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  • 1
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    The Interfield Strength Agreement of Left Ventricular Strain Measurements at 1. 5 T and 3 T Using Cardiac MRI Feature Tracking
    Wiley ; 2023
    In:  Journal of Magnetic Resonance Imaging Vol. 57, No. 4 ( 2023-04), p. 1250-1261
    Details
    In: Journal of Magnetic Resonance Imaging, Wiley, Vol. 57, No. 4 ( 2023-04), p. 1250-1261
    Abstract: Left ventricular (LV) strain measurements can be derived using cardiac MRI from routinely acquired balanced steady‐state free precession (bSSFP) cine images. Purpose To compare the interfield strength agreement of global systolic strain, peak strain rates and artificial intelligence (AI) landmark‐based global longitudinal shortening at 1.5 T and 3 T. Study Type Prospective. Subjects A total of 22 healthy individuals (mean age 36 ± 12 years; 45% male) completed two cardiac MRI scans at 1.5 T and 3 T in a randomized order within 30 minutes. Field Strength/Sequence bSSFP cine images at 1.5 T and 3 T. Assessment Two software packages, Tissue Tracking (cvi42, Circle Cardiovascular Imaging) and QStrain (Medis Suite, Medis Medical Imaging Systems), were used to derive LV global systolic strain in the longitudinal, circumferential and radial directions and peak (systolic, early diastolic, and late diastolic) strain rates. Global longitudinal shortening and mitral annular plane systolic excursion (MAPSE) were measured using an AI deep neural network model. Statistical Tests Comparisons between field strengths were performed using Wilcoxon signed‐rank test ( P value  〈  0.05 considered statistically significant). Agreement was determined using intraclass correlation coefficients (ICCs) and Bland–Altman plots. Results Minimal bias was seen in all strain and strain rate measurements between field strengths. Using Tissue Tracking, strain and strain rate values derived from long‐axis images showed poor to fair agreement (ICC range 0.39–0.71), whereas global longitudinal shortening and MAPSE showed good agreement (ICC = 0.81 and 0.80, respectively). Measures derived from short‐axis images showed good to excellent agreement (ICC range 0.78–0.91). Similar results for the agreement of strain and strain rate measurements were observed with QStrain. Conclusion The interfield strength agreement of short‐axis derived LV strain and strain rate measurements at 1.5 T and 3 T was better than those derived from long‐axis images; however, the agreement of global longitudinal shortening and MAPSE was good. Evidence Level 2 Technical Efficacy Stage 2
    Type of Medium: Online Resource
    ISSN: 1053-1807 , 1522-2586
    URL: Issue
    URL: Article
    DOI: 10.1002/jmri.v57.4
    DOI: 10.1002/jmri.28328
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 2
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    Fibro‐inflammatory recovery and type 2 diabetes remission following a low calorie diet but not exercise training: A secondary analysis of the DIASTOLIC randomised controlled trial
    Wiley ; 2022
    In:  Diabetic Medicine Vol. 39, No. 8 ( 2022-08)
    Details
    In: Diabetic Medicine, Wiley, Vol. 39, No. 8 ( 2022-08)
    Abstract: To investigate the relationship between fibro‐inflammatory biomarkers and cardiovascular structure/function in people with Type 2 Diabetes (T2D) compared to healthy controls and the effect of two lifestyle interventions in T2D. Methods Data were derived from the DIASTOLIC randomised controlled trial (RCT) and includes a comparison between those with T2D and the matched healthy volunteers recruited at baseline. Adults with T2D without cardiovascular disease (CVD) were randomized to a 12‐week intervention either: (1) exercise training, (2) a low‐energy (∼810 kcal/day) meal‐replacement plan (MRP) or (3) standard care. Principal Component and Fisher's linear discriminant analysis were used to investigate the relationships between MRI acquired cardiovascular outcomes and fibro‐inflammatory biomarkers in cases versus controls and pre‐ and post‐intervention in T2D. Results At baseline, 83 people with T2D (mean age 50.5 ± 6.4; 58% male) and 36 healthy controls (mean age 48.6 ± 6.2; 53% male) were compared and 76 people with T2D completed the RCT for pre‐ post‐analysis. Compared to healthy controls, subjects with T2D had adverse cardiovascular remodelling and a fibro‐inflammatory profile (20 differentially expressed biomarkers). The 3D data visualisations showed almost complete separation between healthy controls and those with T2D, and a marked shift towards healthy controls following the MRP (15 biomarkers significantly changed) but not exercise training. Conclusions Fibro‐inflammatory pathways and cardiovascular structure/function are adversely altered before the onset of symptomatic CVD in middle‐aged adults with T2D. The MRP improved the fibro‐inflammatory profile of people with T2D towards a more healthy status. Long‐term studies are required to assess whether these changes lead to continued reverse cardiac remodelling and prevent CVD.
