Explore the vast range of titles available.

IntroductionIn addition to hypertension, the constellation of metabolic abnormalities (diabetes mellitus, dyslipidaemia and/or obesity) independently increases the incidence and severity of cardiovascular diseases, and this is compounded by the modern lifestyle and ageing society. The prevalence of metabolic syndrome is high and non-hypertensive heart failure is common in Asians. Adverse cardiac remodelling is an important substrate for cardiac dysfunction in the onset and progression of heart failure and its amelioration improves outcomes and prognosis. A better understanding of metabolic-driven cardiac remodelling is warranted due to the rising prevalence and complexity of metabolic syndrome and strong interests in targeted therapy.Methods and analysisResponse of the myocardium to hypertrophic conditions in the adult population is a prospective observational cohort study with an aim to establish the significance of cardiac remodelling by cardiovascular magnetic resonance (CMR). The current recruitment target is 2000 participants. Expanding from the initial population with hypertension, the study examines adults with cardiometabolic conditions, including diabetes, dyslipidaemia, obesity and fatty liver disease. Eligible patients are identified at National Heart Centre Singapore, primary care clinics and through public outreach. Physical, clinical, imaging and biochemical data are collected. Cardiac remodelling features pertaining to hypertrophy, fibrosis and functional changes are assessed on CMR. Body adiposity is mapped by MRI across the heart, liver and abdomen. Outcome data are adjudicated and follow-up assessment will be available in a subset of participants. Blood biomarkers will be investigated in relation to imaging findings. Cross-sectional analysis will establish the implication of cardiometabolic disease towards cardiac remodelling, while follow-up and outcome analysis will infer on disease progression and prognosis.Ethics and disseminationThe study was approved by the SingHealth Centralised Institutional Review Board (2015/2603). Written informed consent is obtained from all participants. Study findings will be reported in peer-reviewed journals and at scientific conferences.Trial registration numberClinicalTrials.gov, NCT02670031.

Diffuse interstitial fibrosis is associated with adverse outcomes in hypertensive heart disease and may be reversible. Sacubitril/valsartan could offer greater anti-fibrotic effects than valsartan alone. In the REVERSE-LVH phase 2 open-labelled trial (clinicaltrials.gov NCT: 03553810; funded by the National Medical Research Council of Singapore), 78 patients with essential hypertension and left ventricular hypertrophy (LVH) were randomized 1:1 to sacubitril/valsartan or valsartan for 52 weeks. Primary endpoint was a change in interstitial volume, assessed using cardiovascular magnetic resonance. Despite similar 24-hour systolic blood pressure at 52 weeks (125 ± 11 vs. 126 ± 11 mmHg; P  = 0.762), sacubitril/valsartan resulted in a greater absolute reduction in interstitial volume compared to valsartan (−5.2 ± 5.4 vs. −2.5 ± 3.1 mL; P  = 0.006). Secondary endpoints showed significant differences favoring sacubitril/valsartan in LV mass, left atrial volume, estimated LV filling pressure, and improved cardiac circulating biomarkers (N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T). Other markers of cardiac volumes, function and mechanics were similar between the two treatment arms. Here we show the potential myocardial benefits of sacubitril/valsartan beyond blood pressure control, though larger studies are needed to confirm their clinical relevance. Here the authors compare the efficacy between sacubitril/valsartan and valsartan in improving diffuse myocardial fibrosis in patients with hypertensive heart disease, assessed as change in interstitial volume with cardiovascular magnetic resonance. The results show potential myocardial benefits of sacubitril/valsartan beyond blood pressure control.

