Publications

Purpose To develop and evaluate a free-breathing, highly accelerated, multisection, single-beat cine sequence for cardiac MRI. Materials and Methods This prospective study, conducted from July 2022 to December 2023, included participants with various cardiac conditions as well as healthy participants who were imaged using a 3-T MRI system. A single-beat sequence was implemented, collecting data for each section in one heartbeat. Images were acquired with an in-plane spatiotemporal resolution of 1.9 × 1.9 mm2 and 37 msec and reconstructed using resolution enhancement generative adversarial inline neural network (REGAIN), a deep learning model. Multibreath-hold k-space-segmented (4.2-fold acceleration) and free-breathing single-beat (14.8-fold acceleration) cine images were collected, both reconstructed with REGAIN. Left ventricular (LV) and right ventricular (RV) parameters between the two methods were evaluated with linear regression, Bland-Altman analysis, and Pearson correlation. Three expert cardiologists independently scored diagnostic and image quality. Scan and rescan reproducibility was evaluated in a subset of participants 1 year apart using the intraclass correlation coefficient (ICC). Results This study included 136 participants (mean age [SD], 54 years ± 15; 69 female, 67 male), 40 healthy and 96 with cardiac conditions. k-Space-segmented and single-beat scan times were 2.6 minutes ± 0.8 and 0.5 minute ± 0.1, respectively. Strong correlations (P < .001) were observed between k-space-segmented and single-beat cine parameters in both LV (r = 0.97-0.99) and RV (r = 0.89-0.98). Scan and rescan reproducibility of single-beat cine was excellent (ICC, 0.97-1.0). Agreement among readers was high, with 125 of 136 (92%) images consistently assessed as diagnostic and 133 of 136 (98%) consistently rated as having good image quality by all readers. Conclusion Free-breathing 30-second single-beat cardiac cine MRI yielded accurate biventricular measurements, reduced scan time, and maintained high diagnostic and image quality compared with conventional multibreath-hold k-space-segmented cine images. Keywords: MR-Imaging, Cardiac, Heart, Imaging Sequences, Comparative Studies, Technology Assessment Supplemental material is available for this article. © RSNA, 2025.

This study aimed to assess the associations between recent cannabis use and 49 biochemical biomarkers in a representative sample of American adults, using data from the 2009-2018 National Health and Nutrition Examination Survey. A phenotype-wide association study (PheWAS) was conducted to uncover new biomarkers linked to cannabis use. The analysis included 19,926 adults aged 18-59, with a mean age of 38.93 years (50.8% women), and 36.7% reporting recent cannabis use. Metabolic associations included higher high-density lipoprotein (HDL) cholesterol (3.51 mg/dL, 95% CI [2.50, 4.62]) and lower glycohemoglobin (-0.09%, 95% CI [-0.15, -0.04]) and glucose (-2.39 mg/dL, 95% CI [-4.07, -0.70]). Hematological findings included higher hemoglobin (0.09 g/dL, 95% CI [0.02, 0.16]), mean erythrocyte volume (1.46 fL, 95% CI [1.12, 1.80]), mean erythrocyte hemoglobin (0.46 pg, 95% CI [0.32, 0.60]), erythrocyte volume fraction (0.31%, 95% CI [0.11%, 0.50%]), and lower erythrocyte counts (-0.04 million cells/µL, 95% CI [-0.07, -0.02]). Serum chemistry associations included higher bicarbonate (0.20 mmol/L, 95% CI [0.06, 0.35]) and lower chloride (-0.47 mmol/L, 95% CI [-0.69, -0.24]). Associations were also observed with 25 hydroxyvitamin-3 (OHD3) (2.38 nmol/L, 95% CI [0.55, 4.22]) and epi-25OHD3 (0.40 nmol/L, 95% CI [0.15, 0.65]), and an inverse association with globulin (-0.03 g/dL, 95% CI [-0.06, -0.01]). Sensitivity analyses confirmed the robustness of these associations. Recent marijuana use is associated with diverse and complex phenotypes, several of which have not been previously evaluated. Further validation studies are warranted, this approach offers an opportunity to understand a comprehensive range of potential effects of marijuana use.

BACKGROUND: Exposure to certain chemicals in disinfectants has been associated with vascular dysfunction in toxicological studies, but the association between disinfectant exposure and clinical cardiovascular disease (CVD) remains unclear.

OBJECTIVE: To evaluate the association between occupational exposure to disinfectants and subsequent risk of CVD among United States (US) nurses.

METHODS: We included 75,675 participants from The Nurses' Health Study II who maintained a nursing job and reported data on occupational disinfectant exposure. We estimated hazard ratios (HR) and 95% confidence intervals (CIs) of incident CVD, including coronary heart disease (CHD) and stroke, using Cox proportional hazard models comparing job types and general disinfection tasks between participants. We also used a job-task-exposure matrix to evaluate the risk of CVD by frequency of cleaning/disinfection tasks and exposure levels of 7 specific disinfectants (formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide, alcohol, quaternary ammonium compounds, and enzymatic cleaners).

