per 0.1 CFR unit HR: 1.08, 95% CI: 1.04-1.11). In patients with isolated coronary microvascular dysfunction, an abnormal CFR was associated with a higher incidence of mortality (HR: 5.44, 95% CI: 3.78-7.83) and MACE (HR: 3.56, 95% CI: 2.14-5.90). Abnormal CFR was also associated with a higher incidence of MACE in patients with acute coronary syndromes (HR: 3.76, 95% CI: 2.35-6.00), heart failure (HR: 6.38, 95% CI: 1.95-20.90), heart transplant (HR: 3.32, 95% CI: 2.34-4.71), and diabetes mellitus (HR: 7.47, 95% CI: 3.37-16.55). CONCLUSION: Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice, to target aggressive vascular risk modification for individuals at higher risk.
Foley M, Hall K, Howard J, et al., 2022, Aortic valve calcium score is associated with acute stroke in TAVI patients, Journal of the Society for Cardiovascular Angiography & Interventions, ISSN: 2772-9303
Kelshiker M, Seligman H, Howard J, et al., 2022, The importance of time-to-event analysis in measuring the prognostic impact of coronary flow reserve, European Heart Journal, ISSN: 0195-668X
Rajkumar CA, Ganesananthan S, Ahmad Y, et al., 2022, Mechanical thrombectomy with retrievable stents and aspiration catheters for acute ischaemic stroke: a meta-analysis of randomised controlled trials, EUROINTERVENTION, Vol: 17, Pages: E1425-+, ISSN: 1774-024X
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Nowbar AN, Rajkumar C, Foley M, et al., 2022, A double-blind randomised placebo-controlled trial of percutaneous coronary intervention for the relief of stable angina without antianginal medications: design and rationale of the ORBITA-2 trial, EUROINTERVENTION, Vol: 17, Pages: 1490-+, ISSN: 1774-024X
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Warisawa T, Cook C, Kawase Y, et al., 2022, MEDICAL THERAPY VS. REVASCULARIZATION IN LEFT MAIN CORONARY ARTERY DISEASE WITH PROVEN ISCHEMIA: INSIGHTS FROM THE DEFINE-LM REGISTRY, Publisher: ELSEVIER SCIENCE INC, Pages: 586-586, ISSN: 0735-1097
Kelshiker M, Seligman H, Howard JP, et al., 2022, CORONARY FLOW RESERVE AND CARDIOVASCULAR OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS, 71st Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 989-989, ISSN: 0735-1097
Seligman H, Nijjer SS, van de Hoef TP, et al., 2022, Phasic flow patterns of right versus left coronary arteries in patients undergoing clinical physiological assessment, EUROINTERVENTION, Vol: 17, Pages: 1260-+, ISSN: 1774-024X
Ribeiro HDM, Arnold A, Howard JP, et al., 2022, ECG-based real-time arrhythmia monitoring using quantized deep neural networks: A feasibility study, COMPUTERS IN BIOLOGY AND MEDICINE, Vol: 143, ISSN: 0010-4825
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- Citations: 8
Ahmad Y, Howard J, Madhavan MV, et al., 2022, Single versus dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of randomized clinical trials, Cardiovascular Revascularization Medicine, Vol: 34, Pages: 46-53, ISSN: 1553-8389
BackgroundGuidelines recommend dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) but guidelines predate the publication of the largest randomized trial. There have been few trials in the field to date, and with a small number of total patients; pooling their results may therefore be helpful.MethodsWe systematically identified all randomized trials comparing SAPT to DAPT after TAVR. The primary endpoint was the risk of major bleeding. Secondary endpoints included all bleeding, life-threatening bleeding, stroke, myocardial infarction, death and cardiac death.ResultsFour trials, randomizing 1086 participants, were eligible (541 randomized to SAPT and 545 randomized to DAPT). The weighted mean follow-up was 9.1 months. The risk of major bleeding was significantly increased after DAPT (relative risk (RR) 2.36, 95% confidence interval (CI) 1.27 to 4.40, P = 0.007). There was a similar increased risk for all bleeding (RR 1.65, 95% CI 1.24 to 2.19, P < 0.001), although not for life-threatening bleeding (RR 1.44, 95% CI 0.74 to 2.77, P = 0.282). There were no significant differences in the risk of stroke, myocardial infarction (MI), death or cardiac death. There was no heterogeneity observed for any endpoint (I2 = 0.0%).ConclusionsDAPT after TAVR is associated with an increased risk of major bleeding and all bleeding. There is no evidence of a significant difference between DAPT or SAPT for the risks of stroke, MI, death or cardiac death. However, the total number of patients randomized is small and the duration of follow-up is short. Larger scale randomized trials with longer follow-up are required to assess for any potential differences in ischemic endpoints or mortality.