The T Mapping and Extracellular volume (ECV) Standardization (T1MES) program explored T mapping quality assurance using a purpose-developed phantom with Food and Drug Administration (FDA) and Conformité Européenne (CE) regulatory clearance. We report T measurement repeatability across centers describing sequence, magnet, and vendor performance. Phantoms batch-manufactured in August 2015 underwent 2 years of structural imaging, B and B , and \"reference\" slow T testing. Temperature dependency was evaluated by the United States National Institute of Standards and Technology and by the German Physikalisch-Technische Bundesanstalt. Center-specific T mapping repeatability (maximum one scan per week to minimum one per quarter year) was assessed over mean 358 (maximum 1161) days on 34 1.5 T and 22 3 T magnets using multiple T mapping sequences. Image and temperature data were analyzed semi-automatically. Repeatability of serial T was evaluated in terms of coefficient of variation (CoV), and linear mixed models were constructed to study the interplay of some of the known sources of T variation. Over 2 years, phantom gel integrity remained intact (no rips/tears), B and B homogenous, and \"reference\" T stable compared to baseline (% change at 1.5 T, 1.95 ± 1.39%; 3 T, 2.22 ± 1.44%). Per degrees Celsius, 1.5 T, T (MOLLI 5s(3s)3s) increased by 11.4 ms in long native blood tubes and decreased by 1.2 ms in short post-contrast myocardium tubes. Agreement of estimated T times with \"reference\" T was similar across Siemens and Philips CMR systems at both field strengths (adjusted R ranges for both field strengths, 0.99-1.00). Over 1 year, many 1.5 T and 3 T sequences/magnets were repeatable with mean CoVs < 1 and 2% respectively. Repeatability was narrower for 1.5 T over 3 T. Within T1MES repeatability for native T was narrow for several sequences, for example, at 1.5 T, Siemens MOLLI 5s(3s)3s prototype number 448B (mean CoV = 0.27%) and Philips modified Look-Locker inversion recovery (MOLLI) 3s(3s)5s (CoV 0.54%), and at 3 T, Philips MOLLI 3b(3s)5b (CoV 0.33%) and Siemens shortened MOLLI (ShMOLLI) prototype 780C (CoV 0.69%). After adjusting for temperature and field strength, it was found that the T mapping sequence and scanner software version (both P < 0.001 at 1.5 T and 3 T), and to a lesser extent the scanner model (P = 0.011, 1.5 T only), had the greatest influence on T across multiple centers. The T1MES CE/FDA approved phantom is a robust quality assurance device. In a multi-center setting, T mapping had performance differences between field strengths, sequences, scanner software versions, and manufacturers. However, several specific combinations of field strength, sequence, and scanner are highly repeatable, and thus, have potential to provide standardized assessment of T times for clinical use, although temperature correction is required for native T tubes at least.

To assess whether electronic (e-) coaching, using personalized web-based lifestyle and risk factor counselling with additional email prompts, provides additional risk reduction when added to standard of care (SOC) in individuals at increased risk. Between June 2013 and May 2015, 402 participants were allocated 1:1 to e-coaching and SOC versus SOC. Participants free of manifest cardiovascular disease, with internet access, and a 10-year QRISK2 cardiovascular risk of ≥10% were enrolled. Change in oscillometric carotid-femoral pulse wave velocity (PWV) from baseline to six months was the primary endpoint. Secondary outcomes included change in blood pressure (BP), weight, and risk scores. Analysis was by intention to treat. Mean (±SD) age was 65.5 (5.6) years with 37% females. Primary outcome data were available for 94%. There was no difference in PWV reductions between e-coaching and standard of care groups (-0.16 m/s vs. -0.25 m/s, 95% confidence interval -0.39 to 0.22, p = 0.56). There were no differences in the improvement between groups for BP, weight, Framingham, or QRISK2 scores. Pulse wave velocity change was more favorable in those with a higher level of education (p = 0.04), but was not associated with age, gender, presence of diabetes, baseline QRISK2 score, or logins to the website. In individuals at increased cardiovascular risk, a comprehensive 'health check' program modestly reduced future risk. Personalized e-coaching did not provide added risk reduction. Currently there is no evidence to routinely recommend e-coaching in cardiovascular health check programs. HAPPY London ClinicalTrials.gov: NCT01911910.

