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  • Journal article
    Patlatzoglou K, Pastika L, Barker J, Sieliwonczyk E, Khattak GR, Zeidaabadi B, Ribeiro AH, Ware JS, Peters NS, Ribeiro ALP, Kramer DB, Waks JW, Sau A, Ng FSet al., 2025,

    The cost of explainability in artificial intelligence-enhanced electrocardiogram models

    , npj Digital Medicine, ISSN: 2398-6352

    Artificial intelligence-enhanced electrocardiogram (AI-ECG) models have shown outstanding performance in diagnostic and prognostic tasks, yet their black-box nature hampers clinical adoption. Meanwhile, a growing demand for explainable AI in medicine underscores the need for transparent, trust-worthy decision-making. Moving beyond post-hoc explainability techniques that have shown unreliable results, we focus on explicit representation learning using variational autoencoders (VAE), to capture inherently interpretable ECG features. While VAEs have demonstrated potential for ECG interpretability, the presumed performance-explainability trade-off remains underexplored, with many studies relying on complex, non-linear methods that obscure the morphological information of the features. In this work, we present a novel framework (VAE-SCAN) to model bi-directional, interpretable associations between ECG features and clinical factors. We also investigate how different representations affect ECG decoding performance across models with varying levels of explainability. Our findings demonstrate the cost introduced by intrinsic ECG interpretability, based on which we discuss potential implications and directions.
  • Journal article
    Akbari T, Mach L, Hammersley DJ, Hatipoglu S, Owen R, Taylor D, Wong J, Raja SG, Bhudia SK, Pennell DJ, Halliday BP, Jones RE, Prasad SKet al., 2025,

    Visually assessed ischaemia on cardiac magnetic resonance, but not quantitative perfusion metrics, predicts symptomatic improvement in coronary artery bypass

    , Journal of Cardiovascular Magnetic Resonance, Vol: 27, ISSN: 1097-6647

    BackgroundSerial perfusion cardiovascular magnetic resonance (CMR) in symptomatic patients undergoing coronary artery bypass grafting (CABG) may provide mechanistic insight into dynamic abnormalities of the myocardium.ObjectivesTo assess how changes in cardiac reperfusion and remodelling associate with symptom improvement in patients undergoing CABGMethodsPatients awaiting elective CABG completed serial quality of life questionnaires and detailed CMR at baseline and at 6-12 months post CABG as per protocol. Automated fully quantitative stress and rest myocardial blood flow was calculated, alongside assessment of the visual ischaemic burden. Findings were correlated with changes in symptomatology.ResultsOf 40 patients who underwent serial evaluation with CMR (mean age 62.1±9.3, median LVEF 68% [IQR: 62-73%]), there was improvement in the median visual ischaemic burden (42% [IQR: 27-51] vs 18% [IQR: 11-21], P<0.001), mean global stress myocardial blood flow (1.34±0.5 ml/min/g vs 1.59±0.5 ml/min/g, P=0.002) and median global myocardial perfusion reserve (1.85±0.6 vs 2.4±0.9, P<0.001) following CABG. Greater improvement in the SAQ-7 summary score was associated with a greater decrease in the visual ischaemic burden following CABG (ρ=-0.38, P=0.02). Quantitative MBF metrics did not associate with baseline or change in SAQ-7 summary score.ConclusionSerial perfusion CMR identifies dynamic changes in markers of myocardial perfusion in patients following CABG. Greater reduction of visually assessed ischaemia associated with improvement in SAQ-7 score. Quantitative perfusion indices were not associated with symptom improvement in this study. The results also suggest residual inducible ischaemia post CABG requiring further studies to elucidate its clinical relevance.
  • Journal article
    Le TT, Lim S, Yang C, Bryant JA, Han Y, Phua SK, Aw TC, Cook SA, Chin CWLet al., 2025,

    Circulating Interleukin-6 Predicts Adverse Outcomes in Asians with Hypertrophic Cardiomyopathy