    Type of Medium: Online Resource
    ISSN: 0742-3071 , 1464-5491
    URL: Issue
    URL: Article
    DOI: 10.1111/dme.v39.8
    DOI: 10.1111/dme.14884
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2019647-7
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  • 3
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    A randomized, open‐label, active comparator trial assessing the effects of 26 weeks of liraglutide or sitagliptin on cardiovascular function in young obese adults with type 2 diabetes
    Wiley ; 2020
    In:  Diabetes, Obesity and Metabolism Vol. 22, No. 7 ( 2020-07), p. 1187-1196
    Details
    In: Diabetes, Obesity and Metabolism, Wiley, Vol. 22, No. 7 ( 2020-07), p. 1187-1196
    Abstract: To compare the effects of a glucagon‐like peptide‐1 receptor agonist and a dipeptidyl peptidase‐4 inhibitor on magnetic resonance imaging‐derived measures of cardiovascular function. Materials and methods In a prospective, randomized, open‐label, blinded endpoint trial liraglutide (1.8 mg) and sitagliptin (100 mg) were compared in asymptomatic, non‐insulin treated young (aged 18‐50 years) adults with obesity and type 2 diabetes. The primary outcome was difference in circumferential peak early diastolic strain rate change (PEDSR), a biomarker of cardiac diastolic dysfunction 26 weeks after randomization. Secondary outcomes included other indices of cardiac structure and function, HbA1c and body weight. Results Seventy‐six participants were randomized (54% female, mean ± SD age 44 ± 6 years, diabetes duration 4.4 years, body mass index 35.3 ± 6.1 kg m −2 ), of whom 65% had ≥1 cardiovascular risk factor. Sixty‐one participants had primary outcome data available. There were no statistically significant between‐group differences (intention‐to‐treat; mean [95% confidence interval]) in PEDSR change (−0.01 [−0.07, +0.06] s −1 ), left ventricular ejection fraction (−1.98 [−4.90, +0.94]%), left ventricular mass (+1.14 [−5.23, +7.50] g) or aortic distensibility (−0.35 [−0.98, +0.28] mmHg −1  × 10 −3 ) after 26 weeks. Reductions in HbA1c (−4.57 [−9.10, −0.37] mmol mol −1 ) and body weight (−3.88 [−5.74, −2.01] kg) were greater with liraglutide. Conclusion There were no differences in cardiovascular structure or function after short‐term use of liraglutide and sitagliptin in younger adults with obesity and type 2 diabetes. Longer studies in patients with more severe cardiac dysfunction may be necessary before definitive conclusions can be made about putative pleiotropic properties of incretin‐based therapies.