Background To assess the feasibility of biventricular SAPPHIRE T 1 mapping in vivo across field strengths using diastolic, systolic and dark-blood (DB) approaches. Methods 10 healthy volunteers underwent same-day non-contrast cardiovascular magnetic resonance at 1.5 Tesla (T) and 3 T. Left and right ventricular (LV, RV) T 1 mapping was performed in the basal, mid and apical short axis using 4-variants of SAPPHIRE: diastolic, systolic, 0th and 2nd order motion-sensitized DB and conventional modified Look-Locker inversion recovery (MOLLI). Results LV global myocardial T 1 times (1.5 T then 3 T results) were significantly longer by diastolic SAPPHIRE (1283 ± 11|1600 ± 17 ms) than any of the other SAPPHIRE variants: systolic (1239 ± 9|1595 ± 13 ms), 0th order DB (1241 ± 10|1596 ± 12) and 2nd order DB (1251 ± 11|1560 ± 20 ms, all p  < 0.05). In the mid septum MOLLI and diastolic SAPPHIRE exhibited significant T 1 signal contamination (longer T 1 ) at the blood-myocardial interface not seen with the other 3 SAPPHIRE variants (all p  < 0.025). Additionally, systolic, 0th order and 2nd order DB SAPPHIRE showed narrower dispersion of myocardial T 1 times across the mid septum when compared to diastolic SAPPHIRE (interquartile ranges respectively: 25 ms, 71 ms, 73 ms vs 143 ms, all p  < 0.05). RV T 1 mapping was achievable using systolic, 0th and 2nd order DB SAPPHIRE but not with MOLLI or diastolic SAPPHIRE. All 4 SAPPHIRE variants showed excellent re-read reproducibility (intraclass correlation coefficients 0.953 to 0.996). Conclusion These small-scale preliminary healthy volunteer data suggest that DB SAPPHIRE has the potential to reduce partial volume effects at the blood-myocardial interface, and that systolic SAPPHIRE could be a feasible solution for right ventricular T 1 mapping. Further work is needed to understand the robustness of these sequences and their potential clinical utility.

Dynamic and real-time MRI (rtMRI) of human speech is an active field of research, with interest from both the linguistics and clinical communities. At present, different research groups are investigating a range of rtMRI acquisition and reconstruction approaches to visualise the speech organs. Similar to other moving organs, it is difficult to create a physical phantom of the speech organs to optimise these approaches; therefore, the optimisation requires extensive scanner access and imaging of volunteers. As previously demonstrated in cardiac imaging, realistic numerical phantoms can be useful tools for optimising rtMRI approaches and reduce reliance on scanner access and imaging volunteers. However, currently, no such speech rtMRI phantom exists. In this work, a numerical phantom for optimising speech rtMRI approaches was developed and tested on different reconstruction schemes. The novel phantom comprised a dynamic image series and corresponding k-space data of a single mid-sagittal slice with a temporal resolution of 30 frames per second (fps). The phantom was developed based on images of a volunteer acquired at a frame rate of 10 fps. The creation of the numerical phantom involved the following steps: image acquisition, image enhancement, segmentation, mask optimisation, through-time and spatial interpolation and finally the derived k-space phantom. The phantom was used to: (1) test different k-space sampling schemes (Cartesian, radial and spiral); (2) create lower frame rate acquisitions by simulating segmented k-space acquisitions; (3) simulate parallel imaging reconstructions (SENSE and GRAPPA). This demonstrated how such a numerical phantom could be used to optimise images and test multiple sampling strategies without extensive scanner access.

