Publications by staff affiliated to the Blackrock Clinic

Recent Submissions

  • Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy: the role of myocardial replacement fibrosis and the microcirculation.

    Raphael, Claire E; Mitchell, Frances; Kanaganayagam, Gajen Sunthar; Liew, Alphonsus C; Di Pietro, Elisa; Vieira, Miguel Silva; Kanapeckaite, Lina; Newsome, Simon; Gregson, John; Owen, Ruth; et al. (2021-03-08)
    Introduction: Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational cohort study. Methods: Serial patients with HCM underwent CMR, including adenosine first-pass perfusion, left atrial (LA) and left ventricular (LV) volumes indexed to body surface area (i) and late gadolinium enhancement (%LGE- as a % of total myocardial mass). We used a composite endpoint of HF death, cardiac transplantation, and progression to NYHA class III/IV. Results: A total of 543 patients with HCM underwent CMR, of whom 94 met the composite endpoint at baseline. The remaining 449 patients were followed for a median of 5.6 years. Thirty nine patients (8.7%) reached the composite endpoint of HF death (n = 7), cardiac transplantation (n = 2) and progression to NYHA class III/IV (n = 20). The annual incidence of HF was 2.0 per 100 person-years, 95% CI (1.6-2.6). Age, previous non-sustained ventricular tachycardia, LV end-systolic volume indexed to body surface area (LVESVI), LA volume index ; LV ejection fraction, %LGE and presence of mitral regurgitation were significant univariable predictors of HF, with LVESVI (Hazard ratio (HR) 1.44, 95% confidence interval (95% CI) 1.16-1.78, p = 0.001), %LGE per 10% (HR 1.44, 95%CI 1.14-1.82, p = 0.002) age (HR 1.37, 95% CI 1.06-1.77, p = 0.02) and mitral regurgitation (HR 2.6, p = 0.02) remaining independently predictive on multivariable analysis. The presence or extent of inducible perfusion defect assessed using a visual score did not predict outcome (p = 0.16, p = 0.27 respectively). Discussion: The annual incidence of HF in a contemporary ambulatory HCM population undergoing CMR is low. Myocardial fibrosis and LVESVI are strongly predictive of future HF, however CMR visual assessment of myocardial perfusion was not.
  • Safety of Adalimumab Dosed Every Week and Every Other Week: Focus on Patients with Hidradenitis Suppurativa or Psoriasis.

    Ryan, Caitriona; Sobell, Jeffrey M; Leonardi, Craig L; Lynde, Charles W; Karunaratne, Mahinda; Valdecantos, Wendell C; Hendrickson, Barbara A (American Journal of Clinical Dermatology, 2018-06-01)
    Adalimumab is approved for the treatment of hidradenitis suppurativa (HS), plaque psoriasis, and other inflammatory conditions. Our objective was to examine the safety of adalimumab administered every other week (EOW) and every week (EW) in patients with HS and psoriasis and to investigate informative data from non-dermatologic indications. The safety of adalimumab 40-mg EOW versus EW dosing was examined during placebo-controlled and open-label study periods in patients with HS (three studies), psoriasis (two studies), Crohn's disease (six studies), ulcerative colitis (three studies), and rheumatoid arthritis (one study). No new safety risks or increased rates of particular adverse events (AEs) were identified with EW dosing. In patients with HS or psoriasis, the overall safety of adalimumab 40-mg EOW and EW was generally comparable. In studies of adalimumab for non-dermatologic indications, including Crohn's disease, ulcerative colitis, and rheumatoid arthritis, the overall AE rates were similar for EW and EOW dosing.
  • Transient Coma Due To Epidural Anesthesia: The Role of Loss of Sensory Input.

    Dardis, Christopher; Lawlor, David; Schusse, Courtney M (International Scientific Literature Ltd, 2015-12-21)
    Epidural anesthesia is the most commonly used method of pain relief during labor in the USA. It is not classically associated with alterations in level of alertness. Coma during the procedure is rare, with a reported incidence of 0.1-0.3%.
  • Inter-Reader Reliability of Early FDG-PET/CT Response Assessment Using the Deauville Scale after 2 Cycles of Intensive Chemotherapy (OEPA) in Hodgkin's Lymphoma.

