Fractal Analysis of Right Ventricular Trabeculae in Pulmonary                    Hypertension

Dawes, Timothy J W; Cai, Jiashen; Quinlan, Marina; Marvao, Antonio de; Ostrowski, Philip J.; Tokarczuk, Pawel; Watson, Geoffrey; Wharton, John; Howard, Luke; Gibbs, J. Simon R.; Cook, Stuart A.; Wilkins, Martin R.; O’Regan, Declan P.

doi:10.1148/radiol.2018172821

Cited by 28 publications

(26 citation statements)

References 34 publications

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“…Our comprehensive search identified a total of 22 studies that were included in the meta-analysis ( 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ). The details of the literature search are presented in the supplemental materials, including a Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram ( Supplemental Appendix 3 ).…”

Section: Resultsmentioning

confidence: 99%

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Cardiac-MRI Predicts Clinical Worsening and Mortality in Pulmonary Arterial Hypertension

Alabed¹,

Shahin²,

Garg

et al. 2021

JACC: Cardiovascular Imaging

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Objectives This meta-analysis evaluates assessment of pulmonary arterial hypertension (PAH), with a focus on clinical worsening and mortality. Background Cardiac magnetic resonance (CMR) has prognostic value in the assessment of patients with PAH. However, there are limited data on the prediction of clinical worsening, an important composite endpoint used in PAH therapy trials. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science databases were searched in May 2020. All CMR studies assessing clinical worsening and the prognosis of patients with PAH were included. Pooled hazard ratios of univariate regression analyses for CMR measurements, for prediction of clinical worsening and mortality, were calculated. Results Twenty-two studies with 1,938 participants were included in the meta-analysis. There were 18 clinical worsening events and 8 deaths per 100 patient-years. The pooled hazard ratios show that every 1% decrease in right ventricular (RV) ejection fraction is associated with a 4.9% increase in the risk of clinical worsening over 22 months of follow-up and a 2.2% increase in the risk of death over 54 months. For every 1 ml/m 2 increase in RV end-systolic volume index or RV end-diastolic volume index, the risk of clinical worsening increases by 1.3% and 0.7%, respectively, and the risk of mortality increases by 0.9% and 1%. Every 1 ml/m 2 decrease in left ventricular end-systolic volume index or left ventricular end-diastolic volume index increased the risk of death by 2.1% and 2.3%. Left ventricular parameters were not associated with clinical worsening. Conclusions This review confirms CMR as a powerful prognostic marker in PAH in a large cohort of patients. In addition to confirming previous observations that RV function and RV and left ventricular volumes predict mortality, RV function and volumes also predict clinical worsening. This study provides a strong rationale for considering CMR as a clinically relevant endpoint for trials of PAH therapies.

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Section: Resultsmentioning

confidence: 99%

“…IPAH comprised 51% and CTD-PAH 26% of the PAH population. Dawes 2018 ( 31 ), de Siqueira 2016 ( 16 ), and Jose 2019 ( 30 ) kindly provided additional data that allowed identification of patients with PAH from a mixed PH cohort.…”

Section: Resultsmentioning

confidence: 99%

Cardiac-MRI Predicts Clinical Worsening and Mortality in Pulmonary Arterial Hypertension

Alabed¹,

Shahin²,

Garg

et al. 2021

JACC: Cardiovascular Imaging

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“…ML is likely to play an important role in PH [ 89 ]. Recent approaches include automated segmentation [ 90 , 91 ], biventricular 3D model creation [ 92 ], computational models and decision tree analysis [ 93 ], diagnosis [ 94 ••] and prognostication [ 95 ••, 96 ].…”

