Steffen Erhard Petersen

Queen Mary, University of London | QMUL · William Harvey Research Institute

GitHub code URL: https://github.com/alireza-hokmabadi/DragNet

Aims Heart failure (HF) is a major health problem and early diagnosis is important. Atherosclerosis is the main cause of HF and carotid intima-media thickness (IMT) is a recognized early measure of atherosclerosis. This study aimed to investigate whether increased carotid IMT is associated with changes in cardiac structure and function in middle-ag...

Objectives To assess the feasibility of extracting radiomics signal intensity based features from the myocardium using cardiovascular magnetic resonance (CMR) imaging stress perfusion sequences. Furthermore, to compare the diagnostic performance of radiomics models against standard-of-care qualitative visual assessment of stress perfusion images, w...

Aims Left ventricular systolic dysfunction (LSVD) is a heterogeneous condition with several factors influencing prognosis. Better phenotyping of asymptomatic individuals can inform preventative strategies. This study aims to explore the clinical phenotypes of LVSD in initially asymptomatic subjects and their association with clinical outcomes and c...

Imaging plays an integral role in all aspects of managing heart disease and cardiac imaging is a core competency of cardiologists. The adequate delivery of cardiac imaging services requires expertise in both imaging methodology - with specific adaptations to imaging of the heart - as well as intricate knowledge of heart disease. The European Societ...

Imaging plays an integral role in all aspects of managing heart disease and cardiac imaging is a core competency of cardiologists. The adequate delivery of cardiac imaging services requires expertise in both imaging methodology - with specific adaptations to imaging of the heart - as well as intricate knowledge of heart disease. The European Societ...

Imaging plays an integral role in all aspects of managing heart disease and cardiac imaging is a core competency of cardiologists. The adequate delivery of cardiac imaging services requires expertise in both imaging methodology – with specific adaptations to imaging of the heart – as well as intricate knowledge of heart disease. The European Societ...

Importance: Longer leukocyte telomere length (LTL) is associated with a lower risk of adverse cardiovascular outcomes. The extent to which variation in LTL is associated with intermediary cardiovascular phenotypes is unclear. Objective: To evaluate the associations between LTL and a diverse set of cardiovascular imaging phenotypes. Design, sett...

Aims Artificial intelligence (AI) techniques have been proposed for automating analysis of short-axis (SAX) cine cardiac magnetic resonance (CMR), but no CMR analysis tool exists to automatically analyse large (unstructured) clinical CMR datasets. We develop and validate a robust AI tool for start-to-end automatic quantification of cardiac function...

We conduct a large-scale meta-analysis of heart failure genome-wide association studies (GWAS) consisting of over 90,000 heart failure cases and more than 1 million control individuals of European ancestry to uncover novel genetic determinants for heart failure. Using the GWAS results and blood protein quantitative loci, we perform Mendelian random...

BACKGROUND Identifying the imaging methods that best predict heart failure risk, cardiovascular adverse events and death is crucial for tailoring optimal management. Potential prognostic markers include myocardial mass, left ventricular ejection fraction, myocardial strain, stroke work, contraction fraction, pressure-strain product and a new measur...

The current guidelines recommend intervention in severe degenerative mitral regurgitation (MR) in symptomatic patients or asymptomatic patients with left ventricular dilatation or dysfunction. The insidious onset of symptoms may mean that patients do not report their symptoms. The role of systematic exercise testing for symptoms in MR is not clearl...

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Pat Merriman Clinical Research Training Fellowship Background Hypertension is the commonest cause of left ventricular hypertrophy (LVH), an established independent predictor of cardiovascular morbidity and mortality. Four distinct LVH phe...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health and Care Research British Cardiovascular Society. Background Cardiovascular magnetic resonance imaging (CMR) can estimate left ventricular filling pressure (LVFP). The relationship between LVFP, determined...

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation. Background Metabolomics is the detailed profiling of an individual’s circulating metabolites including carbohydrates, lipids, amino and fatty acids, and ketone bodies. Of all the -omics technologies, it provides the most proxi...

Funding Acknowledgements Type of funding sources: None. Background Assessment of inducible ischemia with stress cardiovascular magnetic resonance (CMR) is recommended in patients with chest pain and intermediate or high pre-test probability of coronary artery disease (CAD). We aimed to provide a contemporary quantitative data synthesis on diagnost...

Background and Aims Chronic kidney disease (CKD) is an established predictor of cardiovascular disease. However, the relationship between cardiovascular disease and the early stages of CKD defined as stage 1 (eGFR > 90 mL/min per 1.73 m² + albuminuria) and stage 2 (eGFR 60–89 mL/min per 1.73 m²) with and without proteinuria, is lacking. In this stu...

