Luca Biasiolli

BACKGROUND: Hypertensive pregnancy disorders are associated with long-term adverse cardiac and vascular remodeling postindex pregnancy. The POP-HT trial (Physician Optimised Postpartum Hypertension Treatment) demonstrated that improved puerperal blood pressure control leads to reduced blood pressure and beneficial cardiac remodeling during the first year postpartum. This study describes the impact on postpartum vascular remodeling. METHODS: A prospective, randomized, open-label, blinded end point trial in a single UK hospital where 220 women were assigned 1:1 to intervention (self-management via physician-guided antihypertensive titration) or control (usual postnatal care via primary care doctor±midwife). Eligible participants were ≥18 years, with preeclampsia or gestational hypertension and requiring antihypertensives on discharge. Prespecified secondary vascular outcomes included aortic blood pressure and pulse wave velocity measured by Vicorder at baseline and 9 months postpartum, and additional cardiovascular magnetic resonance measures of aortic distensibility were performed. RESULTS: There were no baseline differences in aortic blood pressure or pulse wave velocity but by 9 months postpartum, aortic diastolic blood pressure was −5.2 mm Hg lower ([95% CI, −8.0 to −2.2]; P P =0.048) in the intervention arm compared with the control arm, which corresponded with greater aortic distensibility by 0.78×10 ^{− 3} mm Hg ^{− 1} ([95% CI, −0.01 to 1.55]; P =0.046). CONCLUSIONS: Postpartum blood pressure self-monitoring combined with physician-guided medication titration is associated with reduced central arterial stiffness during the first year after a hypertensive pregnancy, in addition to the previously demonstrated effects on blood pressure and cardiac remodeling. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04273854.

Background: People born preterm (2 , 95% CI: 2.60,8.47, interaction term p=0.076) for those in the exercise intervention group versus controls. No significant effects were observed for cardiac structural indices in preterm-born participants. In preterm-born participants, LV basal- and mid-ventricular circumferential strain increased (adjusted mean difference: -1.33, 95% CI: -2.07,-0.60, interaction term p=0.057 and adjusted mean difference: -1.54, 95% CI: -2.46,-0.63, interaction term p=0.046, respectively) and RV global longitudinal strain increased (adjusted mean difference=-1.99%, 95% CI=-3.12,-0.87, interaction p=0.053) for those in the exercise intervention group versus controls. No significant effects were observed for myocardial deformation parameters in term-born participants. Conclusions: Aerobic exercise training induces improved myocardial function but not cardiac structure in preterm-born adults.

Background: Accurate assessment of plaque accumulation near the carotid bifurcation is important for the effective prevention and treatment of stroke. However, vessel and plaque delineation using MRI can be limited by low contrast-to-noise ratio (CNR) and long acquisition times. In this work, a 10-channel phased-array receive coil design for bilateral imaging of the carotid bifurcation using 3T MRI is proposed. Methods: The proposed 10-channel receive coil was compared to a commercial 4-channel receive coil configuration using data acquired from phantoms and healthy volunteers (N = 9). The relative performance of the coils was assessed, by comparing signal-to-noise ratio (SNR), noise correlation, g-factor noise amplification, and the CNR between vessel wall and lumen using black-blood sequences. Patient data were acquired from 12 atherosclerotic carotid artery disease patients. Results: The 10-channel coil consistently provided substantially increased SNR in phantoms (+77 ± 27%) and improved CNR in healthy carotid arteries (+62 ± 11%), or reduced g-factor noise amplification. Patient data showed excellent delineation of atherosclerotic plaque along the length of the carotid bifurcation using the 10-channel coil. Conclusions: The proposed 10-channel coil design allows for improved visualization of the carotid arteries and the carotid bifurcation and increased parallel imaging acceleration factors relative to a commercial 4-channel coil design.

Background Accurate assessment of plaque accumulation near the carotid bifurcation is important for the effective prevention and treatment of stroke. However, vessel and plaque delineation using MRI can be limited by low contrast-to-noise ratio (CNR) and long acquisition times. In this work, a novel 10-channel phased-array receive coil design for bilateral imaging of the carotid bifurcation using 3T MRI is proposed. Methods The novel 10-channel receive coil was compared to a commercial 4-channel receive coil configuration using data acquired from phantoms and healthy volunteers (N = 9). The relative performance of the coils was assessed, by comparing signal-to-noise ratio (SNR), g-factor noise amplification, and the CNR between vessel wall and lumen using black-blood sequences. Patient data were acquired from 12 atherosclerotic carotid artery disease patients. Results The 10-channel coil consistently provided substantially increased SNR in phantoms (+88 ± 2%) and improved CNR in healthy carotid arteries (+62 ± 11%), or reduced g-factor noise amplification. Patient data showed excellent delineation of atherosclerotic plaque along the length of the carotid bifurcation using the 10-channel coil. Conclusions The proposed 10-channel coil design allows for improved visualization of the carotid arteries and the carotid bifurcation and increased parallel imaging acceleration factors.

