Sven Plein

Sapienza University of Rome, Roma, Latium, Italy

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Publications (226)1058.69 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: This study sought to identify the effect of coronary autoregulation on myocardial perfusion during intra-aortic balloon pump (IABP) therapy. IABP is the most commonly used circulatory support device, although its efficacy in certain scenarios has been questioned. The impact of alterations in microvascular function on IABP efficacy has not previously been evaluated in humans. Thirteen patients with ischemic cardiomyopathy (left ventricular ejection fraction: 34 ± 8%) undergoing percutaneous coronary intervention were recruited. Simultaneous intracoronary pressure and Doppler-flow measurements were undertaken in the target vessel following percutaneous coronary intervention, during unassisted and IABP-assisted conditions. Coronary autoregulation was modulated by the use of intracoronary adenosine, inducing maximal hyperemia. Wave intensity analysis characterized the coronary wave energies associated with balloon counterpulsation. Two unique diastolic coronary waves were temporally associated with IABP device use; a forward compression wave and a forward expansion wave caused by inflation and deflation, respectively. During basal conditions, IABP therapy increased distal coronary pressure (82.4 ± 16.1 vs. 88.7 ± 17.8 mm Hg, p = 0.03), as well as microvascular resistance (2.32 ± 0.52 vs. 3.27 ± 0.41 mm Hg cm(-1) s, p = 0.001), with no change in average peak velocity (30.6 ± 12.0 vs. 26.6 ± 11.3 cm s(-1), p = 0.59). When autoregulation was disabled, counterpulsation caused an increase in average peak velocity (39.4 ± 10.5 vs. 44.7 ± 17.5 cm s(-1), p = 0.002) that was linearly related with IABP-forward compression wave energy (R(2) = 0.71, p = 0.001). Autoregulation ameliorates the effect of IABP on coronary flow. However, during hyperemia, IABP augments myocardial perfusion, principally due to a diastolic forward compression wave caused by balloon inflation, suggesting IABP would be of greatest benefit when microcirculatory reserve is exhausted.
    04/2014; · 1.07 Impact Factor
  • Heart (British Cardiac Society) 04/2014; · 5.01 Impact Factor
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    ABSTRACT: There is a growing interest from the scientific community in the appropriate use of cardiovascular imaging techniques for diagnosis and decision making in Europe. To develop appropriateness criteria for cardiovascular imaging use in clinical practice in Europe, a dedicated taskforce has been appointed by the European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging (EACVI). The present paper describes the appropriateness criteria development process.
    European heart journal cardiovascular Imaging. 03/2014;
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    ABSTRACT: Two-dimensional (2D) perfusion cardiovascular magnetic resonance (CMR) remains limited by a lack of complete myocardial coverage. Three-dimensional (3D) perfusion CMR addresses this limitation and has recently been shown to be clinically feasible. However, the feasibility and potential clinical utility of quantitative 3D perfusion measurements, as already shown with 2D-perfusion CMR and positron emission tomography, has yet to be evaluated. The influence of systolic or diastolic acquisition on MBF estimates, diagnostic accuracy and image quality is also unknown for 3D-perfusion CMR. The purpose of this study was to establish the feasibility of quantitative 3D-perfusion CMR for the detection of coronary artery disease (CAD) and to compare systolic and diastolic estimates of myocardial blood flow (MBF). Thirty-five patients underwent 3D-perfusion CMR with data acquired at both end-systole and mid-diastole. MBF and myocardial perfusion reserve (MPR) were estimated on a per patient and per territory basis by Fermi-constrained deconvolution. Significant CAD was defined as stenosis >=70% on quantitative coronary angiography. Twenty patients had significant CAD (involving 38 out of 105 territories). Stress MBF and MPR had a high diagnostic accuracy for the detection of CAD in both systole (area under curve [AUC]: 0.95 and 0.92, respectively) and diastole (AUC: 0.95 and 0.94). There were no significant differences in the AUCs between systole and diastole (p values >0.05). At stress, diastolic MBF estimates were significantly greater than systolic estimates (no CAD: 3.21 +/- 0.50 vs. 2.75 +/- 0.42 ml/g/min, p < 0.0001; CAD: 2.13 +/- 0.45 vs. 1.98 +/- 0.41 ml/g/min, p < 0.0001); but at rest, there were no significant differences (p values >0.05). Image quality was higher in systole than diastole (median score 3 vs. 2, p = 0.002). Quantitative 3D-perfusion CMR is feasible. Estimates of MBF are significantly different for systole and diastole at stress but diagnostic accuracy to detect CAD is high for both cardiac phases. Better image quality suggests that systolic data acquisition may be preferable.