Ahmad Y, Kane C, Arnold AD, et al., 2022, Randomized blinded placebo-controlled trials of renal sympathetic denervation for hypertension: a meta-analysis, Cardiovascular Revascularization Medicine, Vol: 34, Pages: 112-118, ISSN: 1553-8389
BackgroundThe efficacy of renal denervation has been controversial, but the procedure has now undergone several placebo-controlled trials. New placebo-controlled trial data has recently emerged, with longer follow-up of one trial and the full report of another trial (which constitutes 27% of the total placebo-controlled trial data). We therefore sought to evaluate the effect of renal denervation on ambulatory and office blood pressures in patients with hypertension.MethodsWe systematically identified all blinded placebo-controlled randomized trials of catheter-based renal denervation for hypertension. The primary efficacy outcome was ambulatory systolic blood pressure change relative to placebo. A random-effects meta-analysis was performed.Results6 studies randomizing 1232 patients were eligible. 713 patients were randomized to renal denervation and 519 to placebo. Renal denervation significantly reduced ambulatory systolic blood pressure (−3.52 mmHg; 95% CI −4.94 to −2.09; p < 0.0001), ambulatory diastolic blood pressure (−1.93 mmHg; 95% CI −3.04 to −0.83, p = 0.0006), office systolic blood pressure size (−5.10 mmHg; 95% CI −7.31 to −2.90, p < 0.0001) and office diastolic pressure (effect size −3.11 mmHg; 95% CI −4.43 to −1.78, p < 0.0001). Adverse events were rare and not more common with denervation.ConclusionsThe totality of blinded, randomized placebo-controlled data shows that renal denervation is safe and provides genuine reduction in blood pressure for at least 6 months post-procedure. If this effect continues in the long term, renal denervation might provide a life-long 10% relative risk reduction in major adverse cardiac events and 7.5% relative risk reduction in all-cause mortality.
Li Z, Petri C, Howard J, et al., 2022, PAT-CNN: Automatic Segmentation and Quantification of Pericardial Adipose Tissue from T2-Weighted Cardiac Magnetic Resonance Images, Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), Vol: 13593 LNCS, Pages: 359-368, ISSN: 0302-9743
Background: Increased pericardial adipose tissue (PAT) is associated with many types of cardiovascular disease (CVD). Although cardiac magnetic resonance images (CMRI) are often acquired in patients with CVD, there are currently no tools to automatically identify and quantify PAT from CMRI. The aim of this study was to create a neural network to segment PAT from T2-weighted CMRI and explore the correlations between PAT volumes (PATV) and CVD outcomes and mortality. Methods: We trained and tested a deep learning model, PAT-CNN, to segment PAT on T2-weighted cardiac MR images. Using the segmentations from PAT-CNN, we automatically calculated PATV on images from 391 patients. We analysed correlations between PATV and CVD diagnosis and 1-year mortality post-imaging. Results: PAT-CNN was able to accurately segment PAT with Dice score/ Hausdorff distances of 0.74 ± 0.03/27.1 ± 10.9 mm, similar to the values obtained when comparing the segmentations of two independent human observers (0.76 ± 0.06/21.2 ± 10.3 mm). Regression models showed that, independently of sex and body-mass index, PATV is significantly positively correlated with a diagnosis of CVD and with 1-year all cause mortality (p-value < 0.01). Conclusions: PAT-CNN can segment PAT from T2-weighted CMR images automatically and accurately. Increased PATV as measured automatically from CMRI is significantly associated with the presence of CVD and can independently predict 1-year mortality.
Zaman S, Petri C, Vimalesvaran K, et al., 2022, Automatic diagnosis labeling of cardiovascular MRI by using semisupervised natural language processing of text reports, Radiology: Artificial Intelligence, Vol: 4, ISSN: 2638-6100
A semisupervised natural language processing (NLP) algorithm, based on bidirectional transformers, accurately categorized diagnoses from cardiac MRI text of radiology reports for the labeling of MR images; the model had a higher accuracy than traditional NLP models and performed faster labeling than clinicians.
Vimalesvaran K, Uslu F, Zaman S, et al., 2022, Detecting Aortic Valve Pathology from the 3-Chamber Cine Cardiac MRI View, Editors: Wang, Dou, Fletcher, Speidel, Li, Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 571-580, ISBN: 978-3-031-16430-9
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