    Type of Medium: Online Resource
    ISSN: 1462-8902 , 1463-1326
    URL: Issue
    URL: Article
    DOI: 10.1111/dom.v22.7
    DOI: 10.1111/dom.14023
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2004918-3
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  • 4
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    Effects of liraglutide versus sitagliptin on circulating cardiovascular biomarkers, including circulating progenitor cells, in individuals with type 2 diabetes and obesity: Analyses from the LYDIA trial
    Wiley ; 2021
    In:  Diabetes, Obesity and Metabolism Vol. 23, No. 6 ( 2021-06), p. 1409-1414
    Details
    In: Diabetes, Obesity and Metabolism, Wiley, Vol. 23, No. 6 ( 2021-06), p. 1409-1414
    Abstract: The mechanisms behind the beneficial cardiovascular effects of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) compared with dipeptidyl peptidase‐4 inhibitors (DPP4is) remain largely unknown, despite both targeting the incretin pathway to improve glycaemic control. In these prespecified secondary analyses of the LYDIA trial, we examined the impact of the GLP‐1RA liraglutide (1.8 mg once‐daily) and the DPP4i sitagliptin (100 mg once‐daily) on circulating cardiovascular biomarkers associated with atherosclerotic risk, including circulating progenitor cells (CPCs). LYDIA was a 26‐week, randomized, active‐comparator trial in 61 adults with type 2 diabetes and obesity (mean ± SD: age 43.8 ± 6.5 years, body mass index 35.3 ± 6.4 kg/m 2 , HbA1c 7.5% ± 0.83% [58.5 ± 9.1 mmol/mol]). Vascular endothelial growth factor (VEGF) and stromal cell‐derived factor‐1‐alpha (SDF‐1ɑ), both of which are implicated in endothelial function, were higher at 26 weeks with liraglutide therapy compared with sitagliptin (mean between‐group difference [95% CI] : 77.03 [18.29, 135.77] pg/mL, p = .010; and 996.25 [818.85, 1173.64] pg/mL, p 〈  .001, respectively). There were no between‐group differences in CPCs, nitric oxide, C‐reactive protein, interleukin‐6, tumour necrosis factor alpha and advanced glycation end‐products. These analyses suggest a favourable impact of liraglutide on VEGF and SDF‐1ɑ levels compared with sitagliptin. These factors may therefore be implicated in the differential cardiovascular effects observed between these agents in large cardiovascular outcome trials. However, these are secondary analyses from a previous trial and thus hypothesis‐generating. Purposive trials are required to examine these findings further.
    Type of Medium: Online Resource
    ISSN: 1462-8902 , 1463-1326
    URL: Issue
    URL: Article
    DOI: 10.1111/dom.v23.6
    DOI: 10.1111/dom.14343
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2004918-3
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  • 5
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    Intertechnique agreement and interstudy reproducibility of strain and diastolic strain rate at 1.5 and 3 tesla: A comparison of feature‐tracking and tagging in patients with aortic stenosis
    Wiley ; 2015
    In:  Journal of Magnetic Resonance Imaging Vol. 41, No. 4 ( 2015-04), p. 1129-1137
    Details
    In: Journal of Magnetic Resonance Imaging, Wiley, Vol. 41, No. 4 ( 2015-04), p. 1129-1137
    Abstract: To determine the interstudy reproducibility of myocardial strain and peak early‐diastolic strain rate (PEDSR) measurement on cardiovascular magnetic resonance imaging (MRI) assessed with feature tracking (FT) and tagging, in patients with aortic stenosis (AS). Materials and Methods Cardiac MRI was performed twice (1–14 days apart) in 18 patients (8 at 1.5 Tesla [T], 10 at 3T) with moderate–severe AS. Circumferential peak systolic strain (PSS) and PEDSR were measured in all patients. Longitudinal PSS and PEDSR were assessed using FT in all patients, and tagging in the 3T sub‐group. Results PSS was higher with FT than tagging (21.0 ± 1.9% versus 17.0 ± 3.4% at 1.5T, 21.4 ± 4.0% versus 17.7 ± 3.0% at 3T, P 〈 0.05), as was PEDSR (1.3 ± 0.3 s −1 versus 1.0 ± 0.3 s −1 , P = 0.10 at 1.5T and 1.3 ± 0.4 s −1 versus 0.8 ± 0.3 s −1 , P 〈 0.05 at 3T). The reproducibility of PSS was excellent with FT (coefficient of variation [CoV] 9–10%) and good with tagging at 1.5T (13–19%). Reproducibility of circumferential PEDSR was best at 1.5T when only basal/mid slices were included (CoV 12%), but moderate to poor at 3T (29–35%). Reproducibility of longitudinal strain was good with FT (10–16%) but moderate for PEDSR (∼30%). Conclusion In patients with AS, FT consistently produces higher values compared with tagging. The interstudy reproducibility of PSS is excellent with FT and good with tagging. The reproducibility of circumferential PEDSR at 1.5T is good when only basal and mid slices are used. J. Magn. Reson. Imaging 2015;41:1129–1137 . © 2014 Wiley Periodicals, Inc .