    Journal of Cardiovascular Magnetic Resonance 02/2014; 16(1):19. · 4.44 Impact Factor
  • Source
    Sven Plein, Manish Motwani
    European heart journal cardiovascular Imaging. 02/2014;
  • Source
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    ABSTRACT: This study compared the myocardial ischaemic burden (MIB) in patients with angiographic three-vessel coronary artery disease (3VD) using high-resolution and standard-resolution myocardial perfusion cardiovascular magnetic resonance (perfusion CMR) imaging. One hundred and five patients undergoing coronary angiography had two separate stress/rest perfusion CMR studies, one with standard-resolution (2.5 mm in-plane) and another with high-resolution (1.6 mm in-plane). Quantitative coronary angiography was used to define patients with angiographic 3VD. Perfusion CMR images were anonymized, randomly ordered and visually reported by two observers acting in consensus and blinded to all clinical and angiographic data. Perfusion was graded in each segment on a four-point scale and summed to produce a perfusion score and estimate of MIB for each patient. In patients with angiographic 3VD (n = 35), high-resolution acquisition identified more abnormal segments (7.2 ± 3.8 vs. 5.3 ± 4.0; P = 0.004) and territories (2.4 ± 0.9 vs. 1.6 ± 1.1; P = 0.002) and a higher overall perfusion score (20.1 ± 7.7 vs. 11.9 ± 9.4; P < 0.0001) per patient compared with standard-resolution. The number of segments with subendocardial ischaemia was greater with high-resolution acquisition (195 vs. 101; P < 0.0001). Hypoperfusion in all three territories was identified in 57% of 3VD patients by high-resolution compared with only 29% by standard-resolution (P = 0.04). The area-under-the-curve (AUC) for detecting angiographic 3VD using the estimated MIB was significantly greater with high-resolution than standard-resolution acquisition (AUC = 0.90 vs. 0.69; P < 0.0001). In patients with angiographic 3VD, the ischaemic burden detected by perfusion CMR is greater with high-resolution acquisition due to better detection of subendocardial ischaemia. High-resolution perfusion CMR may therefore be preferred for risk stratification and management of this high-risk patient group.
    European heart journal cardiovascular Imaging. 02/2014;
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    ABSTRACT: The benefits of cardiac imaging are immense, and modern medicine requires the extensive and versatile use of a variety of cardiac imaging tech- niques. Cardiologists are responsible for a large part of the radiation exposures every person gets per year from all medical sources. Therefore, they have a particular responsibility to avoid unjustified and non-optimized use of radiation,but sometimes are imperfectly aware of the radiological dose of the examination they prescribe or practice. This position paper aims to summarize the current knowledge on radiation effective doses (and risks) related to cardiac imaging procedures. We have reviewed the literature on radiation doses, which can range from the equivalent of 1 – 60 milliSievert (mSv) around a reference dose average of 15 mSv (corresponding to 750 chest X-rays) for a percutaneous coronary inter- vention, a cardiac radiofrequency ablation, a multidetector coronary angiography, or a myocardial perfusion imaging scintigraphy. We provide a European perspective on the best way to play an active role in implementing into clinical practice the keyprinciple of radiation protection that: each patient should get the right imaging exam, at the right time, with the right radiation dose.
    European Heart Journal 01/2014; · 14.10 Impact Factor
  • Journal of Cardiovascular Magnetic Resonance 01/2014; 16(Suppl 1):P178. · 4.44 Impact Factor
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    ABSTRACT: Objectives This study sought to identify the effect of coronary autoregulation on myocardial perfusion during intra-aortic balloon pump (IABP) therapy. Background IABP is the most commonly used circulatory support device, although its efficacy in certain scenarios has been questioned. The impact of alterations in microvascular function on IABP efficacy has not previously been evaluated in humans. Methods Thirteen patients with ischemic cardiomyopathy (left ventricular ejection fraction: 34 ± 8%) undergoing percutaneous coronary intervention were recruited. Simultaneous intracoronary pressure and Doppler-flow measurements were undertaken in the target vessel following percutaneous coronary intervention, during unassisted and IABP-assisted conditions. Coronary autoregulation was modulated by the use of intracoronary adenosine, inducing maximal hyperemia. Wave intensity analysis characterized the coronary wave energies associated with balloon counterpulsation. Results Two unique diastolic coronary waves were temporally associated with IABP device use; a forward compression wave and a forward expansion wave caused by inflation and deflation, respectively. During basal conditions, IABP therapy increased distal coronary pressure (82.4 ± 16.1 vs. 88.7 ± 17.8 mm Hg, p = 0.03), as well as microvascular resistance (2.32 ± 0.52 vs. 3.27 ± 0.41 mm Hg cm–1 s, p = 0.001), with no change in average peak velocity (30.6 ± 12.0 vs. 26.6 ± 11.3 cm s–1, p = 0.59). When autoregulation was disabled, counterpulsation caused an increase in average peak velocity (39.4 ± 10.5 vs. 44.7 ± 17.5 cm s–1, p = 0.002) that was linearly related with IABP–forward compression wave energy (R2 = 0.71, p = 0.001). Conclusions Autoregulation ameliorates the effect of IABP on coronary flow. However, during hyperemia, IABP augments myocardial perfusion, principally due to a diastolic forward compression wave caused by balloon inflation, suggesting IABP would be of greatest benefit when microcirculatory reserve is exhausted.