    , Medcomm, Vol: 6
  • Journal article
    Teh I, Moulin K, Ferreira PF, Absil J, Afzali M, Agger P, Akbari B, Aletras AH, Aono S, Benton C, Bhattacharya S, Croisille P, De Bruecker Y, Dall'Armellina E, Ennis DB, Glessgen C, Glinska A, Haltmeier S, Hannum A, Hedström E, Hussein T, Jones S, Joy G, Kettless K, Kim WY, Kozerke S, Magat J, Muthupillai R, Nezafat R, Nielles-Vallespin S, Oshinski J, Ozenne V, Pennell DJ, Pettigrew R, Pierce I, Raman B, Sabisz A, Schneider JE, Sherman JH, Shetye A, Symons R, Thoma P, Treibel T, Tsuneta S, Vallee J-P, Vejlstrup N, Viallon M, Nguyen C, Scott AD, Stoeck CTet al., 2025,

    Multi-center investigation of cardiac diffusion tensor imaging in healthy volunteers by the Society of Cardiovascular Magnetic Resonance Cardiac Diffusion Special Interest Group NETwork (SIGNET)

    , Journal of Cardiovascular Magnetic Resonance, Vol: 27, ISSN: 1097-6647

    BackgroundCardiac diffusion tensor imaging (cDTI) is an emerging technique for microstructural characterization of the heart and has shown clinical potential in a range of cardiomyopathies. However, there is substantial variation reported for in vivo cDTI results across the literature, and sensitivity of cDTI to differences in imaging sites, scanners, acquisition protocols, and post-processing methods remains incompletely understood.MethodsSIGNET is a prospective multi-center, observational study in traveling and non-traveling healthy volunteers. The study was initiated by the executive board of the Society of Cardiovascular Magnetic Resonance (SCMR) Cardiac Diffusion Special Interest Group (SIG) as a follow-up to a previous multi-center study on phantom validation of cardiac DTI and a recently published SCMR consensus statement on cardiac diffusion MRI. The study has been developed by the Project Management Committee in consultation with the SCMR cardiac diffusion SIG, which includes international experts in cardiac diffusion MRI. To date, more than 20 international institutions have engaged with the study, including sites that are new to cardiac DTI, making this the largest collaborative effort in the field.DiscussionSIGNET will provide important information about the key sources of variation in cardiac DTI. This will help rationalize strategies for addressing and minimizing such variation. Harmonization of protocols in this and future studies will underpin efforts to translate cardiac DTI for clinical application.
  • Journal article
    Akbari T, Hammersley DJ, May CY-Y, Halliday BP, Prasad SKet al., 2025,

    The impact of cardio-renal-metabolic profile in dilated cardiomyopathy

    , Current Cardiology Reports, Vol: 27, ISSN: 1534-3170

    Purpose of ReviewDilated cardiomyopathy is an important contributor to heart failure burden worldwide. With an aging population and rising multimorbidity, in this review, we describe the prevalence of metabolic syndrome and renal failure in patients with dilated cardiomyopathy and focus on common underlying mechanisms, evaluate outcomes in these patients and highlight newer therapeutic strategies.Recent FindingsA significant proportion of patients with dilated cardiomyopathy has concomitant metabolic syndrome and renal disease. This combination of multimorbidity portends worse prognosis and often presents unique challenges in treatment given the complex interplay and shared pathophysiological pathways.SummaryOptimization of the cardio-renal-metabolic profile should be a key consideration in the management of patients with dilated cardiomyopathy. Therapeutic strategies targeting common pathophysiological pathways are needed in order to improve overall outcomes.
  • Journal article
    Wang H, Chen Y, Chen W, Xu H, Zhao H, Sheng B, Fu H, Yang G, Zhu Let al., 2025,

    Serp-Mamba: Advancing High-Resolution Retinal Vessel Segmentation With Selective State-Space Model.