RESULTS: During 10 years of follow-up (2009-2019), we documented 726 incident cases of CVD. In fully adjusted models, the hazard ratio of CVD among nurses who worked in operating rooms was 1.72 (95% CI: 1.25 to 2.36), compared with those working as educators or administrators. A similar pattern of associations was found when we separately assessed the risk for CHD and stroke (HR= 1.69 [95% CI: 1.11 to 2.58] and 1.69 [95% CI: 1.05 to 2.74 ], respectively) among operating room nurses, compared with those working as educators or administrators. Those who used disinfectants weekly had modest elevations in CVD risk (HR=1.21 [95% CI: 1.04 to 1.40]), compared with women who never used disinfectants. The highest CVD risk was observed among nurses using disinfectants or spray or aerosol products 4-7 days/week and those exposed to the highest levels of the 7 specific disinfectants listed above.

CONCLUSION: Exposure to disinfectants in real-world healthcare settings was associated with a higher risk of CVD, including CHD and stroke, among US nurses. https://doi.org/10.1289/EHP14945.

BACKGROUND: A novel mind-body intervention (MBI) targeting vascular surgery patients undergoing peripheral vascular interventions (PVIs) under procedural sedation and analgesia (PSA) was recently developed, but has yet to be clinically tested. An exploratory randomized controlled trial is planned to test the novel intervention in patients undergoing PVIs under PSA.

METHODS: Patients undergoing PVIs under PSA by vascular surgeons across four hospitals in Massachusetts and New Hampshire will be screened for enrollment. Exclusion criteria include urgent or emergent procedures, prior ipsilateral lower extremity amputations (including digit amputations) and non-English speakers. 30 patients will be enrolled and randomized 1:1 to either a perioperative MBI on the day of surgery (n = 15), or a standard of care control (n = 15). There would be no restriction on anesthesia practice, and collected data will include perioperative pain and sedation requirements and qualitative feedback from both the patients and perioperative staff.

CONCLUSIONS: This protocol delineates a pilot randomized controlled trial to test the feasibility and acceptability of a novel perioperative MBI for patients undergoing PVIs under PSA.

OBJECTIVE: To determine the effects of intensive blood pressure treatment on orthostatic hypertension.

DESIGN: Systematic review and individual participant data meta-analysis.

DATA SOURCES: MEDLINE, Embase, and Cochrane CENTRAL databases through 13 November 2023.

INCLUSION CRITERIA: Population: ≥500 adults, age ≥18 years with hypertension or elevated blood pressure; intervention: randomized trials of more intensive antihypertensive drug treatment (lower blood pressure goal or active agent) with duration ≥6 months; control: less intensive antihypertensive drug treatment (higher blood pressure goal or placebo); outcome: measured standing blood pressure.

MAIN OUTCOMES: Orthostatic hypertension, defined as an increase in systolic blood pressure ≥20 mm Hg or diastolic blood pressure ≥10 mm Hg after changing from sitting to standing.

DATA SYNTHESIS: Two investigators independently abstracted articles. Individual participant data from nine trials identified during the systematic review were appended together as a single dataset.

RESULTS: Of 31 124 participants with 315 497 standing blood pressure assessments, 9% had orthostatic hypotension (that is, a drop in blood pressure after standing of systolic ≥20 mm Hg or diastolic ≥10 mm Hg), 17% had orthostatic hypertension, and 3.2% had both a rise in systolic blood pressure and standing blood pressure ≥140 mm Hg at baseline. The effects of more intensive treatment were similar across trials with odds ratios for orthostatic hypertension ranging from 0.85 to 1.08 (I2=38.0%). During follow-up, 17% of patients assigned to more intensive treatment had orthostatic hypertension, whereas 19% of those assigned less intensive treatment had orthostatic hypertension. Compared with less intensive treatment, the risk of orthostatic hypertension was lower with more intensive blood pressure treatment (odds ratio 0.93, 95% confidence interval 0.90 to 0.96). Effects were greater among non-black versus black adults (odds ratio 0.86 v 0.97; P for interaction=0.003) and adults without diabetes versus those with diabetes (0.88 v 0.96; P for interaction=0.05) but did not differ by age ≥75 years, sex, baseline seated blood pressure ≥130/≥80 mm Hg, obesity, stage 3 kidney disease, stroke, cardiovascular disease, standing systolic blood pressure ≥140 mm Hg, or pre-randomization orthostatic hypertension (P for interactions ≥0.05).

CONCLUSIONS: In this pooled cohort of adults with elevated blood pressure or hypertension, orthostatic hypertension was common and more intensive blood pressure treatment modestly reduced the occurrence of orthostatic hypertension. These findings suggest that approaches generally used for seated hypertension may also prevent hypertension on standing.

STUDY REGISTRATION: Prospero CRD42020153753 (original proposal).