    JACC Cardiovascular Interventions 01/2014; · 6.55 Impact Factor
  • Journal of Cardiovascular Magnetic Resonance 01/2014; 16(Suppl 1):O25. · 4.44 Impact Factor
  • Journal of Cardiovascular Magnetic Resonance 01/2014; 16(Suppl 1):P344. · 4.44 Impact Factor
  • Journal of Cardiovascular Magnetic Resonance 01/2014; 16(Suppl 1):P206. · 4.44 Impact Factor
  • Journal of Cardiovascular Magnetic Resonance 01/2014; 16(Suppl 1):P209. · 4.44 Impact Factor
  • Peter P Swoboda, Sven Plein
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    ABSTRACT: The syndrome of heart failure is prevalent and a cause of significant morbidity and mortality. Cardiovascular magnetic resonance (CMR) offers a unique method to quantify the extent of left ventricular dysfunction and also characterize the myocardium, particularly according to the presence and distribution of late gadolinium enhancement. The prognostic value of late gadolinium enhancement in various etiologies of heart failure has been demonstrated. Newer techniques that non-invasively assess the extracellular volume may also add to the prognostic value of CMR in heart failure. Management decisions in patients with heart failure can often be complex. CMR can provide useful information when planning cardiac device therapy and the CMR assessment of viability is key when planning revascularization.
    Expert Review of Cardiovascular Therapy 12/2013;
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    ABSTRACT: Purpose:To determine if myocardial perfusion cardiac magnetic resonance (MR) imaging can show changes in myocardial blood flow (MBF) during the cold pressor test (CPT) and can allow identification of the differing endothelial function of smokers and nonsmokers when compared during adenosine stress.Materials and Methods:The study was approved by the institutional ethics review board and all participants gave informed written consent. Twenty-nine healthy volunteers (19 nonsmokers, 10 smokers; mean age ± standard deviation, 22 years ± 4) underwent 1.5-T MR imaging and analysis. Myocardial perfusion was assessed during rest, peak CPT, and adenosine hyperemia with a saturation-recovery gradient-echo pulse sequence (spatial resolution, 2.4 × 2.4 × 10 mm). Global, endocardial, and epicardial MBF were calculated by using Fermi-constrained deconvolution. Paired and independent t test statistical analyses were used to compare the responses between tests and groups. Regression analysis was performed to identify predictors of MBF change.Results:MBF at rest was similar between the nonsmoking and smoking groups (0.97 mL/g/min ± 0.4 vs 0.96 mL/g/min ± 0.3, respectively; P = .96). Nonsmokers responded to CPT with a 47% increase in MBF (1.43 mL/g/min ± 0.5) and smokers responded with a 27% increase (1.22 mL/g/min ± 0.4; P < .001). An endocardial-to-epicardial gradient existed at rest (nonsmokers, 1.10 [P = .002]; smokers, 1.30 [P = .01]) and CPT (nonsmokers, 1.19 [P < .001] smokers, 1.28 [P = .04]) but reversed during adenosine stress (nonsmokers, 0.89 [P = .03]; smokers, 0.92 [P = .42]).Conclusion:Myocardial perfusion cardiac MR imaging during CPT can allow assessment of changes in MBF globally and in the separate myocardial layers in healthy smokers and nonsmokers. This allows the combined assessment of endothelium-dependent (CPT) and endothelium-independent (adenosine stress test) MBF reserve in a single study.© RSNA, 2013Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13122345/-/DC1.