    , IEEE Trans Med Imaging, Vol: 44, Pages: 4811-4825

    Ultra-Wide-Field Scanning Laser Ophthalmoscopy (UWF-SLO) images capture high-resolution views of the retina with typically spanning 200 degrees. Accurate segmentation of vessels in UWF-SLO images is essential for detecting and diagnosing fundus disease. Recent studies highlight that Mamba's selective State Space Model (SSM) excels in modeling long-range dependencies with linear computational complexity, making it highly suitable for preserving the continuity of elongated vessel structures, especially for high-resolution UWF images. Inspired by this, we propose the Serpentine Mamba (Serp-Mamba) network to address this challenging task. Specifically, we recognize the intricate, varied, and delicate nature of the tubular structure of vessels. Furthermore, the high-resolution of UWF-SLO images exacerbates the imbalance between the vessel and background categories. Based on the above observations, we first devise a Serpentine Interwoven Adaptive (SIA) scan mechanism, which scans UWF-SLO images along curved vessel structures in a snake-like crawling manner. This approach, consistent with vascular texture transformations, ensures the effective and continuous capture of curved vascular structure features. Second, we propose an Ambiguity-Driven Dual Recalibration (ADDR) module to address the category imbalance problem intensified by high-resolution images. Our ADDR module delineates pixels by two learnable thresholds and refines ambiguous pixels through a dual-driven strategy, thereby accurately distinguishing vessels and background regions. Experiment results on three datasets demonstrate the superior performance of our Serp-Mamba on high-resolution vessel segmentation. We also conduct a series of ablation studies to verify the impact of our designs. Our code will be released upon publication (https://github.com/whq-xxh/Serp-Mamba).
  • Journal article
    Jin W, Tian X, Wang N, Wu B, Shi B, Zhao B, Yang Get al., 2025,

    Representation-driven sampling and adaptive policy resetting for improving multi-Agent reinforcement learning

    , NEURAL NETWORKS, Vol: 192, ISSN: 0893-6080
  • Journal article
    Wang Z, Xiao M, Zhou Y, Wang C, Wu N, Li Y, Gong Y, Chang S, Chen Y, Zhu L, Zhou J, Cai C, Wang H, Jiang X, Guo D, Yang G, Qu Xet al., 2025,

    Deep Separable Spatiotemporal Learning for Fast Dynamic Cardiac MRI

    , IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, Vol: 72, Pages: 3642-3654, ISSN: 0018-9294
  • Journal article
    Kacar P, Prokselj K, Ghonim S, Semple T, V Babu-Narayan S, Nashat H, Wort SJ, Gatzoulis MA, Brida Met al., 2025,

    Advances in the imaging of pulmonary hypertension

    , INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE, Vol: 22, ISSN: 2666-6685
  • Journal article
    Hao P, Wang H, Yang G, Zhu Let al., 2025,

    Enhancing Visual Reasoning With LLM-Powered Knowledge Graphs for Visual Question Localized-Answering in Robotic Surgery

    , IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, Vol: 29, Pages: 9027-9040, ISSN: 2168-2194
  • Journal article
    Hatipoglu S, Voges I, Pushparajah K, Pomiato E, Mohiaddin R, Izgi C, Pennell DJ, Krupickova S, Di Salvo Get al., 2025,

    Stress imaging in paediatric and congenital heart disease patients.

    , Eur Heart J Cardiovasc Imaging

    Stress imaging in paediatric cardiology and congenital heart disease patients has an increasing role for functional assessment. Indications include coronary artery anomalies and disease in association with anomalous aortic origin of coronary arteries, Kawasaki disease or surgical manipulation of the coronary ostia, as well as assessment of elevated filling pressures, dynamic left ventricular outflow obstruction or significance of valvular heart disease. This review provides practical guidance focused on commonly used stress echocardiography and stress cardiovascular magnetic resonance in context of their clinical indications for this age group.
  • Journal article
    Halliday BP, Owen R, Ragavan A, Smith KL, Statton B, Berry A, Kasiakogias A, Tsoumani Z, Shanmuganathan M, Dungu JN, De Marvao A, Tayal U, Ware JS, O'regan DP, Pennell DJ, Cleland JGF, Prasad SK, Gregson J, Murphy MP, Rider OJ, Valkovic Let al., 2025,

    A double-blind, randomized placebo-controlled trial examining the effect of MitoQ on myocardial energetics in patients with dilated cardiomyopathy

    , EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, ISSN: 2047-2404
  • Journal article
    Danylenko O, Babu-Narayan S, Brida M, Heng EL, Li Wet al., 2025,

    Biventricular Interatrial Shunt With Desaturation After Atrial Septal Defect Repair.

