Publications
487 results found
Shah BN, Gujral DM, Chahal NS, et al., 2016, Plaque Neovascularization Is Increased in Human Carotid Atherosclerosis Related to Prior Neck Radiotherapy A Contrast-Enhanced Ultrasound Study, JACC-Cardiovascular Imaging, Vol: 9, Pages: 668-675, ISSN: 1936-878X
ObjectivesThe aim of this study was to determine the effect of radiotherapy (RT) on intraplaque neovascularization (IPN) in human carotid arteries.BackgroundExposure of the carotid arteries to RT during treatment for head and neck cancer is associated with increased risk for stroke. However, the effect of RT on IPN, a precursor to intraplaque hemorrhage and thus associated with plaque vulnerability, is unknown.MethodsIn this cross-sectional study, patients who had undergone unilateral RT for head and neck cancer ≥2 years previously underwent B-mode and contrast-enhanced ultrasound of both RT-side and non–RT-side carotid arteries. Presence of IPN during contrast-enhanced ultrasound was judged semiquantitatively as grade 0 (absent), grade 1 (present but limited to plaque base), or grade 2 (extensive and noted within plaque body).ResultsOf 49 patients studied, 38 (78%) had plaques. The number of plaques was significantly greater in the RT than the non-RT arteries. Overall, 48 of 64 RT-side plaques (75%) had IPN compared with 9 of 23 non-RT-side (39%) plaques (p = 0.002). Among patients with plaques, IPN was present in 81% of patients with RT-side plaques and 41% of patients with non-RT-side plaques (p = 0.004). Grade 0 IPN was significantly more common in patients with non-RT-side plaques (25% vs. 61%; p = 0.002), whereas grade 2 plaques were more common on the RT side (31% vs. 9%; p = 0.03). The only clinical variable that predicted the presence or absence of IPN was RT laterality.ConclusionsThis is the first study in humans to reveal a significant association between RT and the presence and extent of IPN. This may provide insights into the mechanisms underlying the increased stroke risk among survivors of head and neck cancer treated by RT.
Gurunathan S, Parsons G, Young G, et al., 2016, Postcardiac Injury Syndrome: A Rare Complication of Elective Coronary Angioplasty, American Journal of Medicine, Vol: 129, Pages: E13-E14, ISSN: 1555-7162
Quah J, Carlton E, Rana O, et al., 2016, Insulin-induced hypoglycaemia and the detection of myocardial injury using an ultrasensitive troponin assay, International Journal of Cardiology, Vol: 215, Pages: 446-448, ISSN: 1874-1754
Senior R, Friberg L, Travin M, et al., 2016, PROGNOSTIC USEFULNESS OF ADREVIEW SCINTIGRAPHY IN IDENTIFYING HEART FAILURE PATIENTS AT LOWER RISK OF DEATH DURING 5-YEAR FOLLOW-UP IN THE ADMIRE-HF STUDY, 65th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: Elsevier, Pages: 1812-1812, ISSN: 1558-3597
Senior R, Shah B, Zacharias K, et al., 2016, SIMULTANEOUS CAROTID ULTRASONOGRAPHY PROVIDES INCREMENTAL PROGNOSTIC VALUE BEYOND CLINICAL AND STRESS ECHOCARDIOGRAPHY DATA IN PATIENTS WITH SUSPECTED ANGINA WITHOUT KNOWN CORONARY ARTERY DISEASE: A PROSPECTIVE STUDY, 65th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: Elsevier, Pages: 1802-1802, ISSN: 1558-3597
Kataoka A, Scherrer-Crosbie M, Senior R, et al., 2016, Transient Ischemic Dilatation during Stress Echocardiography: An Additional Marker of Significant Myocardial Ischemia., Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques, ISSN: 1540-8175
AIM: Left ventricular (LV) transient ischemic dilatation (TID) is not clear how it relates to inducible myocardial ischemia during stress echocardiography (SE). METHODS AND RESULTS: Eighty-eight SEs were examined from the site certification phase of the ISCHEMIA Trial. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were measured at rest and peak stages and the percent change calculated. Moderate or greater ischemia was defined as ≥3 segments with stress-induced severe hypokinesis or akinesis. Optimum cut points in stress-induced percent EDV and ESV change that identified moderate or greater myocardial ischemia were analyzed. Analysis from percentage distribution identified a > 13% LV volume increase in EDV or a > 9% LV volume increase in ESV as the optimum cutoff points for moderate or greater ischemia. Using these definitions for TID, there were 27 (31%) with TIDESV and 12 (14%) with TIDEDV . By logistic regression analysis and receiver operating characteristic curves, the percent change in ESV had a stronger association with moderate or greater myocardial ischemia than that of EDV change. Compared to those without TIDESV , cases with TIDESV had larger extent of inducible wall-motion abnormalities, lower peak stress LVEF, and higher likelihood of moderate or grater ischemia. For moderate or greater myocardial ischemia detection, TIDESV had a sensitivity of 46%, specificity of 83%, positive predictive value of 70%, and negative predictive value of 64%. CONCLUSION: Transient ischemic dilatation by SE is a marker of extensive myocardial ischemia and can be used as an additional marker of higher risk.
