Eylem Levelt

Eylem Levelt
University of Leeds

DPhil (Oxon)

About

191
Publications
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Publications

Publications (191)
Conference Paper
Full-text available
Cardiovascular magnetic resonance (CMR) stress perfusion imaging is widely used to assess ischemic heart disease, typically requiring gadolinium-based contrast agents (GBCAs). However, GBCAs pose potential risks, especially in patients with renal impairment, and add complexity to the imaging process. Recent advances in stress T1 mapping offer a pro...
Article
Full-text available
The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19...
Conference Paper
Full-text available
Introduction Pulmonary transit time (PTT) is a valuable measure of cardiopulmonary function. The impact of Atrial Fibrillation (AF) on PTT in athletes remains understudied. Understanding the relationship between fitness levels and PTT could offer insights into cardiopulmonary adaptation from exercise.This study aims to compare PTT at rest and durin...
Conference Paper
Introduction COVID-HEART was a prospective, longitudinal, multicenter, observational cohort study of patients hospitalized with COVID-19 and elevated serum troponin in the United Kingdom. From a pre-specified subanalysis, we evaluated and compared the interaction of age and sex with CMR abnormalities in COVID-19 inpatients and contemporary controls...
Conference Paper
Introduction Endurance athletes with left ventricular (LV) dilatation and mildly reduced resting LV function can be difficult to differentiate from dilated cardiomyopathy (DCM). Myocardial fibrosis is increasingly recognised in lifelong athletes and is also prevalent in DCM where it confers adverse prognosis. However, it is unknown whether the patt...
Article
Background: GDM and preeclampsia are common complications of pregnancy, for which overweight/obesity is a common risk factor. Both conditions are associated with a two-to- four-fold increase in future incident heart failure, which may be linked to early maladaptive myocardial changes. Objectives: To determine maternal myocardial structural, functi...
Article
Background: Primary cardiac involvement in systemic sclerosis (SSc) is heterogenous, poorly defined and associated with significant cardiac morbidity and mortality. The underlying mechanism is not well understood but may include the impact of coronary microvascular dysfunction and myocardial inflammation. Myocardial cellular metabolic alterations i...
Article
Background: Patients with rheumatoid arthritis (RA) display around 20% increased risk of heart failure, even after adjusting for traditional atherosclerotic risk factors. The reasons behind this are not fully understood. Analogous states of chronic inflammation such as type two diabetes have been shown to be associated with deleterious effects on m...
Article
Full-text available
Metformin is an antihyperglycemic used to treat type 2 diabetes mellitus (T2DM). Patients with T2DM are at increased risk of cardiovascular disease. We explored the association between metformin use and cardiovascular magnetic resonance (CMR) derived stress myocardial blood flow (MBF), myocardial perfusion reserve (MPR) and major adverse cardiovasc...
Article
Full-text available
Aims Diabetes mellitus (DM) increases heart failure incidence and worsens prognosis, but its molecular basis is poorly defined in humans. We aimed to define the diabetic myocardial transcriptome and validate hits in their circulating protein form to define disease mechanisms and biomarkers. Methods and Results RNA-sequencing data from the Genotype...
Article
Background Patients with diabetes mellitus (DM) and heart failure (HF) have worse outcomes than normoglycemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify the extent of silent IHD and...
Article
Full-text available
Background Pulmonary transit time (PTT) can be measured automatically from arterial input function (AIF) images of dual sequence first-pass perfusion imaging. PTT has been validated against invasive cardiac catheterisation correlating with both cardiac output and left ventricular filling pressure (both important prognostic markers in heart failure)...
Article
Introduction Non-ischaemic myocardial fibrosis can be detected by cardiovascular magnetic resonance (CMR) imaging in a significant proportion of lifelong endurance athletes. 1 Similar focal fibrosis is known to be arrhythmogenic in non-ischaemic cardiomyopathy but its significance in asymptomatic athletes is unknown. Purpose To determine whether f...
Conference Paper
Background Type 2 diabetes (T2D) confers loss of cardiac metabolic flexibility in fuel selection and impaired mitochondrial function. Enhanced ketone metabolism observed in T2D may represent a compensatory adaptive mechanism. This is because ketones are a more efficient energy resources than carbohydrates or free fatty acids. Favorable energetic pr...