Aims To describe hypertension-related cardiovascular magnetic resonance (CMR) phenotypes in the UK Biobank considering variations across patient populations. Methods and results We studied 39 095 (51.5% women, mean age: 63.9 ± 7.7 years, 38.6% hypertensive) participants with CMR data available. Hypertension status was ascertained through health re...

Aims: Clinical likelihood (CL) models are designed based on a reference of coronary stenosis in patients with suspected obstructive coronary artery disease (CAD). However, a reference standard of a myocardial perfusion defects (MPD) could be more appropriate.We aimed to investigate the ability of the 2019 European Society of Cardiology pre-test pr...

Importance: The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown. Objective: To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of...

Chronological age is an imperfect measure of the aging process, which is affected by a wide range of genetic and environmental exposures. Biological age estimates may be derived using mathematical modelling with biomarkers set as predictors and chronological age as the output. The difference between biological and chronological age is denoted the "...

Aims Left ventricular hypertrophy (LVH) is an established, independent predictor of cardiovascular disease. Indices derived from the electrocardiogram (ECG) have been used to infer the presence of LVH with limited sensitivity. This study aimed to classify LVH defined by cardiovascular magnetic resonance (CMR) imaging using the 12-lead ECG for cost-...

Background and aims: Chronic liver disease (CLD) is associated with increased cardiovascular disease (CVD) risk. We investigated whether early signs of liver disease (measured by iron corrected T1-mapping, cT1) was associated with increased risk of major CVD events. Methods: Liver disease activity (cT1) and fat (PDFF) were measured using LiverMu...

Aim: This study examined sex-based differences in associations of vascular risk factors with incident cardiovascular events in the UK Biobank. Methods: Baseline participant demographic, clinical, laboratory, anthropometric, and imaging characteristics were collected. Multivariable Cox regression was used to estimate independent associations of v...

Aims: Chronic degenerative mitral regurgitation leads to volume overload causing left ventricular (LV) enlargement and eventually LV impairment. Current guidelines determining thresholds for intervention are based on LV diameters and ejection fraction (LVEF). There are sparse data examining the value of LV volumes and newer markers of LV performan...

eXplainable artificial intelligence (XAI) methods have emerged to convert the black box of machine learning models into a more digestible form. These methods help to communicate how the model works with the aim of making machine learning models more transparent and increasing the trust of end-users into their output. SHapley Additive exPlanations (...

Background: Diabetes and its cardiovascular complications are a growing concern worldwide. Recently, some studies have demonstrated that relative risk of heart failure (HF) is higher in women with type 1 diabetes (T1DM) than in men. This study aims to validate these findings in cohorts representing five countries across Europe. Methods: This stu...

In recent years, several deep learning models have been proposed to accurately quantify and diagnose cardiac pathologies. These automated tools heavily rely on the accurate segmentation of cardiac structures in MRI images. However, segmentation of the right ventricle is challenging due to its highly complex shape and ill-defined borders. Hence, the...

Artificial intelligence applications have shown success in different medical and health care domains, and cardiac imaging is no exception. However, some machine learning models, especially deep learning, are considered black box as they do not provide an explanation or rationale for model outcomes. Complexity and vagueness in these models necessita...

Background: Ischemic heart disease (IHD) has been linked with poor brain outcomes. The brain magnetic resonance imaging-derived difference between predicted brain age and actual chronological age (brain-age delta in years, positive for accelerated brain aging) may serve as an effective means of communicating brain health to patients to promote hea...

Autonomic neural control of the cardiovascular system is formed of complex and dynamic processes able to adjust rapidly to mitigate perturbations in hemodynamics and maintain homeostasis. Alterations in autonomic control feature in the development or progression of a multitude of diseases with wide-ranging physiological implications given the neura...

Background: Biological heart age estimation can provide insights into cardiac aging. However, existing studies do not consider differential aging across cardiac regions. Purpose: To estimate biological age of the left ventricle (LV), right ventricle (RV), myocardium, left atrium, and right atrium using magnetic resonance imaging radiomics phenot...

Background: Comparisons of transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) derived left ventricular ejection fraction (LVEF) have been reported in core-lab settings but are limited in the real-world setting. Methods: We retrospectively identified outpatients from 4 hospital sites who had clinically indicated quan...

Background: Guidelines recommend verification of myocardial ischemia by selective second-line myocardial perfusion imaging (MPI) following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Head-to-head data on the diagnostic performance of different MPI modalities in this setting are sparse....