Donal E, Lip GYH, Galderisi M, et al., 2016, EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 17, Pages: 355-383, ISSN: 2047-2404
Atrial fibrillation (AF) is the commonest cardiac rhythm disorder. Evaluation of patients with AF requires an electrocardiogram, but imaging techniques should be considered for defining management and driving treatment. The present document is an expert consensus from the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association. The clinical value of echocardiography, cardiac magnetic resonance (CMR), computed tomography (CT), and nuclear imaging in AF patients are challenged. Left atrial (LA) volume and strain in echocardiography as well as assessment of LA fibrosis in CMR are discussed. The value of CT, especially in planning interventions, is highlighted. Fourteen consensus statements have been reached. These may serve as a guide for both imagers and electrophysiologists for best selecting the imaging technique and for best interpreting its results in AF patients.
Nam MC, Nel K, Senior R, et al., 2016, Abnormal Myocardial Blood Flow Reserve Observed in Cardiac Amyloidosis, Journal of Cardiovascular Ultrasound, Vol: 24, Pages: 64-67, ISSN: 1975-4612
We performed real-time myocardial contrast echocardiography on a patient with cardiac amyloidosis and previous normal coronary angiography presenting with atypical chest pain to assess myocardial blood flow reserve (MBFR). Myocardial contrast echocardiography was performed and flash microbubble destruction and replenishment analysis was used to calculate myocardial blood flow. Dipyridamole was used to achieve hyperemia. MBFR was derived from the ratio of peak myocardial blood flow at hyperemia and rest. The results show a marked reduction in MBFR in our patient. Previous reports of luminal obstruction of intramyocardial rather than epicardial vessels by amyloid deposition may be causing microvascular dysfunction.
Zacharias K, Ahmed A, Shah BN, et al., 2016, Relative clinical and economic impact of exercise echocardiography vs. exercise electrocardiography, as first line investigation in patients without known coronary artery disease and new stable angina: a randomized prospective study, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 18, Pages: 195-202, ISSN: 2047-2404
Shah BN, Zacharias K, Pabla JS, et al., 2016, The clinical impact of contemporary stress echocardiography in morbid obesity for the assessment of coronary artery disease, HEART, Vol: 102, Pages: 370-375, ISSN: 1355-6037
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- Citations: 14
Gujral DM, Shah BN, Chahal NS, et al., 2016, Arterial Stiffness as a Biomarker of Radiation-Induced Carotid Atherosclerosis, ANGIOLOGY, Vol: 67, Pages: 266-271, ISSN: 0003-3197
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- Citations: 18
Garg P, Underwood SR, Senior R, et al., 2016, Noninvasive cardiac imaging in suspected acute coronary syndrome., Nature Reviews Cardiology, Vol: 13, Pages: 266-275, ISSN: 1759-5010
Noninvasive cardiac imaging has an important role in the assessment of patients with acute-onset chest pain. In patients with suspected acute coronary syndrome (ACS), cardiac imaging offers incremental value over routine clinical assessment, the electrocardiogram, and blood biomarkers of myocardial injury, to confirm or refute the diagnosis of coronary artery disease and to assess future cardiovascular risk. This Review covers the current guidelines and clinical use of the common noninvasive imaging techniques, including echocardiography and stress echocardiography, computed tomography coronary angiography, myocardial perfusion scintigraphy, positron emission tomography, and cardiovascular magnetic resonance imaging, in patients with suspected ACS, and provides an update on the developments in noninvasive imaging techniques in the past 5 years.