Conference Paper
Introduction Myocardial fibrosis on cardiac magnetic resonance (CMR) has increasingly been detected in lifelong endurance athletes, particularly those who are male. In non-ischaemic cardiomyopathy, the presence of myocardial fibrosis on CMR is known to be associated with arrhythmia and adverse outcome. However, the significance of myocardial fibros...
Conference Paper
Background Type 2 diabetes (T2D) confers three times higher mortality in patients with ischemic heart disease (IHD). Moreover, amongst patients with IHD those with diabetes were shown to have higher long-term mortality from heart failure despite angiographic or surgical revascularisation with coronary artery bypass grafting (CABG). Impaired myocard...
Conference Paper
Background Aortic stenosis (AS) accounts for substantial global morbidity and premature mortality even in moderate AS (Mod-AS). Whilst myocardial remodeling response is considered critical in the adverse prognosis of Mod-AS, the precise mechanisms remain poorly understood. We aimed to prospectively assess myocardial remodeling, perfusion and energe...
Conference Paper
Background Bicuspid aortic valve (BAV) is a common congenital heart disease and a major risk factor for aortic stenosis (AS). Myocardial remodelling response to AS plays an important prognostic role1. Cardiovascular magnetic resonance (CMR) allows evaluation of myocardial structure, function and perfusion in AS. Phosphorus magnetic resonance spectr...
Conference Paper
Single-cell RNA-seq is a vital tool for deciphering patterns of gene expression within the multitude of cell lineages comprising any tissue. However, price and technical complexities limit the use of this technology. Deconvolution of bulk RNA-seq data from whole tissues offers an alternative approach to derive some of these insights and gain valuab...
Article
Full-text available
Purpose Exercise imaging using current modalities can be challenging. This was patient focused study to establish the feasibility and reproducibility of exercise-cardiovascular magnetic resonance imaging (EX-CMR) acquired during continuous in-scanner exercise in asymptomatic patients with primary mitral regurgitation (MR). Methods This was a prosp...
Article
Aims We aimed to identify the distinctive cardiovascular magnetic resonance (CMR) features of patients with left bundle branch block (LBBB) and heart failure with reduced ejection fraction (HFrEF) of presumed non-ischaemic aetiology. The secondary aim was to determine whether these individuals exhibit characteristics that could potentially serve as...
Conference Paper
Introduction Cardiac magnetic resonance imaging (CMR) evaluates aortic stenosis (AS) and concurrent myocardial abnormalities. Initial diagnosis of aortic valve (AV) disease can occur during CMR scanning, but universal multiparametric AS assessment is inefficient. An automated strategy for identifying AS patients from the 3-chamber view (part of all...
Conference Paper
Introduction In patients presenting with heart failure with reduced ejection fraction (HFrEF), a total of 21–40% have recovery of left ventricular ejection fraction (LVEF). Patients with heart failure with improved ejection fraction (HFimpEF) have a more favourable prognosis compared to those without improvement in LVEF. The study aimed to determin...
Article
Full-text available
Accumulating evidence suggests that ectopic/visceral adiposity may play a key role in the pathogenesis of nonischaemic cardiovascular diseases associated with type 2 diabetes. Epicardial adipose tissue (EAT) is a complex visceral fat depot, covering 80% of the cardiac surface with anatomical and functional contiguity to the myocardium and coronary...
Preprint
Full-text available
Background Aortic stenosis (AS) accounts for substantial global morbidity and premature mortality even in moderate AS (Mod-AS). The mechanisms for this adverse prognosis in Mod-AS, however, remain poorly understood, although the myocardial remodeling response is thought to be critical. We aimed to prospectively assess myocardial remodeling, perfusi...
Article
Background Four‐dimensional‐flow cardiac MR (4DF‐MR) offers advantages in primary mitral regurgitation. The relationship between 4DF‐MR‐derived mitral regurgitant volume (MR‐Rvol) and the post‐operative left ventricular (LV) reverse remodeling has not yet been established. Purpose To ascertain if the 4DF‐MR‐derived MR‐Rvol correlates with the LV r...
Preprint
Full-text available
Aims Diabetes mellitus (DM) increases heart failure incidence and worsens prognosis, but the molecular basis of diabetic heart disease is poorly defined in humans. We aimed to define the diabetic myocardial transcriptome and validate hits in their circulating protein form to define disease mechanisms and biomarkers. Methods and Results RNA-sequenc...