Background Wave intensity analysis (WIA) in the aorta offers important clinical and mechanistic insights but is difficult non-invasively. We performed WIA by combining high temporal resolution cardiovascular magnetic resonance (CMR) flow velocity and non-invasive central blood pressure (BP) waveform data. Method 206 healthy volunteers (36 ± 11 years, 47% male) underwent sequential phase contrast CMR (Siemens Aera 1.5T, 1.97 × 1.77 mm 2 , ~9 ms temporal resolution) and supra-systolic oscillometric central BP (Uscom Ltd BP+) measurement. Velocity (U) and central pressure (P) waveforms (200 Hz) were aligned using the wave foot, and local wave speed was calculated both from the P-U slope during early systole (c) and the sum of squares method (cSS) ( Figure 1 ), and compared with CMR aortic arch pulse wave velocity (PWV) by transit time. Results The peak intensity of the initial compression wave (dI+1), backward compression wave (dI-) and protodiastolic decompression wave (dI + 2) were 69.5 ± 28, −6.6 ± 4.2 and 6.2 ± 2.5 W/m 2 respectively. PWV correlated with c or cSS (r = 0.60, and 0.68 respectively; bias −1.3 [limits of agreement: −3.8 to 1.2 m/s], and bias −0.64 [limits of agreement: −3.0 to 1.7 m/s] respectively), Figure 1 . Conclusion Wave intensity patterns and values are similar to those measured using invasive methods. Local wave speed showed good agreement with PWV. CMR and central blood pressure provides a novel non-invasive technique for performing wave intensity analysis and is feasible for large scale studies. Figure 1 Calculation of wave speed from a pressure - velocity (P-U) loop and comparison with pulse wave velocity by transit time. Top left : alignment of scaled pressure (blue) and velocity (red) waveforms and example of wave intensity analysis showing initial compression (dl+1), backward compression (dl-)and protodiastolic decompression (dl+2) waves. Top right: P-U loop showing wave speed measurement in early systole ( c ); and using sum of squares ( c SS). Bottom left and Bottom right : Correlation and Bland-Altman analysis of cSS and PWV from phase-contrast MRI showing good correlation and slight underestimation

UK Biobank's ambitious aim is to perform cardiovascular magnetic resonance (CMR) in 100,000 people previously recruited into this prospective cohort study of half a million 40-69 year-olds. We describe the CMR protocol applied in UK Biobank's pilot phase, which will be extended into the main phase with three centres using the same equipment and protocols. The CMR protocol includes white blood CMR (sagittal anatomy, coronary and transverse anatomy), cine CMR (long axis cines, short axis cines of the ventricles, coronal LVOT cine), strain CMR (tagging), flow CMR (aortic valve flow) and parametric CMR (native T1 map). This report will serve as a reference to researchers intending to use the UK Biobank resource or to replicate the UK Biobank cardiovascular magnetic resonance protocol in different settings.

Abstract Rationale Patients with chronic obstructive pulmonary disease develop increased cardiovascular morbidity with structural alterations. Objectives To investigate through a double-blind, placebo-controlled, crossover study the effect of lung deflation on cardiovascular structure and function using cardiac magnetic resonance. Methods Forty-five hyperinflated patients with chronic obstructive pulmonary disease were randomized (1:1) to 7 (maximum 14) days inhaled corticosteroid/long-acting β2-agonist fluticasone furoate/vilanterol 100/25 μg or placebo (7-day minimum washout). Primary outcome was change from baseline in right ventricular end-diastolic volume index versus placebo. Measurements and Main Results There was a 5.8 ml/m2 (95% confidence interval, 2.74–8.91; P < 0.001) increase in change from baseline right ventricular end-diastolic volume index and a 429 ml (P < 0.001) reduction in residual volume with fluticasone furoate/vilanterol versus placebo. Left ventricular end-diastolic and left atrial end-systolic volumes increased by 3.63 ml/m2 (P = 0.002) and 2.33 ml/m2 (P = 0.002). In post hoc analysis, right ventricular stroke volume increased by 4.87 ml/m2 (P = 0.003); right ventricular ejection fraction was unchanged. Left ventricular adaptation was similar; left atrial ejection fraction improved by +3.17% (P < 0.001). Intrinsic myocardial function was unchanged. Pulmonary artery pulsatility increased in two of three locations (main +2.9%, P = 0.001; left +2.67%, P = 0.030). Fluticasone furoate/vilanterol safety profile was similar to placebo. Conclusions Pharmacologic treatment of chronic obstructive pulmonary disease has consistent beneficial and plausible effects on cardiac function and pulmonary vasculature that may contribute to favorable effects of inhaled therapies. Future studies should investigate the effect of prolonged lung deflation on intrinsic myocardial function. Clinical trial registered with www.clinicaltrials.gov (NCT 01691885).