    , JACC Case Rep, Vol: 30

    BACKGROUND: Patients after atrial septal defect (ASD) repair with residual shunt, elevated pulmonary arterial pressure or arrhythmias, and those repaired at adult age should be followed on a regular basis. CASE SUMMARY: This case describes a 43-year-old female with previous ASD repair, who presented with breathlessness, tiredness, and evidence of desaturation on exercise with a mildly positive bubble echo. While local investigations were inconclusive, diagnostic tests performed at our center revealed an inferior sinus venosus ASD-type defect with bidirectional flow, even though neither right-heart dilatation, pulmonary hypertension nor hemodynamically significant shunt was identified. The patient was offered surgical repair of the residual interatrial communication to give the patient symptomatic benefit. DISCUSSION: This case demonstrates a rare presentation of a post-ASD repair patient with bidirectional shunt without right-heart overload and no pulmonary hypertension. TAKE-HOME MESSAGE: Patients with repaired congenital defects should be followed up by specialized congenital services at reasonable interval based on the lesion and the results of the repair.
  • Journal article
    Ai R, Mao L, Jin X, Campos-Marques C, Zhang S-Q, Pan J, Lagartos-Donate MJ, Cao S-Q, Barros-Santos B, Nobrega-Martins R, Katsaitis F, Yang G, Xie C, Kang X, Wang P, Novello M, Hu Y, Bergersen LH, Storm-Mathisen J, Kuroyanagi H, Escobar-Doncel B, Gonzalez NV, Chaudhry FA, Wang Z, Zhang Q, Lu G, Sotiropoulos I, Niu Z, Chen G, Nair RR, Silva JM, Luo OJ, Fang EFet al., 2025,

    NAD<SUP>+</SUP> reverses Alzheimer's neurological deficits via regulating differential alternative RNA splicing of <i>EVA1C</i>

    , SCIENCE ADVANCES, Vol: 11
  • Conference paper
    O'Neill M, Ma J, Aldridge J, Solus J, Harvey G, Roberson P, Barc J, Bezzina C, Roden D, Walsh R, Vandenberg J, Ng C, Glazer Aet al., 2025,

    Cohort-scale automated patch clamp data improves variant classification and penetrance stratification for <i>SCN5A</i>-Brugada Syndrome

    , American-Heart-Association Scientific Sessions / American-Heart-Association Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
  • Conference paper
    Mubarak O, Constantine A, Moledina S, Kempny A, Rafiq I, Li W, Babu-Narayan S, Gatzoulis M, Hudsmith L, Al-Sakini N, Brida M, Ghonim S, Bowater S, Thorne S, Heng EL, Arif S, Clift P, Dimopoulos Ket al., 2025,

    Long-Term Outcomes in Adults with Double Outlet Right Ventricle: A Multi-centred Cohort Study

    , Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
  • Conference paper
    Gvinianidze L, Toulemonde M, Hampson R, Huang B, Bioh G, Wakefield L-A, De SK, Howard E, Tang M-X, Senior Ret al., 2025,

    Quantitative Myocardial Perfusion Assessment With Ultrafast Myocardial Contrast Echocardiography In Ischaemic Heart Disease - First in-human study

    , American-Heart-Association Scientific Sessions / American-Heart-Association Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
  • Conference paper
    Przybylski R, Norrish G, Claggett B, Fornaro A, Girolami F, Lin K, Rossano J, Lakdawala N, Olivotto I, Ingles J, Gray B, Ware J, Parikh V, Helms A, Russell M, Saberi S, Day S, Owens A, Lampert R, Stendahl J, Ryan T, Ashley E, Fernandez A, Weintraub R, Spentzou G, Radulescu CR, Delle Donne G, Bhole V, Kubus P, Ziolkowska L, Ho C, Kaski JP, Abrams Det al., 2025,

    Natural History and Outcomes of Massive Left Ventricular Hypertrophy in Childhood Hypertrophic Cardiomyopathy

    , American-Heart-Association Scientific Sessions / American-Heart-Association Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
  • Journal article
    Jurcut R, Barriales-Villa R, Biagini E, Garcia-Pavia P, Olivotto I, Protonotarios A, Arbustini E, Mogensen J, Elliott P, Arbelo E, Kaski JP, Members of the Task Force for the 2023 ESC Guidelines for the management of cardiomyopathieset al., 2025,

    Key priorities for the implementation of the 2023 ESC Guidelines for the management of cardiomyopathies in low-resource settings.