Article
Full-text available
Purpose Guidelines recommend measuring myocardial extracellular volume (ECV) using T1‐mapping before and 10–30 min after contrast agent administration. Data are then analyzed using a linear model (LM), which assumes fast water exchange (WX) between the ECV and cardiomyocytes. We investigated whether limited WX influences ECV measurements in patient...
Article
Introduction Epicardial adipose tissue (EAT) is an active endocrine organ that regulates multiple aspects of cardiac biology including myocardial redox state, intracellular Ca2+ cycling, the electrophysiological and contractile properties of cardiomyocytes, cardiac fibrosis, and coronary atherosclerosis progression. Purpose We evaluated associatio...
Article
Background Gestational diabetes mellitus (GDM) and preeclampsia (PE) are the leading obstetric complications of pregnancy. Both are associated with a substantial increase in the risk of long-term cardiovascular disease. However, pregnant women are underrepresented in clinical research and the mechanisms of long-term cardiovascular complications in...
Article
Full-text available
Background Obesity and diabetes mellitus (DM) frequently co-exist, yet their individual contributions to cardiovascular risk remain debated. Purpose We explored cardiovascular disease biomarkers, events and mortality in a large cohort stratified by body mass index (BMI) and DM. We hypothesised that DM with normal BMI is associated with a cardiovas...
Article
Background Both the insulin secretion and insulin resistance in Type 2 diabetes (T2D) are amenable to pharmacological intervention. In a single center, open-label, randomized, cross-over design trial we sought to compare two distinct glycaemic control strategies of targeting beta-cell dysfunction and promoting insulin secretion using Glucagon-like...
Article
Background: Insulin secretion and insulin resistance in Type 2 diabetes (T2D) are amenable to pharmacological intervention. In a single center, open-label, randomized, cross-over drug trial we compared two glycaemic control strategies using Glucagon-like peptide-1 receptor agonists liraglutide and peroxisome proliferator activated receptor-gamma ag...
Article
Introduction: Abnormal myocardial perfusion and MI are each associated with cardiovascular events in individuals with diabetes mellitus (DM). Hypothesis: We hypothesised that, in patients with T2DM, CMR determined quantitative myocardial perfusion and MI are independent predictors of major adverse cardiovascular and cerebrovascular events (MACCE) a...
Article
BACKGROUND Type 2 diabetes (T2D) is associated with an increased risk of left ventricular dysfunction after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). Persistent impairments in myocardial energetics and myocardial blood flow (MBF) may underpin this observation. Using phosphorus magnetic resonance spectroscopy and c...
Article
Full-text available
Left ventricular fibrosis can be identified by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in some veteran athletes. We aimed to investigate prevalence of ventricular fibrosis in veteran athletes and associations with cardiac arrhythmia. 50 asymptomatic male endurance athletes were recruited. They underwent CMR imaging...
Article
Full-text available
Aims: Left ventricular filling pressure (LVFP) can be estimated from cardiovascular magnetic resonance (CMR). We aimed to investigate whether CMR-derived LVFP is associated with signs, symptoms, and prognosis in patients with recently diagnosed heart failure (HF). Methods and results: This study recruited 454 patients diagnosed with HF who under...
Article
Full-text available
Objectives: To determine baseline characteristics predictive of left ventricular ejection fraction (LVEF) recovery in patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and presumed non-ischaemic aetiology. Methods: We prospectively recruited patients who were diagnosed with HFrEF (LVEF ≤40%) on echocardiography and sub...
Article
Full-text available
Background When feasible, guidelines recommend mitral valve repair (MVr) over mitral valve replacement (MVR) to treat primary mitral regurgitation (MR), based upon historic outcome studies and transthoracic echocardiography (TTE) reverse remodeling studies. Cardiovascular magnetic resonance (CMR) offers reference standard biventricular assessment w...
Article
Full-text available
Objective: Obesity and diabetes frequently coexist, yet their individual contributions to cardiovascular risk remain debated. We explored cardiovascular disease biomarkers, events, and mortality in the UK Biobank stratified by BMI and diabetes. Research design and methods: A total of 451,355 participants were stratified by ethnicity-specific BMI...
Article
Full-text available
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation. Background Myocardial fibrosis has been demonstrated to be highly prevalent amongst endurance athletes. However, it is unknown whether endurance athletes with a greater exercise capacity have an increased prevalence of fibrosi...