Vamvakidou A, Gurunathan S, Senior R, 2016, Novel techniques in stress echocardiography: a focus on the advantages and disadvantages., Expert Review of Cardiovascular Therapy, Vol: 14, Pages: 477-494, ISSN: 1744-8344
Stress echocardiography (SE) is an established tool not only for the assessment of coronary artery disease (CAD), but also for the evaluation of valvular disease and cardiomyopathy. New techniques, namely contrast echocardiography for function and perfusion including assessment of coronary flow reserve, strain imaging, 3-dimensional echocardiography, Doppler-derived coronary flow reserve and multimodality echocardiography, have been incorporated into stress protocols for improving assessment of cardiac disease. In this review, the advantages and disadvantages of these novel SE techniques are examined in terms of feasibility, accuracy, reproducibility and applications.
Gujral DM, Shah BN, Chahal NS, et al., 2016, Carotid intima-medial thickness as a marker of radiation-induced carotid atherosclerosis, RADIOTHERAPY AND ONCOLOGY, Vol: 118, Pages: 323-329, ISSN: 0167-8140
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- Citations: 16
Vamvakidou A, Gurunathan S, Senior R, 2016, A 56-year-old man with exercise-induced chest pains, HEART, Vol: 102, Pages: 277-+, ISSN: 1355-6037
Li Y, Ho CP, Chahal N, et al., 2016, Myocardial segmentation of contrast echocardiograms using random forests guided by shape model, Pages: 158-165, ISSN: 0302-9743
Myocardial Contrast Echocardiography (MCE) with microbubble contrast agent enables myocardial perfusion quantification which is invaluable for the early detection of coronary artery diseases. In this paper,we proposed a new segmentation method called Shape Model guided Random Forests (SMRF) for the analysis of MCE data. The proposed method utilizes a statistical shape model of the myocardium to guide the Random Forest (RF) segmentation in two ways. First,we introduce a novel Shape Model (SM) feature which captures the global structure and shape of the myocardium to produce a more accurate RF probability map. Second,the shape model is fitted to the RF probability map to further refine and constrain the final segmentation to plausible myocardial shapes. Evaluated on clinical MCE images from 15 patients,our method obtained promising results (Dice = 0.81,Jaccard = 0.70,MAD = 1.68 mm,HD = 6.53mm) and showed a notable improvement in segmentation accuracy over the classic RF and its variants.
Kataoka A, Scherrer-Crosbie M, Senior R, et al., 2015, The value of core lab stress echocardiography interpretations: observations from the ISCHEMIA Trial, Cardiovascular Ultrasound, Vol: 13, ISSN: 1476-7120
BackgroundStress echocardiography (SE) is dependent on subjective interpretations. As a prelude to the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) Trial, potential sites were required to submit two SE, one with moderate or severe left ventricular (LV) myocardial ischemia and one with mild ischemia. We evaluated the concordance of site and core lab interpretations.MethodsEighty-one SE were submitted from 41 international sites. Ischemia was classified by the number of new or worsening segmental LV wall motion abnormalities (WMA): none, mild (1 or 2) or moderate or severe (3 or more) by the sites and the core lab.ResultsCore lab classified 6 SE as no ischemia, 35 mild and 40 moderate or greater. There was agreement between the site and core in 66 of 81 total cases (81 %, weighted kappa coefficient [K] =0.635). Agreement was similar for SE type - 24 of 30 exercise (80 %, K = 0.571) vs. 41 of 49 pharmacologic (84 %, K = 0.685). The agreement between poor or fair image quality (27 of 36 cases, 75 %, K = 0.492) was not as good as for the good or excellent image quality cases (39 of 45 cases, 87 %, K = 0.755). Differences in concordance were noted for degree of ischemia with the majority of discordant interpretations (87 %) occurring in patients with no or mild LV myocardial ischemia.ConclusionsWhile site SE interpretations are largely concordant with core lab interpretations, this appears dependent on image quality and the extent of WMA. Thus core lab interpretations remain important in clinical trials where consistency of interpretation across a range of cases is critical.