    , Eur Heart J Qual Care Clin Outcomes, Vol: 11, Pages: 910-918

    ESC Guidelines provide best practice, evidence-based recommendations for diagnosing and treating patients with cardiovascular diseases. It is not always possible for best practices to be followed, however, particularly in low-resource settings. To address this issue, a set of guideline-related documents were created to identify key priorities for users in these settings. The documents highlight the related recommendations and describe key strategies for clinicians to approach implementation of these recommendations or discuss alternatives which are in line with the intention of the recommendations, if not having all of the same advantages. The suggestions cannot be used as exact substitutes for the original recommendations in the guidelines, which have not been altered and continue to reflect best practice. This document on key priorities for low-resource settings was developed by the task force chairs and other members of the task force who produced the 2023 ESC Guidelines for the management of cardiomyopathies, which are freely available on the ESC website (https://www.escardio.org/Guidelines). This document also underwent external review including international experts from within and beyond Europe and ESC partner organizations, including the Interamerican Society of Cardiology, the Pan-African Society of Cardiology, the Asian Pacific Society of Cardiology, and the ASEAN Federation of Cardiology.
  • Journal article
    Wang J, Ruan D, Li Y, Tan T, Wu L, Yang G, Jiang Met al., 2025,

    Dynamic mask stitching-guided region consistency for semi-supervised 3D medical image segmentation

    , EXPERT SYSTEMS WITH APPLICATIONS, Vol: 292, ISSN: 0957-4174
  • Journal article
    Ademi Z, Rodda SE, Vivoda K, Hennessy S, Fenton O, Ware JS, Global Heart Hub Manifestoet al., 2025,

    Highlights from the manifesto on the health economics of cardiovascular disease prevention

    , PharmacoEconomics, Vol: 43, Pages: 1281-1292, ISSN: 1170-7690

    Cardiovascular disease (CVD) is a major contributor to the health and economic burden of disease globally. In this paper we discuss the literature on the health economics of the prevention and early intervention in CVD. We reveal the large economic impact of CVD and provide the economic argument supporting the calls for early detection and diagnosis of CVD outlined in the Global Heart Hub's patient-led Manifesto for Change. Many challenges in conducting cost-effectiveness analyses of interventions for CVD prevention are identified, as well as the emerging statistical and economic methods to help overcome these issues. Lastly, we acknowledge the profound disparities in cardiovascular health faced by minority or underserved populations, and the important role that prevention and early intervention can play in improving health equity.
  • Journal article
    Pan Q, Li Z, Qiao W, Lou J, Yang Q, Yang G, Ji Bet al., 2025,

    AMVLM: Alignment-Multiplicity Aware Vision-Language Model for Semi-Supervised Medical Image Segmentation

    , IEEE TRANSACTIONS ON MEDICAL IMAGING, Vol: 44, Pages: 4307-4322, ISSN: 0278-0062
  • Journal article
    Abdlhamid H, Krupickova S, Daubeney P, Pennell D, Mohiaddin Ret al., 2025,

    Unusual cause of myocardial infarction in a 3-year-old: role of cardiovascular magnetic resonance in diagnosis-a case report

    , EUROPEAN HEART JOURNAL-CASE REPORTS, Vol: 9
  • Journal article
    Fang EF, Fang Y, Chen G, Wang H-L, Zhang J, Wu C, Liao J, Xie C, Liu X, Wang K, Liu Y, Yang G, Wang Q, He L-T, Li J, Chen H-Z, Kang L, Jiang Y, Su H, Jiang H, He N, Tao J, Leng SX, Siow RC, Liu C, Khan HTA, Liu Y, Kato H, Sasaki T, Kim JI, Maier AB, Zhang L, Rasmussen LJ, Woo J, Wu J, Zou Het al., 2025,

    Adapting health, economic and social policies to address population aging in China

    , NATURE AGING, Vol: 5, Pages: 2176-2187
  • Journal article
    Stroeks SLVM, Merlo M, Mora-Ayestaran N, Jason M, Tayal U, Wang P, Cannata A, Sikking MA, Dal Ferro M, Peiro B, Willemars M, Hellebrekers DMEI, Van Leeuwen REW, Setti M, Gonzalez-Lopez E, Krapels IPC, Pio Loco Detto Gava C, Van Den Wijngaard A, Henkens MTHM, Iseppi M, Raafs AG, Hoes MF, Van Empel VPM, Jones EAV, Nabben M, Taylor M, Brunner HG, Ochoa JP, Dominguez F, Lakdawala NK, Sinagra G, Garcia-Pavia P, Mestroni L, Heymans SRB, Verdonschot JAJet al., 2025,

    Sex Differences in Prognosis of Patients With Genetic Dilated Cardiomyopathy

    , CIRCULATION-HEART FAILURE, Vol: 18, ISSN: 1941-3289

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