Excessive trabeculation, often referred to as "noncompacted" myocardium, has been described at all ages, from the fetus to the adult. Current evidence for myocardial development, however, does not support the formation of compact myocardium from noncompacted myocardium, nor the arrest of this process to result in so-called noncompaction. Excessive...

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Academy of Medical Sciences Background LV myocardial interstitial fibrosis has been reported to influence LA morphology and function via LV remodelling and diastolic dysfunction. However, this association, as well as their combined influe...

BACKGROUND Left ventricular maximum wall thickness (LVMWT) is an important biomarker of left ventricular hypertrophy and provides diagnostic and prognostic information in hypertrophic cardiomyopathy (HCM). Limited information is available on the genetic determinants of LVMWT. METHODS We performed a genome-wide association study of LVMWT measured f...

It is now accepted that the mitral valve functions on the basis of a complex made up of the annulus, the leaflets, the tendinous cords and the papillary muscles. So as to work properly, these components must combine together in harmonious fashion. Despite the features of the arrangement of each component having been the focus of anatomical investig...

Objective: Convolutional neural networks (CNNs) have demonstrated promise in automated cardiac magnetic resonance image segmentation. However, when using CNNs in a large real-world dataset, it is important to quantify segmentation uncertainty and identify segmentations which could be problematic. In this work, we performed a systematic study of Ba...

Medical imaging provides numerous insights into the subclinical changes that precede serious diseases such as heart disease and dementia. However, most imaging research either describes a single organ system or draws on clinical cohorts with small sample sizes. In this study, we use state-of-the-art multi-organ magnetic resonance imaging phenotypes...

Background: Recent studies have shown that epicardial adipose tissue (EAT) is an independent atrial fibrillation (AF) prognostic marker and has influence on the myocardial function. In computed tomography (CT), EAT volume (EATv) and density (EATd) are parameters that are often used to quantify EAT. While increased EATv has been found to correlate w...

Background Assessment of inducible ischemia with stress cardiovascular magnetic resonance (CMR) is recommended in patients with chest pain and intermediate or high pre-test probability of coronary artery disease (CAD). We aimed to provide a contemporary quantitative data synthesis on diagnostic accuracy and prognostic value of stress CMR in patient...

Background: Chronic liver disease (CLD) and cardiovascular diseases (CVD) share common risk factors; the former is associated with a two-fold greater incidence of CVD. With most CLD being preventable/modifiable, early identification of at high-risk individuals is crucial. Using data from the UK Biobank imaging sub-study, we tested the hypothesis th...

Background Although prior reports have evaluated the clinical and cost impacts of cardiovascular magnetic resonance (CMR) for low-to-intermediate-risk patients with suspected significant coronary artery disease (CAD), the cost-effectiveness of CMR compared to relevant comparators remains poorly understood. We aimed to summarize the cost-effectivene...

Background Measurement of cardiac structure and function from images (e.g. volumes, mass and derived parameters such as left ventricular (LV) ejection fraction [LVEF]) guides care for millions. This is best assessed using cardiovascular magnetic resonance (CMR), but image analysis is currently performed by individual clinicians, which introduces er...

Background: The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS). Methods: Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL reco...

In gestation, the coronary circulation develops initially in the compact layer and it expands only in fetal development to the trabeculations. Conflicting data have been published as to whether the trabecular layer is hypoperfused relative to the compact wall after birth. If so, this could explain the poor pump function in patients with left ventri...

Objectives Evaluation of the feasibility of using cardiovascular magnetic resonance (CMR) radiomics in the prediction of incident atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), and stroke using machine learning techniques. Methods We identified participants from the UK Biobank who experienced incident AF, HF, MI, or stro...

Recent evidence suggests that shorter telomere length (TL) is associated with neuro degenerative diseases and aging related outcomes. The causal association between TL and brain characteristics represented by image derived phenotypes (IDPs) from different magnetic resonance imaging (MRI) modalities remains unclear. Here, we use two-sample Mendelian...

Objective To examine associations of birth weight with clinical and imaging indicators of cardiovascular health and evaluate mechanistic pathways in the UK Biobank. Methods Competing risk regression was used to estimate associations of birth weight with incident myocardial infarction (MI) and mortality (all-cause, cardiovascular disease, ischaemic...

A growing number of artificial intelligence (AI)-based systems are being proposed and developed in cardiology, driven by the increasing need to deal with the vast amount of clinical and imaging data with the ultimate aim of advancing patient care, diagnosis and prognostication. However, there is a critical gap between the development and clinical d...

