Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender

This work was funded by a grant from the Engineering and Physical Sciences Research Council (EP/G030693/1) and supported by the Oxford British Heart Foundation Centre of Research Excellence and the National Institute for Health Research Oxford Biomedical Research Centr

From gene to epigene-based therapies targeting the vascular endothelium.

Vascular endothelial dysfunction is a key biological process underlying the development of cardiovascular disease and therefore of potential importance as a target for gene-based therapy. Modification of nitric oxide bioavailability through gene therapy is possible in animal studies and of clinical relevance because of the central role for nitric oxide in vascular homeostasis. However, most clinical trials have so far focused on endothelial-related pathways, in particular, vascular endothelial growth factor, to induce angiogenesis, with variable results. The slow progress of the development of gene-therapy targeted at the endothelium relates to a range of complexities of design of therapy including mode of gene delivery. This is usually achieved through the use of viral or non-viral vectors but the best physical and vector methods for delivery of complimentary DNA to the vascular endothelium remains under investigation. More recently there has been emerging interest into other genome-based methods to alter vascular phenotype, in particular, gene-based modification of endothelial progenitor cell function and whether gene function might be modifiable through induced epigenetic changes

Computational mesh as a descriptor of left ventricular shape for clinical diagnosis

Shape and size of the left ventricle are cardiac biomarkers used in clinical routine practice. They are typically assessed by partial metrics including volume, length, diameter or wall thickness. The aim of this work is to illustrate the potential of an alternative shape analysis methodology based on a comprehensive description of the anatomy using a computational atlas. 40 cardiovascular magnetic resonance scans of young women defined the cohort data set. A stack of 7 to 8 slices from end diastolic frames of dynamic MRI studies were analysed by manual segmentation and automatic personalization of high order computational meshes. The most significant modes of variation of shape of this population were identified by principal component analysis. Statistical significant differences in shape were found in women with higher cardiovascular risk profiles (P<0.05, Hotelling T2 test). The analysis revealed differences in the position of the apex in the left to right direction, which had not been captured by standard clinical parameters. These results show computational statistical atlases may offer the potential to improve stratification of cardiac diseases. © 2013 CCAL

Prevention of vascular dysfunction after preeclampsia: a potential long-term outcome measure and an emerging goal for treatment.

Preeclampsia is increasingly being recognised as more than an isolated disease of pregnancy. In particular, preeclampsia has emerged as an independent risk factor for maternal cardiovascular disease and has recently been recognised as a risk factor for cardiovascular disease in children exposed in utero. Preeclampsia and cardiovascular disease may share important pathophysiological and molecular mechanisms and further investigation into these is likely to offer insight into the origins of both conditions. This paper considers the links between cardiovascular disease and preeclampsia and the implication of these findings for refinement of the management of patients whose care is complicated by preeclampsia

Impaired endothelial responses in apparently healthy young people associated with subclinical variation in blood pressure and cardiovascular phenotype

Background A phenomenon of endothelial impairment, independent of classical cardiovascular risk factors, has been observed in young people. We identified subjects with persistently reduced, or declining, endothelial function during adolescence and early adulthood, without apparent cardiovascular risk, and investigated the clinical relevance of this finding.MethodsEndothelial vasomotor responses were assessed by brachial artery flow-mediated dilatation (FMD) at age 15 years in 47 subjects (22 males) who returned for a repeated measurement at age 25. Subjects underwent quantification of left ventricular mass (LVM) and function by cardiovascular magnetic resonance, central arterial stiffness by applanation tonometry, and common carotid artery intima-media thickness using ultrasound on their visit at age 25. Results Individuals with low average FMD over 10-year period, although normotensive, had 5 mm Hg higher systolic blood pressure and, significantly greater LVM (73.48 ± 7.73 vs. 56.25 ± 9.54 g/m 2, P = 0.0001), carotid intima-media thickness (cIMT) (0.53 ± 0.06 vs. 0.47 ± 0.04 mm, P = 0.03), and pulse wave velocity (5.97 ± 0.63 vs. 5.29 ± 0.59 m/s, P = 0.02) than those with higher endothelial responses. Subjects with the greatest decline in FMD over 10 years had a significant increase in mean arterial pressure but similar cardiovascular phenotype. Conclusion Persistently reduced, or declining, endothelial function during adolescence, in the absence of overt cardiovascular disease, is a sensitive early marker associated with subclinical changes in blood pressure (BP) and an adverse cardiovascular phenotype. The findings highlight the potential importance of endothelial responses during adolescence in primary prevention strategies for hypertension