    Kluge, Regine; Chavdarova, Lidia; Hoffmann, Martha; Kobe, Carsten; Malkowski, Bogdan; Montravers, Françoise; Kurch, Lars; Georgi, Thomas; Dietlein, Markus; Wallace, W Hamish; et al. (PLoS One, 2016)
    The five point Deauville (D) scale is widely used to assess interim PET metabolic response to chemotherapy in Hodgkin lymphoma (HL) patients. An International Validation Study reported good concordance among reviewers in ABVD treated advanced stage HL patients for the binary discrimination between score D1,2,3 and score D4,5. Inter-reader reliability of the whole scale is not well characterised.
  • Effect of alveolar bone support on zygomatic implants in an extra-sinus position – an FEA study

    Freedman, Michael; Ring, Michael; Stassen, Leo F.A. (International Journal of Oral and Maxillofacial Surgery, 2016-02)
    Objective: To investigate the influence of maxillary alveolar bone on the stress distribution of zygomatic implants in an extra-sinus position. Materials & Methods: A threedimensional finite element model was created based on a CT scan of an edentulous female patient. Two zygomatic implants were modelled and placed in the skull in an extrasinus position. These were supported by the zygomatic bone and the maxillary alveolar bone and were connected by a fixed bridge. This model was duplicated, and the area of the maxillary alveolar bone supporting the implants was removed. Occlusal and lateral forces were applied to both models and the maximum von Mises stresses were recorded. Results: Higher maximum stresses were noted in the model with no alveolar support. Occlusal stresses were higher than lateral stresses in the model with no alveolar support, while occlusal stresses were lower than lateral stresses in the model with alveolar support. Low stresses were noted in the zygomatic bone in both models. Conclusion: Maxillary alveolar bone support is beneficial in the distribution of forces for zygomatic implants placed in an extra-sinus position.
  • An unusual cause for massive inflation

    ME Kelly, ME; Courtney, D; Heeney, A; Allen, M (Irish Medical Journal, 2015-05)
    Chagas disease is a rare condition but with an increasing incidence. Megacolon is a known sequelae. Surgical management remains the only disease modifying treatment option; with variable long-term success. We highlight an interesting case to emphasize attention to this rare condition as a differential diagnosis in any patient presenting with massive intestinal dilatation.
  • Multiple myocardial clefts on cardiac magnetic resonance imaging.

    McGorrian, Catherine; O'Hanlon, Rory; Galvin, Joseph; Mahon, Niall G; Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (C.M., J.G., N.G.M.); Centre for Cardiac Magnetic Resonance Imaging, Blackrock Clinic, Dublin, Ireland (R.O'H.); and Department of Cardiology, Connolly Hospital Blanchardstown, Dublin, Ireland (J.G.). (2013-09-17)
  • Imaging focal and interstitial fibrosis with cardiovascular magnetic resonance in athletes with left ventricular hypertrophy: implications for sporting participation.

    Waterhouse, Deirdre F; Ismail, Tevfik F; Prasad, Sanjay K; Wilson, Mathew G; O'Hanlon, Rory; Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland. (BMJ Publishing Group Ltd, 2012-11)
    Long-term high-intensity physical activity is associated with morphological changes, termed as the 'athlete's heart'. The differentiation of physiological cardiac adaptive changes in response to high-level exercise from pathological changes consistent with an inherited cardiomyopathy is imperative. Cardiovascular magnetic resonance (CMR) imaging allows definition of abnormal processes occurring at the tissue level, including, importantly, myocardial fibrosis. It is therefore vital in accurately making this differentiation. In this review, we will review the role of CMR imaging of fibrosis, and detail CMR characterisation of myocardial fibrosis in various cardiomyopathies, and the implications of fibrosis. Additionally, we will outline advances in imaging fibrosis, in particular T1 mapping. Finally we will address the role of CMR in pre-participation screening.