    Type of Medium: Online Resource
    ISSN: 1053-1807 , 1522-2586
    URL: Issue
    URL: Article
    DOI: 10.1002/jmri.v41.4
    DOI: 10.1002/jmri.24625
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 6
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    Implementable Deep Learning for Multi‐sequence Proton MRI Lung Segmentation: A Multi‐center, Multi‐vendor, and Multi‐disease Study
    Wiley ; 2023
    In:  Journal of Magnetic Resonance Imaging Vol. 58, No. 4 ( 2023-10), p. 1030-1044
    Details
    In: Journal of Magnetic Resonance Imaging, Wiley, Vol. 58, No. 4 ( 2023-10), p. 1030-1044
    Abstract: Recently, deep learning via convolutional neural networks (CNNs) has largely superseded conventional methods for proton ( 1 H)‐MRI lung segmentation. However, previous deep learning studies have utilized single‐center data and limited acquisition parameters. Purpose Develop a generalizable CNN for lung segmentation in 1 H‐MRI, robust to pathology, acquisition protocol, vendor, and center. Study type Retrospective. Population A total of 809 1 H‐MRI scans from 258 participants with various pulmonary pathologies (median age (range): 57 (6–85); 42% females) and 31 healthy participants (median age (range): 34 (23–76); 34% females) that were split into training (593 scans (74%); 157 participants (55%)), testing (50 scans (6%); 50 participants (17%)) and external validation (164 scans (20%); 82 participants (28%)) sets. Field Strength/Sequence 1.5‐T and 3‐T / 3D spoiled‐gradient recalled and ultrashort echo‐time 1 H‐MRI . Assessment 2D and 3D CNNs, trained on single‐center, multi‐sequence data, and the conventional spatial fuzzy c‐means (SFCM) method were compared to manually delineated expert segmentations. Each method was validated on external data originating from several centers. Dice similarity coefficient (DSC), average boundary Hausdorff distance (Average HD), and relative error (XOR) metrics to assess segmentation performance. Statistical Tests Kruskal–Wallis tests assessed significances of differences between acquisitions in the testing set. Friedman tests with post hoc multiple comparisons assessed differences between the 2D CNN, 3D CNN, and SFCM. Bland–Altman analyses assessed agreement with manually derived lung volumes. A P value of 〈 0.05 was considered statistically significant. Results The 3D CNN significantly outperformed its 2D analog and SFCM, yielding a median (range) DSC of 0.961 (0.880–0.987), Average HD of 1.63 mm (0.65–5.45) and XOR of 0.079 (0.025–0.240) on the testing set and a DSC of 0.973 (0.866–0.987), Average HD of 1.11 mm (0.47–8.13) and XOR of 0.054 (0.026–0.255) on external validation data. Data Conclusion The 3D CNN generated accurate 1 H‐MRI lung segmentations on a heterogenous dataset, demonstrating robustness to disease pathology, sequence, vendor, and center. Evidence Level 4. Technical Efficacy Stage 1.