    Radiology 09/2013; · 6.34 Impact Factor
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    ABSTRACT: ST-elevation acute myocardial infarction (STEMI) is frequently associated with reciprocal ST depression in contralateral ECG leads. The relevance of these changes is debated. This study examined whether reciprocal ECG changes in STEMI reflect larger myocardial area at risk (AAR) and/or infarct size. Patients were stratified by presence of reciprocal change on the presenting ECG, defined as ≥1 mm ST depression in ≥2 inferior leads for anterior STEMI, or ≥2 anterior leads for inferior STEMI. Infarcted tissue was defined on late enhancement and AAR on T2-weighted cardiovascular magnetic resonance (CMR). Patients with reperfused first STEMI underwent CMR within 3 days of presentation. In addition to AAR and infarct mass, myocardial salvage was calculated as (AAR mass-infarct mass) and salvage index as myocardial salvage/AAR mass. Thirty-five patients were analysed (n=35). Patients with reciprocal ECG changes (n=19) had higher AAR mass than those without (42 g vs 29 g, p<0.001), and higher myocardial salvage (27 g vs 9 g, p<0.001) and myocardial salvage index (61% vs 17%, p<0.001) but similar infarct size (16 g vs 20 g, p=0.3) and ejection fraction (43% vs 45%, p=0.5). STEMI patients with reciprocal ECG changes have larger AAR, higher myocardial salvage and salvage index than those without. Reciprocal changes appear to be a marker of increased ischaemic myocardium at risk and indicate the potential for increased salvage with emergency revascularisation. Reciprocal changes showed no relationship to infarct size, which may be influenced by ischaemia time and other treatment factors.
    Heart (British Cardiac Society) 09/2013; · 5.01 Impact Factor
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    ABSTRACT: To establish the reproducibility of complementary spatial modulation of magnetization (CSPAMM) tagged cardiovascular MR (CMR) data in normal volunteers. Twelve healthy volunteers underwent CMR studies on two separate occasions using an identical CSPAMM pulse sequence with images acquired in three short axis slices. Data were analyzed by two independent observers using harmonic phase analysis (HARP). Lagrangian circumferential and radial strain, rotation, and left ventricular twist were calculated. The intraobserver reproducibility of circumferential strain (CoV [coefficient of variation] 1.5-4.3%) and LV twist (CoV 1.2-4.4%) was better than radial strain (CoV 10.6-14.8%). For interobserver reproducibility, circumferential strain (CoV 3.5-6.2%) and LV twist (CoV 3.5-7.2%) were more reproducible than radial strain (CoV 11.8-21.8%). Interstudy reproducibility of circumferential strain (CoV 3.7-5.5%) and LV twist (CoV 9.8-12.2%) were good but radial strain (CoV 13.8-23.4%) but showed poorer interstudy reproducibility. Sample size calculations suggested 20 or fewer subjects are needed to detect a 10% change in circumferential strain (power 90%; α error 0.05), whereas for twist, 66 subjects would be required. In normal volunteers, the intraobserver, interobserver, and interstudy reproducibility of circumferential strain and LV twist measured from CSPAMM tagged CMR data are good, but are less so for radial strain. J. Magn. Reson. Imaging 2013. © 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 09/2013; · 2.57 Impact Factor
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    ABSTRACT: Dynamic first pass contrast-enhanced myocardial perfusion is the standard CMR method for the estimation of myocardial blood flow (MBF) and MBF reserve in man, but it is challenging in rodents because of the high temporal and spatial resolution requirements. Hyperemic first pass myocardial perfusion CMR during vasodilator stress in mice has not been reported. Five C57BL/6 J mice were scanned on a clinical 3.0 Tesla Achieva system (Philips Healthcare, Netherlands). Vasodilator stress was induced via a tail vein catheter with an injection of dipyridamole. Dynamic contrast-enhanced perfusion imaging (Gadobutrol 0.1 mmol/kg) was based on a saturation recovery spoiled gradient echo method with 10-fold k-space and time domain undersampling (k-t PCA). One week later the mice underwent repeat anaesthesia and LV injections of fluorescent microspheres at rest and at stress. Microspheres were analysed using confocal microscopy and fluorescence-activated cell sorting. Mean MBF at rest measured by Fermi-function constrained deconvolution was 4.1 +/- 0.5 ml/g/min and increased to 9.6 +/- 2.5 ml/g/min during dipyridamole stress (P = 0.005). The myocardial perfusion reserve was 2.4 +/-0.54. The mean count ratio of stress to rest microspheres was 2.4 +/-0.51 using confocal microscopy and 2.6 +/- 0.46 using fluorescence. There was good agreement between cardiovascular magnetic resonance CMR and microspheres with no significant difference (P = 0.84). First-pass myocardial stress perfusion CMR in a mouse model is feasible at 3Tesla. Rest and stress MBF values were consistent with existing literature and perfusion reserve correlated closely to microsphere analysis. Data were acquired on a 3 Tesla scanner using an approach similar to clinical acquisition protocols, potentially facilitating translation of imaging findings between rodent and human studies.