Vamvakidou A, Karogiannis N, Ramzy I, et al., 2015, Exercise echocardiography in asymptomatic severe aortic stenosis, INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, Vol: 31, Pages: 1561-1562, ISSN: 1569-5794
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- Citations: 1
Cordina R, von Klemperer K, Kempny A, et al., 2015, Echocardiographic Predictors of Mortality in Adults With a Fontan Circulation, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Sehmi JS, Dungu J, Davies SW, et al., 2015, Unsuspected large left ventricular pseudoaneurysm: rapid bedside diagnosis by contrast-enhanced echocardiography., Oxford Medical Case Reports, Vol: 2015, Pages: 358-359, ISSN: 2053-8855
An asymptomatic 72-year-old man with cardiomegaly was referred to our centre for assessment. His medical history comprised metastatic colonic cancer and granulomatosis with polyangiitis.Transthoracic echocardiography was performed. In the apical four-chamber view, a large cavity was identified adjacent to the apex, measuring 45 × 54 mm (Fig. 1A and Supplementary Video 1). All apical segments of the left ventricle were thin and akinetic. On colour Doppler, bidirectional blood flow due to swirling of blood was observed within the cavity (Fig. 1B and Supplementary Video 2). Contrast-enhanced echocardiography established the …
Vamvakidou A, Ramzy I, Senior R, 2015, Dobutamine stress echo for suspected paradoxical low-flow low-gradient severe aortic stenosis: Value of left ventricular wall thickening assessment, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 198, Pages: 182-184, ISSN: 0167-5273
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- Citations: 1
Shah BN, Gonzalez-Gonzalez AM, Drakopoulou M, et al., 2015, The Incremental Prognostic Value of the Incorporation of Myocardial Perfusion Assessment into Clinical Testing with Stress Echocardiography Study, JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, Vol: 28, Pages: 1358-1365, ISSN: 0894-7317
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- Citations: 15
Sehmi JS, West C, Khattar R, et al., 2015, Mass Confusion Defining Aortic Pathology With Ultrasound Contrast, CIRCULATION, Vol: 132, Pages: 1433-1434, ISSN: 0009-7322
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- Citations: 2
Chahal NS, Drakopoulou M, Gonzalez-Gonzalez AM, et al., 2015, Resting Aortic Valve Area at Normal Transaortic Flow Rate Reflects True Valve Area in Suspected Low-Gradient Severe Aortic Stenosis, JACC-CARDIOVASCULAR IMAGING, Vol: 8, Pages: 1133-1139, ISSN: 1936-878X
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- Citations: 53
Gujral DM, Shah BN, Chahal NS, et al., 2015, Do traditional risk stratification models for cerebrovascular events apply in irradiated head and neck cancer patients?, European Cancer Congress, Publisher: ELSEVIER SCI LTD, Pages: S570-S570, ISSN: 0959-8049
Gujral DM, Shah BN, Bhattacharyya S, et al., 2015, Contrast-enhanced ultrasound to assess plaque neovascularization in irradiated carotid arteries, International Journal of Cardiology, Vol: 202, Pages: 3-4, ISSN: 1874-1754
Gurunathan S, Ahmed A, Adel N, et al., 2015, Giant lymphomatous cardiac mass: In vivo imaging and histological findings, International Journal of Cardiology, Vol: 202, Pages: 81-83, ISSN: 1874-1754
Venneri L, Calicchio F, Manivarmane R, et al., 2015, Impaired myocardial function despite normal ejection fraction in patients on current cancer drug therapies, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 150-150, ISSN: 0195-668X
Appadurai V, Nel K, Anstey CM, et al., 2015, The influence of endothelin-1, hs-CRP, coronary artery plaque burden and plaque morphology on calcific aortic valve disease, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 266-266, ISSN: 0195-668X
Shah BN, Chahal NS, Anantharam B, et al., 2015, Carotid plaque neovascularization is independently associated with asymptomatic South Asians vs Europeans: A possible mechanism underlying the greater cardiovascular disease burden in South Asians, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 433-433, ISSN: 0195-668X
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