Introduction: New-onset atrial fibrillation (NOAF) following transcatheter aortic valve replacement (TAVR) has been associated with higher morbidity and mortality. Numerous studies have focused on clinical variables for NOAF prediction. In this study, we examine pre-operative cardiac computed tomography (cCT) and echocardiographic measurements for...

Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is associated with a higher risk of important adverse health outcomes such as stroke and death. AF is linked to distinct electro-anatomic alterations. The main tool for AF diagnosis is the Electrocardiogram (ECG). However, an ECG recorded at a single time point may not detect indivi...

Deformable image registration (DIR) can be used to track cardiac motion. Conventional DIR algorithms aim to establish a dense and non-linear correspondence between independent pairs of images. They are, nevertheless, computationally intensive and do not consider temporal dependencies to regulate the estimated motion in a cardiac cycle. In this pape...

The European Heart Journal-Cardiovascular Imaging was introduced in 2012 and has during these 10 years become one of the leading multimodality cardiovascular imaging journals. The journal is currently ranked as Number 19 among all cardiovascular journals. It has an impressive impact factor of 9.130 and our journal is well established as one of the...

Objective: To examine association of COVID-19 with incident cardiovascular events in 17 871 UK Biobank cases between March 2020 and 2021. Methods: COVID-19 cases were defined using health record linkage. Each case was propensity score-matched to two uninfected controls on age, sex, deprivation, body mass index, ethnicity, diabetes, prevalent isc...

Background Assessment of ischemia with stress cardiovascular magnetic resonance (CMR) imaging is recommended in patients with stable chest pain and intermediate or high pre-test probability of coronary artery disease (CAD). Purpose To provide an updated synthesis on prognostic significance of stress CMR imaging in patients with stable chest pain a...

Introduction Left ventricular (LV) myocardial fibrosis is posited to result in left atrial (LA) changes via LV remodelling and diastolic dysfunction, though the association remains poorly characterised. Native myocardial T1 mapping is a non-invasive modality that quantifies diffuse myocardial fibrosis. This study examines the relationship between L...

Background Cardiac magnetic resonance (CMR) radiomics is a novel image quantification technique with the potential to improve image-based disease diagnosis and prediction. Purpose In this proof-of-concept study, we aimed to evaluate the utility of CMR radiomics in the prediction of incident heart failure (HF). Methods We studied 32,121 UK Biobank...

Background/Introduction To guide implantable defibrillator (ICD) use in hypertrophic cardiomyopathy (HCM), European Society of Cardiology (ESC) guidelines recommend using individualised sudden death (SCD) risk scores based on quantitative clinical data. Newly published American guidelines are based on the accumulation of binary risk markers, which...

Background/Introduction Left ventricular (LV) mid-cavity obstruction (LVMCO) in hypertrophic cardiomyopathy (HCM) is an uncommon phenotypic feature predisposed to the formation of myocardial fibrosis and apical aneurysms (LVAA). These features may be independently proarrhythmic, and LVAA is considered a class 2a indication for implantable cardiover...

Background Stress cardiovascular magnetic resonance (CMR) imaging is utilised for the evaluation of patients with stable chest pain and intermediate or high pre-test likelihood of coronary artery disease (CAD). Purpose To provide an updated synthesis of diagnostic accuracy of stress CMR imaging for the diagnosis of anatomically and functionally si...

Aims We described sex-differential disease patterns and outcomes of over 20.6 million cardiovascular emergency department (ED) encounters in the USA. Methods and results We analysed primary cardiovascular encounters from the Nationwide Emergency Department Sample (between 2016–2018). We grouped the documented cardiovascular diagnoses into 15 disea...

https://doi.org/10.1093/eurheartj/ehac237

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute For Health Research (NIHR), UK Introduction Aberrations in left ventricular (LV) filling or relaxation – known as diastolic dysfunction – occur in heart failure with preserved ejection fraction. CMR is the reference...

Introduction Hypertrophic cardiomyopathy (HCM) patients with left ventricular (LV) mid-cavity obstruction (LVMCO) often experience severe drug-refractory symptoms thought to be related to intraventricular obstruction. We tested whether ventricular pacing, guided by invasive haemodynamic assessment, reduced LVMCO and improved refractory symptoms. M...

Background and aims There is limited data on temporal trends of cardiovascular hospitalizations and outcomes amongst cancer patients. We describe the distribution, trends of admissions, and in-hospital mortality associated with key cardiovascular diseases among cancer patients in the USA between 2004 to 2017. Methods Using the Nationwide Inpatient...