    Journal of Cardiovascular Magnetic Resonance 07/2013; 15(1):62. · 4.44 Impact Factor
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    ABSTRACT: Cardiac masses are usually first detected at echocardiography. In their further evaluation, cardiac magnetic resonance (MR) imaging has become a highly valuable technique. MR imaging offers incremental value owing to its larger field of view, superior tissue contrast, versatility in image planes, and unique ability to enable discrimination of different tissue characteristics, such as water and fat content, which give rise to particular signal patterns with T1- and T2-weighted techniques. With contrast material-enhanced MR imaging, additional tissue properties such as vascularity and fibrosis can be demonstrated. MR imaging can therefore contribute to the diagnosis of a cardiac mass as well as be used to detail its relationship to other cardiac and extracardiac structures. These assessments are important to plan therapy, such as surgical intervention. In addition, serial MR studies can be used to monitor tumor regression after surgery or chemotherapy. Primary cardiac tumors are very rare; metastases and pseudotumors (eg, thrombus) are much more common. This article provides an overview of cardiac masses and reviews the optimal MR imaging techniques for their assessment. © RSNA, 2013 Supplemental material:http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121239/-/DC1.
    Radiology 07/2013; 268(1):26-43. · 6.34 Impact Factor
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    ABSTRACT: Following acute myocardial infarction (AMI), microvascular obstruction (MO) and intramyocardial hemorrhage (IMH) adversely affect left ventricular remodeling and prognosis independently of infarct size. Whether this is due to infarct zone remodeling, changes in remote myocardium or other factors is unknown. We investigated the role of MO and IMH in recovery of contractility in infarct and remote myocardium. Thirty-nine patients underwent cardiovascular magnetic resonance (CMR) with T2-weighted and T2* imaging, late gadolinium enhancement (LGE) and myocardial tagging at 2, 7, 30 and 90 days following primary percutaneous coronary intervention for AMI. Circumferential strain in infarct and remote zones was stratified by presence of MO and IMH. Overall, infarct zone strain recovered with time (p < 0.001). In the presence of MO with IMH and without IMH, epicardial strain recovered (p = 0.03, p < 0.01 respectively), but mid-myocardial or endocardial strain did not (mid-myocardium: p = 0.05, p = 0.12; endocardium: p = 0.27, p = 0.05, respectively). By day 90, infarcts with MO had more attenuated strain in all myocardial layers compared to infarcts without MO (p < 0.01); those with IMH were attenuated further (p < 0.01). Remote myocardial strain was similar across groups at all time-points (p > 0.2). Infarct transmural extent did not correlate with strain (p > 0.05 at each time point). In multivariable logistic regression, MO and IMH were the only significant independent predictors of attenuated 90-day infarct zone strain (p = 0.004, p = 0.011, respectively). Strain improves within the infarct zone overall following reperfusion with or without MO or IMH. Mid-myocardial and endocardial infarct contractility is diminished in the presence of MO, and further in the presence of IMH. MO and IMH are greater independent predictors of infarct zone contractile recovery than infarct volume or transmural extent.
    Journal of Cardiovascular Magnetic Resonance 06/2013; 15(1):58. · 4.44 Impact Factor

Publication Stats

2k Citations
1,058.69 Total Impact Points

Institutions

  • 2013
    • Sapienza University of Rome
      • Department of Radiological, Oncological and Pathological Sciences
      Roma, Latium, Italy
    • University of Tripoli
      Ţarābulus, Ţarābulus, Libya
  • 2011–2013
    • ICL
      Londinium, England, United Kingdom
    • Philips
      Eindhoven, North Brabant, Netherlands
  • 2007–2013
    • University of Leeds
      • School of Medicine
      Leeds, ENG, United Kingdom
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
  • 2012
    • National Health Service
      Radditch, England, United Kingdom
  • 2010–2012
    • Guy's and St Thomas' NHS Foundation Trust
      • Cardiovascular Department
      Londinium, England, United Kingdom
  • 2009–2012
    • King's College London
      • Division of Imaging Sciences and Biomedical Engineering
      London, ENG, United Kingdom
    • UHN: Toronto General Hospital
      Toronto, Ontario, Canada
  • 2001–2012
    • Nottinghamshire Healthcare NHS Trust
      Nottigham, England, United Kingdom
  • 2007–2010
    • ETH Zurich
      • Institute for Biomedical Engineering
      Zürich, ZH, Switzerland
  • 2008
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2005
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2002–2005
    • British Heart Foundation
      Londinium, England, United Kingdom
  • 2003–2004
    • University of Leipzig
      Leipzig, Saxony, Germany