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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Automatic Measurement of the Myocardial Interstitium Synthetic Extracellular Volume Quantification Without Hematocrit Sampling
JACC: Cardiovascular Imaging, Volume 9, No. 1, Year 2016
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Description
Objectives The authors sought to generate a synthetic extracellular volume fraction (ECV) from the relationship between hematocrit and longitudinal relaxation rate of blood. Background ECV quantification by cardiac magnetic resonance (CMR) measures diagnostically and prognostically relevant changes in the extracellular space. Current methodologies require blood hematocrit (Hct) measurement - a complication to easy clinical application. We hypothesized that the relationship between Hct and longitudinal relaxation rate of blood (R1 = 1/T1blood) could be calibrated and used to generate a synthetic ECV without Hct that was valid, user-friendly, and prognostic. Methods Proof-of-concept: 427 subjects with a wide range of health and disease were divided into derivation (n = 214) and validation (n = 213) cohorts. Histology cohort: 18 patients with severe aortic stenosis with histology obtained during valve replacement. Outcome cohort: For comparison with external outcome data, we applied synthetic ECV to 1,172 consecutive patients (median follow-up 1.7 years; 74 deaths). All underwent CMR scanning at 1.5-T with ECV calculation from pre- and post-contrast T1 (blood and myocardium) and venous Hct. Results Proof-of-concept: In the derivation cohort, native R1blood and Hct showed a linear relationship (R2 = 0.51; p < 0.001), which was used to create synthetic Hct and ECV. Synthetic ECV correlated well with conventional ECV (R2 = 0.97; p < 0.001) without bias. These results were maintained in the validation cohort. Histology cohort: Synthetic and conventional ECV both correlated well with collagen volume fraction measured from histology (R2 = 0.61 and 0.69, both p < 0.001) with no statistical difference (p = 0.70). Outcome cohort: Synthetic ECV related to all-cause mortality (hazard ratio 1.90; 95% confidence interval 1.55 to 2.31; for every 5% increase in ECV). Finally, we engineered a synthetic ECV tool, generating automatic ECV maps during image acquisition. Conclusions Synthetic ECV provides validated noninvasive quantification of the myocardial extracellular space without blood sampling and is associated with cardiovascular outcomes. © 2016 American College of Cardiology Foundation.
Authors & Co-Authors
Treibel, Thomas Alexander
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
United Kingdom, London
University College London
Fontana, Marianna
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
United Kingdom, London
University College London
Castelletti, Silvia
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
United Kingdom, London
University College London
Bhuva, Anish N.
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
United Kingdom, London
University College London
Bulluck, Heerajnarain
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
United Kingdom, London
University College London
Abdel-Gadir, Amna
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
United Kingdom, London
University College London
Manisty, Charlotte H.
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
United Kingdom, London
University College London
Spottiswoode, Bruce S.
Unknown Affiliation
Piechnik, Stefan Kazimierz
United Kingdom, Oxford
John Radcliffe Hospital
Robson, Matthew D.
United Kingdom, Oxford
John Radcliffe Hospital
Schelbert, Erik B.
United States, Pittsburgh
University of Pittsburgh
Statistics
Citations: 110
Authors: 11
Affiliations: 6
Identifiers
Doi:
10.1016/j.jcmg.2015.11.008
ISSN:
1936878X
Research Areas
Environmental
Noncommunicable Diseases
Study Design
Cohort Study