Preprint
Full-text available
Recent developments in Magnetic resonance spectroscopy (MRS) techniques have demonstrated great potential for the quantification of myocardial energy metabolites, enabling an in-depth glimpse into the energetic state of the heart to better explain the onset and severity of disease states. However, more evidence is required to establish its clinical...
Conference Paper
Background Both the insulin secretion and insulin resistance in Type 2 diabetes (T2D) are amenable to pharmacological intervention. promote insulin secretion, causes weight loss and is an important pharmacological target in T2D. In a single center, open-label, randomized, cross-over design trial we sought to compare two distinct glycaemic control s...
Conference Paper
Introduction Obesity and diabetes mellitus (DM) frequently co-exist, yet their individual contributions to cardiovascular risk remain debated. We explored cardiovascular disease biomarkers, events and mortality in a large cohort stratified by body mass index (BMI) and DM. Methods 451,355 UK Biobank participants were stratified by ethnicity-specifi...
Conference Paper
Introduction Accurate assessment of degenerative mitral regurgitation (MRegurg) by transthoracic echocardiography (TTE) can be challenging. Phase-contrast cardiovascular magnetic resonance (PCMR) imaging enables reliable quantitation of MRegurg volume, even in the presence of eccentric and multiple jets, highlighting its advantage in the evaluation...
Conference Paper
Full-text available
Introduction Cardiovascular magnetic resonance (CMR) is recommended in both NICE and ESC guidelines in patients with new onset left ventricular systolic dysfunction (LVSD) to identify aetiology. In patients with LVSD, type 2 diabetes is associated with increased prevalence of silent myocardial infarction (MI). We aimed to investigate if silent MI i...
Conference Paper
Introduction Histological studies show that myocardial fibrosis accompanies cellular hypertrophy in severe aortic stenosis (AS). Following aortic valve replacement (AVR), left ventricular hypertrophy regresses by 20%-30% by one year (1) and both cellular hypertrophy and fibrosis may regress as early as 6 months post AVR (2, 3). With T1 mapping, CMR...
Conference Paper
Both the insulin secretion and insulin resistance in Type 2 diabetes (T2D) are amenable to pharmacological intervention. In a single center, open-label, randomized, cross-over design trial we sought to compare two distinct glycaemic control strategies of promoting insulin secretion using Glucagon-like peptide-1 receptor agonists (GLP-1RA) -liraglut...
Conference Paper
Background Gestational diabetes mellitus (GDM) and preeclampsia (PE) are the leading obstetric complications of pregnancy. Both are associated with a substantial increase in the risk of long-term cardiovascular disease. However, pregnant women are underrepresented in clinical research and the mechanisms of long-term cardiovascular complications in...
Preprint
Background Metformin is an antihyperglycemic agent frequently used in the treatment of Type 2 Diabetes Mellitus (T2DM). Patients with T2DM are at increased risk of cardiovascular diseases, including coronary artery disease (CAD), silent myocardial infarction (MI) and coronary microvascular dysfunction (CMD), all of which can be detected and quantif...
Article
Full-text available
Background: Ischaemia with nonobstructive coronary arteries is most commonly caused by coronary microvascular dysfunction but remains difficult to diagnose without invasive testing. Myocardial blood flow (MBF) can be quantified noninvasively on stress perfusion cardiac magnetic resonance (CMR) or positron emission tomography but neither is routine...
Conference Paper
Introduction Long-term right ventricular (RV) pacing leads to heart failure or a decline in left ventricular (LV) function in up to a fifth of patients.¹ We aimed to establish whether the presence of focal left ventricular myocardial fibrosis detected by late gadolinium enhancement on cardiovascular magnetic resonance (CMR) is associated with long...
Conference Paper
Introduction Myocardial perfusion reserve (MPR) is the ratio of global myocardial blood flow (MBF) at stress compared with rest. It is independently associated with major adverse events in coronary artery disease (CAD). Whilst MPR has been shown to be reduced in dilated cardiomyopathy (DCM), its prognostic significance is unclear. Materials and Me...
Conference Paper
Introduction Extracellular volume (ECV) is an independent predictor of mortality and outcome in patients with severe aortic stenosis (AS).¹ SCMR guidelines recommend measurement of ECV using T1 maps taken before and 10–30 minutes post contrast.² These measurements use a conventional model (CM) which assumes rapid water exchange (WX) between the ECV...