    Type of Medium: Online Resource
    ISSN: 1053-1807 , 1522-2586
    URL: Issue
    URL: Article
    DOI: 10.1002/jmri.v58.4
    DOI: 10.1002/jmri.28643
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 7
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    A systematic review of micro‐RNAs in aortic stenosis and cardiac fibrosis
    Wiley ; 2022
    In:  Clinical and Translational Science Vol. 15, No. 8 ( 2022-08), p. 1809-1817
    Details
    In: Clinical and Translational Science, Wiley, Vol. 15, No. 8 ( 2022-08), p. 1809-1817
    Abstract: Aortic stenosis (AS) is the commonest valve lesion requiring surgery in the Western world. The presence of myocardial fibrosis is associated with mortality even after valve replacement. MicroRNAs could serve as biomarkers of fibrosis and risk stratify patients for earlier intervention. This study aimed to systematically review reports of micro‐RNA (miR) associated with fibrosis in AS and identify potential biomarkers. We searched EMBASE, Medline, and Web of Science up to May 2020. Studies that reported on the role of miRs in AS and cardiac fibrosis were included. Study quality was assessed using the Newcastle‐Ottawa scale. Of 4230 reports screened, 25 were included. All studies were of low to moderate quality. MiRs were analyzed in myocardial tissue ( n  = 10), aortic valve tissue ( n  = 5), plasma ( n  = 5), and serum ( n  = 5). A total of 365 miRs were reported, of which only a few were reported in more than one paper (3 in the myocardium, 5 in the aortic valve, and 1 in plasma). miR‐21 was upregulated in plasma and myocardial tissue. MiR‐19b was downregulated in the myocardium. Papers reporting myocardial miR‐1 contradicted each other, and miR‐133a was associated with increased left ventricular mass regression post‐surgery. In the aortic valve, miRs‐665, 602 and 939 were downregulated, and miRs‐193b and 214 were upregulated. The data on miR in fibrosis in AS is scarce and of low to moderate quality. Further studies are needed to identify novel miRs as biomarkers, especially at an earlier asymptomatic phase of the disease.
    Type of Medium: Online Resource
    ISSN: 1752-8054 , 1752-8062
    URL: Issue
    URL: Article
    DOI: 10.1111/cts.v15.8
    DOI: 10.1111/cts.13303
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2433157-0
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  • 8
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    An attention‐based deep learning method for right ventricular quantification using 2D echocardiography: Feasibility and accuracy
    Wiley ; 2024
    In:  Echocardiography Vol. 41, No. 1 ( 2024-01)
    Details
    In: Echocardiography, Wiley, Vol. 41, No. 1 ( 2024-01)
    Abstract: To test the feasibility and accuracy of a new attention‐based deep learning (DL) method for right ventricular (RV) quantification using 2D echocardiography (2DE) with cardiac magnetic resonance imaging (CMR) as reference. Methods and Results We retrospectively analyzed images from 50 adult patients (median age 51, interquartile range 32–62 42% women) who had undergone CMR within 1 month of 2DE. RV planimetry of the myocardial border was performed in end‐diastole (ED) and end‐systole (ES) for eight standardized 2DE RV views with calculation of areas. The DL model comprised a Feature Tokenizer module and a stack of Transformer layers. Age, gender and calculated areas were used as inputs, and the output was RV volume in ED/ES. The dataset was randomly split into training, validation and testing subsets (35, 5 and 10 patients respectively). Mean RVEDV, RVESV and RV ejection fraction (EF) were 163 ± 70 mL, 82 ± 42 mL and 51% ± 8% respectively without differences among the subsets. The proposed method achieved good prediction of RV volumes (R 2  = .953, absolute percentage error [APE] = 9.75% ± 6.23%) and RVEF (APE = 7.24% ± 4.55%). Per CMR, there was one patient with RV dilatation and three with RV dysfunction in the testing dataset. The DL model detected RV dilatation in 1/1 case and RV dysfunction in 4/3 cases. Conclusions An attention‐based DL method for 2DE RV quantification showed feasibility and promising accuracy. The method requires validation in larger cohorts with wider range of RV size and function. Further research will focus on the reduction of the number of required 2DE to make the method clinically applicable.