BACKGROUND: To ensure that health services are high-quality, trusted and used by the population, their design and improvement should start from the perspective of what matters to people. Patient journey mapping (PJM) is one research method that centers the experiences of individuals living with health conditions and follows their pathways through care and recovery. This paper describes a novel, qualitative PJM methodology used in Vietnam and the Philippines to inform the co-design of a people-centered viral hepatitis screening, care and treatment pathway for individuals living with chronic hepatitis, which is a significant public health concern in the Asia-Pacific region.

METHODS: Data collection involved in-depth interviews with a purposive sample of 63 people living with hepatitis (demand-side) and focus group discussions with healthcare providers working in the same geographical areas (supply-side). Rapid deductive qualitative analysis was used to identify typical journeys, and related barriers and enablers. The methodology was implemented over 8 weeks, adapting the Consolidated Criteria for Reporting Qualitative Research (COREQ).

RESULTS: This paper demonstrates how a PJM methodology that incorporates patient and HCP perspectives can be feasibly implemented in two LMIC contexts, while fulfilling many of the criteria identified by the COREQ guidelines. Sharing such methods and associated instruments may help to enable broader uptake and application in other LMIC settings, providing health systems practitioners with a critical tool to identify and overcome barriers in and promote the delivery of people-centered health services globally.

CONCLUSION: Despite limited uptake, especially in resource-limited contexts and at the primary healthcare level, PJM is a novel research method with the potential to make promising contributions to people-centered health service design.

PURPOSE: To inform decision making around mammography-screening frequency and cessation, we previously used Fine-Gray competing-risk regression to develop and validate a model to estimate older women's 10-year risk of breast cancer and their competing risk of non-breast cancer (non-BC) death. Here, we aimed to understand the amount of incident breast cancer and non-BC death risk explained by our model among women ≥ 65y.

METHODS: We included women ≥ 65y who completed the 2004 Nurses' Health Study questionnaire (NHS, n = 59,662) or who participated in the Women's Health Initiative-Extension Study (WHI-ES, n = 82,528). We calculated our model's full and risk factor-specific population attributable risk (PAR%) for incident breast cancer and non-BC death.

RESULTS: Mean age of the NHS participants was 73.5y (SD 5.2); 3.1% were diagnosed with breast cancer and 26.1% experienced non-BC death within 10 years. Mean age of WHI-ES participants was 73.6y (SD 5.4); 4.2% were diagnosed with breast cancer and 17.7% experienced non-BC death within 10 years. The full-model PAR% for breast cancer was 58.8% (22.7-80.6) in NHS and 54.8% (24.8-75.2%) in WHI-ES. Modifiable risk factors explained approximately 1/3 of breast cancer risk; BMI ≥ 30 had a PAR% of 6.5% (3.1-9.9%) in NHS and 12.2% (8.5-16.0%) in WHI-ES. For non-BC death, the full-model PAR% was 94.2% (91.4-96.1%) in NHS and 86.2% (80.9-90.0%) in WHI-ES.

CONCLUSIONS: Our competing-risk model explained the majority of breast cancers and non-BC deaths in women ≥ 65y, and we identified risk factors (e.g., elevated BMI) that may be targeted to reduce the burden of breast cancer in older women.

CONTEXT: Total fasting non-esterified fatty acid (NEFA) levels have been associated with mortality. The corresponding associations with NEFA levels following an oral glucose tolerance test (OGTT) and with individual fasting NEFA species are unclear.

OBJECTIVE: We evaluated the associations of post-load NEFA, fasting subclasses and individual NEFA with mortality.

DESIGN AND SETTING: The Cardiovascular Health Study is a population-based cohort study of community-dwelling adults over 64 years from four US communities that began in 1989-1990. Participants had total NEFA measured enzymatically before and two hours after an OGTT from archived serum samples collected in 1996-1997. Fasting individual NEFA were also measured using gas chromatography. Cox proportional hazard models were used to evaluate adjusted hazard ratios (aHR) for mortality associated with fasting and post-load total NEFA, and fasting individual and fatty acid subclasses (saturated, monounsaturated, n-3 and n-6 polyunsaturated, and trans).

RESULTS: The final population included 1996 participants with a mean age of 78 years. 60.5% were female. Over a median 11-year follow-up period, 1678 participants died. Total fasting NEFA was associated with higher risk of all-cause mortality (aHR per standard deviation: 1.17, 95% CI [1.10-1.23]). Total post-load NEFA was not associated with mortality. Among subclasses, only monounsaturated fatty acid (MUFA) was associated with total mortality (aHR 1.24, 95% CI [1.09-1.41]). For individual NEFAs, nervonic acid (aHR 1.06, 95% CI [1.01-1.12]), petroselaidic acid (aHR 1.21, 95% CI [1.03-1.42]) and eicosapentaenoic acid (aHR 0.90, 95% CI [0.82-0.99]) were associated with all-cause mortality.

CONCLUSION: Individual fasting NEFAs represent attractive candidates for medical and public health interventions aimed at improving survivorship in older adults and should be investigated further.