Section: Machine Learningmentioning

confidence: 99%

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Alabed

Garg

Johns

et al. 2020

Curr Cardiovasc Imaging Rep

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Purpose of Review This article reviews advances over the past 3 years in cardiac magnetic resonance (CMR) imaging in pulmonary hypertension (PH). We aim to bring the reader up-to-date with CMR applications in diagnosis, prognosis, 4D flow, strain analysis, T1 mapping, machine learning and ongoing research. Recent Findings CMR volumetric and functional metrics are now established as valuable prognostic markers in PH. This imaging modality is increasingly used to assess treatment response and improves risk stratification when incorporated into PH risk scores. Emerging techniques such as myocardial T1 mapping may play a role in the follow-up of selected patients. Myocardial strain may be used as an early marker for right and left ventricular dysfunction and a predictor for mortality. Machine learning has offered a glimpse into future possibilities. Ongoing research of new PH therapies is increasingly using CMR as a clinical endpoint. Summary The last 3 years have seen several large studies establishing CMR as a valuable diagnostic and prognostic tool in patients with PH, with CMR increasingly considered as an endpoint in clinical trials of PH therapies. Machine learning approaches to improve automation and accuracy of CMR metrics and identify imaging features of PH is an area of active research interest with promising clinical utility.

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“…Right ventricular dysfunction is increasingly recognised as a significant predictor of morbidity and mortality in patients in the acute , chronic and peri‐operative settings. The complexity of RV function has prompted efforts to summarise function by markers of longitudinal and transverse function, though these markers have weaknesses .…”

Section: Discussionmentioning

confidence: 99%

“…Right ventricular (RV) function has prognostic value in acute and chronic cardiorespiratory disease and in the peri‐operative period , although rapid and accurate assessment is challenging due to the right ventricle's complex geometry and motion . Several regional surrogate measures of global RV function have been investigated, most commonly targeting the contributions of longitudinal and transverse motion, because these are thought to predominate .…”

Section: Introductionmentioning

confidence: 99%

Identifying the optimal regional predictor of right ventricular global function: a high‐resolution three‐dimensional cardiac magnetic resonance study

et al. 2018

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Summary Right ventricular (RV) function has prognostic value in acute, chronic and peri‐operative disease, although the complex RV contractile pattern makes rapid assessment difficult. Several two‐dimensional (2D) regional measures estimate RV function, however the optimal measure is not known. High‐resolution three‐dimensional (3D) cardiac magnetic resonance cine imaging was acquired in 300 healthy volunteers and a computational model of RV motion created. Points where regional function was significantly associated with global function were identified and a 2D, optimised single‐point marker (SPM‐O) of global function developed. This marker was prospectively compared with tricuspid annular plane systolic excursion (TAPSE), septum‐freewall displacement (SFD) and their fractional change (TAPSE‐F, SFD‐F) in a test cohort of 300 patients in the prediction of RV ejection fraction. RV ejection fraction was significantly associated with systolic function in a contiguous 7.3 cm2 patch of the basal RV freewall combining transverse (38%), longitudinal (35%) and circumferential (27%) contraction and coinciding with the four‐chamber view. In the test cohort, all single‐point surrogates correlated with RV ejection fraction (p < 0.010), but correlation (R) was higher for SPM‐O (R = 0.44, p < 0.001) than TAPSE (R = 0.24, p < 0.001) and SFD (R = 0.22, p < 0.001), and non‐significantly higher than TAPSE‐F (R = 0.40, p < 0.001) and SFD‐F (R = 0.43, p < 0.001). SPM‐O explained more of the observed variance in RV ejection fraction (19%) and predicted it more accurately than any other 2D marker (median error 2.8 ml vs 3.6 ml, p < 0.001). We conclude that systolic motion of the basal RV freewall predicts global function more accurately than other 2D estimators. However, no markers summarise 3D contractile patterns, limiting their predictive accuracy.

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Fractal Analysis of Right Ventricular Trabeculae in Pulmonary Hypertension

Cited by 28 publications

References 34 publications

Cardiac-MRI Predicts Clinical Worsening and Mortality in Pulmonary Arterial Hypertension

Cardiac-MRI Predicts Clinical Worsening and Mortality in Pulmonary Arterial Hypertension

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Identifying the optimal regional predictor of right ventricular global function: a high‐resolution three‐dimensional cardiac magnetic resonance study

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