Existing evidence suggests links between brain and cardiovascular health. We investigated associations between cognitive performance and cardiovascular magnetic resonance (CMR) phenotypes in the UK Biobank, considering a range of potential confounders. We studied 29 763 participants with CMR and cognitive testing, specifically, fluid intelligence (FI, 13 verbal-numeric reasoning questions), and reaction time (RT, a timed pairs matching exercise); both were considered continuous variables for modelling. We included the following CMR metrics: left and right ventricular (LV and RV) volumes in end-diastole and end-systole, LV/RV ejection fractions, LV/RV stroke volumes, LV mass, and aortic distensibility. Multivariable linear regression models were used to estimate the association of each CMR measure with FI and RT, adjusting for age, sex, smoking, education, deprivation, diabetes, hypertension, high cholesterol, prior myocardial infarction, alcohol intake, and exercise level. We report standardized beta-coefficients, 95% confidence intervals, and P-values adjusted for multiple testing. In this predominantly healthy cohort (average age 63.0 ± 7.5 years), better cognitive performance (higher FI, lower RT) was associated with larger LV/RV volumes, higher LV/RV stroke volumes, greater LV mass, and greater aortic distensibility in fully adjusted models. There was some evidence of non-linearity in the relationship between FI and LV end-systolic volume, with reversal of the direction of association at very high volumes. Associations were consistent for men and women and in different ages. Better cognitive performance is associated with CMR measures likely representing a healthier cardiovascular phenotype. These relationships remained significant after adjustment for a range of cardiometabolic, lifestyle, and demographic factors, suggesting possible involvement of alternative disease mechanisms.

Kidney donation reduces renal function by ≈30% allowing study of the cardiovascular effects of a reduced estimated glomerular filtration rate without comorbidities. We report 5-year results of a longitudinal, parallel-group, blinded end-point study of living kidney donors (n=50) and healthy controls (n=45). The primary end point, left ventricular mass, was measured using cardiac magnetic resonance. Secondary end points, 24-hour ambulatory blood pressure, and pulse wave velocity were measured using validated blood pressure monitors and the SphygmoCor device. Effect sizes were calculated as differences between change from baseline in the donor and control groups. In donors, estimated glomerular filtration rate was 95±15 mL/min per 1.73 m2 at baseline (predonation) and 67±14 mL/min per 1.73 m2 at 5 years. In controls, there was a −1±2 mL/min per 1.73 m2 decline per annum. Change in left ventricular mass at 5 years was not significantly different between donors and controls (mean difference, +0.40 g [95% CI, −4.68 to 5.49] P =0.876), despite an initial increase in mass in donors compared with controls at 12 months. Pulse wave velocity, which increased in donors at 12 months, returned to levels not different from controls at 5 years (mean difference, −0.24 m/s [95% CI, −0.69 to 0.21]). Change in ambulatory systolic blood pressure was not different in donors compared with controls (mean difference, +1.91 mm Hg [95% CI, −2.72 to 6.54]). We found no evidence that the reduction in estimated glomerular filtration rate after kidney donation was associated with a change in left ventricular mass detectable by magnetic resonance imaging at 5 years.

Osteoporosis and ischemic heart disease (IHD) represent important public health problems. Existing research suggests an association between the two conditions beyond that attributable to shared risk factors, with a potentially causal relationship. In this study, we tested the association of bone speed of sound (SOS) from quantitative heel ultrasound with (i) measures of arterial compliance from cardiovascular magnetic resonance (aortic distensibility [AD]); (ii) finger photoplethysmography (arterial stiffness index [ASI]); and (iii) incident myocardial infarction and IHD mortality in the UK Biobank cohort. We considered the potential mediating effect of a range of blood biomarkers and cardiometabolic morbidities and evaluated differential relationships by sex, menopause status, smoking, diabetes, and obesity. Furthermore, we considered whether associations with arterial compliance explained association of SOS with ischemic cardiovascular outcomes. Higher SOS was associated with lower arterial compliance by both ASI and AD for both men and women. The relationship was most consistent with ASI, likely relating to larger sample size available for this variable (n = 159,542 versus n = 18,229). There was no clear evidence of differential relationship by menopause, smoking, diabetes, or body mass index (BMI). Blood biomarkers appeared important in mediating the association for both men and women, but with different directions of effect and did not fully explain the observed effects. In fully adjusted models, higher SOS was associated with significantly lower IHD mortality in men, but less robustly in women. The association of SOS with ASI did not explain this observation. In conclusion, our findings support a positive association between bone and vascular health with consistent patterns of association in men and women. The underlying mechanisms are complex and appear to vary by sex. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Purpose To assess whether artifacts in multi‐slice multi‐echo spin echo neck imaging, thought to be caused by brief motion events such as swallowing, can be corrected by reacquiring corrupted central k‐space data and estimating the remainder with parallel imaging. Methods A single phase‐encode line (k_y = 0, phase‐encode direction anteroposterior) navigator echo was used to identify motion‐corrupted data and guide the online reacquisition. If motion corruption was detected in the 7 central k‐space lines, they were replaced with reacquired data. Subsequently, GRAPPA reconstruction was trained on the updated central portion of k‐space and then used to estimate the remaining motion‐corrupted k‐space data from surrounding uncorrupted data. Similar compressed sensing‐based approaches have been used previously to compensate for respiration in cardiac imaging. The g‐factor noise amplification was calculated for the parallel imaging reconstruction of data acquired with a 10‐channel neck coil. The method was assessed in scans with 9 volunteers and 12 patients. Results The g‐factor analysis showed that GRAPPA reconstruction of 2 adjacent motion‐corrupted lines causes high noise amplification; therefore, the number of 2‐line estimations should be limited. In volunteer scans, median ghosting reduction of 24% was achieved with 2 adjacent motion‐corrupted lines correction, and image quality was improved in 2 patient scans that had motion corruption close to the center of k‐space. Conclusion Motion‐corrupted echo‐trains can be identified with a navigator echo. Combined reacquisition and parallel imaging estimation reduced motion artifacts in multi‐slice MESE when there were brief motion events, especially when motion corruption was close to the center of k‐space.