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Title: Established and emerging cardiovascular magnetic resonance imaging techniques in the evaluation of subclinical cardiovascular disease
Author: Fent, Graham John
ISNI:       0000 0004 7225 099X
Awarding Body: University of Leeds
Current Institution: University of Leeds
Date of Award: 2017
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Introduction: Cardiovascular disease (CVD) remains the number one cause of mortality in the world for both men and women, thus improving its diagnosis and treatment is a priority. Rheumatoid Arthritis (RA) is a common auto-immune disease associated with high rates of CVD. Cardiovascular magnetic resonance (CMR) offers a multi-parametric, quantitative approach to the assessment of the heart and cardiovascular system with a host of techniques allowing assessment of anatomy, ventricular function, myocardial composition, myocardial perfusion, vascular performance and myocardial metabolism during a single scan. Its quantitative nature and lack of ionising radiation lend themselves ideally to the longitudinal study of subclinical CVD. Aims: To assess 1) whether blood longitudinal relaxation (T1) can be used to estimate blood haematocrit value to allow calculation of extracellular myocardial volume fraction (ECV), 2) whether CMR feature tracking (CMR-FT) is a feasible means of assessing aortic stiffness, 3) whether global longitudinal strain (GLS) is reduced in patients with prior MI with preserved left ventricular ejection fraction versus healthy controls, 4) whether aortic stiffness is present at all time points in the disease course of RA and 5) whether subclinical CV abnormalities in newly diagnosed RA improve with treatment and if the anti-tumour necrosis α Inhibitor Etanercept offers additional benefit over standard treatment. Methods: Patients were recruited between and February 2011 and February 2017. All patients underwent a comprehensive, multi-parametric CMR study including cine and late Gadolinium enhancement imaging at either 1.5 or 3.0T. Results: 1) estimation of blood haematocrit from blood T1 value provides accurate estimation of ‘synthetic’ ECV, 2) CMR-FT assessment of aortic stiffness is feasible and provides reproducible values for descending and ascending aortic strain values, 3) GLS is reduced in prior MI patients versus healthy controls (-17.3 ± 3.7% versus -19.3 ± 1.9% respectively, p=0.012). A GLS cut-off value of 18% correctly identifies prior MI with a sensitivity of 60% and specificity of 72.5%, 4) Aortic stiffness is evident in at risk RA individuals, newly diagnosed RA as well as established RA and 5) Aortic distensibility and left ventricular mass improve significantly in newly diagnosed RA patients following treatment. Etanercept appears to offer additional benefit over standard treatment evidenced by numerical improvements in aortic distensibility.
Supervisor: Plein, Sven ; Buch, Maya H. ; Greenwood, John P. Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available