Conference Paper
Introduction Diabetic patients with heart failure (HF) have worse outcomes compared to normoglycaemic HF patients.1 2 Patients with diabetes mellitus (DM) are at increased risk of ischaemic heart disease (IHD), silent myocardial infarction (MI) and coronary microvascular dysfunction (CMD).³ All of these can be assessed and quantified using cardiac...
Conference Paper
Introduction Cardiac hypoxia is a key cause of myocardial dysfunction, but remains under-investigated due to challenges with direct myocardial oxygen assessment. Fast low flip angle short (FLASH) normalised blood-oxygen level-dependent cardiovascular magnetic resonance (nBOLD CMR) is a novel oxygen-sensitive CMR approach which allows for precise me...
Article
Full-text available
Background: Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation. Methods: Across 25 hospitals in the United Kingdom...
Preprint
Full-text available
Introduction Obesity and diabetes mellitus (DM) frequently co-exist, yet their individual contributions to cardiovascular risk remain debated. We explored cardiovascular disease biomarkers, events and mortality in a large cohort stratified by body mass index (BMI) and DM. Methods 451,355 UK Biobank participants were stratified by ethnicity-specific...
Preprint
Purpose Left ventricular fibrosis can be identified by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in some veteran athletes. We aimed to investigate prevalence of ventricular fibrosis in veteran athletes and its association with cardiac arrhythmia. Methods Fifty asymptomatic male endurance athletes (inclusion criteria:...
Article
Full-text available
Aims Recently developed in-line automated cardiovascular magnetic resonance (CMR) myocardial perfusion mapping has been shown to be reproducible and comparable with positron emission tomography (PET), and can be easily integrated into clinical workflows. Bringing quantitative myocardial perfusion CMR into routine clinical care requires knowledge of...
Article
Full-text available
Aims The 2016 European Society of Cardiology Heart Failure Guidelines defined a new category: heart failure with mid-range ejection fraction (HFmrEF) of 40–49%. This new category was highlighted as having limited evidence and research was advocated into underlying characteristics, pathophysiology, and diagnosis. We used multi-parametric cardiovascu...
Article
Background Aortic stenosis (AS) and type 2 diabetes mellitus (DM) are increasingly frequent comorbidities in aging populations, and diabetes is associated with increased morbidity and mortality after aortic valve replacement (AVR). Although distinct pathological entities, AS and DM share common features of impaired myocardial energetics and coronar...
Article
Background Patients with T2D and heart disease have normal body mass index (BMI), suggesting that diabetes and obesity mediate cardiovascular change by different mechanisms. Changes in cardiac energy metabolism in lean diabetic patients during exercise stress have not been previously reported. Objectives We aimed to assess if there are BMI-associa...
Article
Background Type 2 diabetes mellitus (DM) is associated with worsened clinical outcomes in hypertrophic cardiomyopathy (HCM) patients. The reasons for this adverse prognostic association are incompletely understood. Although distinct entities both HCM and DM share common features of impaired myocardial energetics and coronary microvascular function....
Article
Full-text available
Background Gestational diabetes mellitus (GDM) and preeclampsia (pE) are both associated with an increased risk of cardiovascular mortality and morbidity, including an increased risk of developing heart failure in later life. Both conditions are increasing in prevalence; GDM affects up to 12% and pE affects 3–5% of pregnancies worldwide. Compromise...
Article
Full-text available
Introduction Mitral regurgitation (MR) is the second most common valvular pathology worldwide. When untreated, severe MR is associated with significant morbidity and mortality. Mitral valve surgery is recommended in symptomatic patients and those with evidence of adverse left atrial or left ventricular remodelling. Although uncommon, stroke is a re...
Article
Introduction The underlying pathophysiology of Post-COVID-19 syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus magne...
Article
Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) are at increased risk of cardiovascular disease, including epicardial coronary heart disease, silent myocardial infarction (MI), and coronary microvascular dysfunction (CMD) [1]. All of these can be assessed and quantified using cardiac magnetic resonance (CMR), including most recently qua...
Article
Introduction The phosphocreatine-to-adenosine triphosphate ratio (PCr/ATP) is a sensitive marker of the energetic state of the heart and can be reliably measured non-invasively using 31Phosphorus magnetic resonance spectroscopy (31P-MRS). Derangements in cardiac energetics are a distinctive feature in the pathophysiology of several cardiac diseases...