    Type of Medium: Online Resource
    ISSN: 0742-2822 , 1540-8175
    URL: Issue
    URL: Article
    DOI: 10.1111/echo.v41.1
    DOI: 10.1111/echo.15719
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2041033-5
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  • 9
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    Comparison of local sine wave modeling with harmonic phase analysis for the assessment of myocardial strain
    Wiley ; 2013
    In:  Journal of Magnetic Resonance Imaging Vol. 38, No. 2 ( 2013-08), p. 320-328
    Details
    In: Journal of Magnetic Resonance Imaging, Wiley, Vol. 38, No. 2 ( 2013-08), p. 320-328
    Abstract: To compare local sine‐wave modeling (SinMod) with harmonic phase analysis (HARP), for assessment of left ventricular (LV) circumferential strain (εcc) from tagged cardiovascular magnetic resonance images. Materials and Methods Mid‐ventricular spatial modulation of magnetization was performed in 60 participants (15 each with hypertrophic, dilated or ischemic cardiomyopathy and 15 healthy controls) at 1.5 Tesla. Global and segmental peak transmural εcc were measured using HARP and SinMod. Repeated measurements were performed on 25% of examinations to assess observer variability. Effect of contrast was assessed in 10 additional patients. Results SinMod showed a high level of agreement with HARP for global εcc (mean difference −0.02, 95% limits of agreement −6.46 to 6.43%). Agreement was much lower for segmental εcc. Both methods showed excellent observer agreement for global εcc (intraclass correlation coefficient 〉 0.75). Observer agreement for segmental εcc was also excellent with SinMod, but was significantly lower with HARP. Analysis time was significantly shorter using SinMod. Pre‐ and postcontrast εcc measurements were not significantly different using either technique, although postcontrast measurements showed greater variability with HARP. Conclusion SinMod and HARP‐based measurements of global εcc have a high level of agreement, but segmental agreement is substantially lower. SinMod has generally lower observer variability, is faster and is less affected by contrast, but requires further validation. J. Magn. Reson. Imaging 2013;38:320–328. © 2012 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 1053-1807 , 1522-2586
    URL: Issue
    URL: Article
    DOI: 10.1002/jmri.v38.2
    DOI: 10.1002/jmri.23973
    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 10
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    Plasma P‐selectin is a predictor of mortality in heart failure with preserved ejection fraction
    Wiley ; 2021
    In:  ESC Heart Failure Vol. 8, No. 3 ( 2021-06), p. 2328-2333
    Details
    In: ESC Heart Failure, Wiley, Vol. 8, No. 3 ( 2021-06), p. 2328-2333
    Abstract: The aim of the study was to assess the association of P‐selectin with outcomes in heart failure with preserved ejection fraction (HFpEF). Methods and results This is a prospective, observational study of 130 HFpEF patients who underwent clinical profiling, blood sampling, 6 min walk testing, Minnesota Living with Heart Failure Questionnaire evaluation, echocardiography, cardiovascular magnetic resonance imaging, calculation of the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) risk scores, and blinded plasma P‐selectin measurement. Patients were followed up for the endpoint of all‐cause mortality. The HFpEF subgroup with higher P‐selectin levels [overall median 26 372, inter‐quartile range (19 360–34 889) pg/mL] was associated with lower age, higher heart rate, less prevalent atrial fibrillation, more frequent current smoking status, and lower right ventricular end‐diastolic volumes. During follow‐up (median 1428 days), there were 38 deaths. Following maximal sensitivity and specificity receiver operating characteristic curve analysis, P‐selectin levels above 35 506 pg/mL were associated with greater risk of all‐cause mortality [hazard ratio (HR) 2.700; 95% confidence interval (CI) 1.416–5.146; log‐rank P  = 0.002]. Following multivariable Cox proportional hazards regression analysis and when added to MAGGIC scores, only P‐selectin (adjusted HR 1.707; 95% CI 1.099–2.650; P   〈  0.017) and myocardial infarction detected by cardiovascular magnetic resonance imaging (HR 2.377; 95% CI 1.114–5.075; P   〈  0.025) remained significant predictors. In a final model comprising all three parameters, only P‐selectin (HR 1.447; 95% CI 1.130–1.853; P   〈  0.003) and MAGGIC scores (HR 1.555; 95% CI 1.136–2.129; P   〈  0.006) remained independent predictors of death. Adding P‐selectin (0.618, P  = 0.035) improved the area under the receiver operating characteristic curve for mortality prediction for MAGGIC scores (0.647, P  = 0.009) to 0.710, P   〈  0.0001. Conclusions Plasma P‐selectin is an independent predictor of mortality and provides incremental prognostic information beyond MAGGIC scores in HFpEF.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v8.3
    DOI: 10.1002/ehf2.13280
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2814355-3
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