bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary insights into cardiovascular risk and erterial stiffness in patients with ankylosing spondylitis and psoriatic arthritis: a comparative study
Authors: Dimova-Mileva M , Markov M M , Kosturkova M K , Georgiev T A
Published: January 2025

Introduction

Chronic inflammation has long been considered as a driving factor for accelerated atherosclerosis and cardiovascular events in patients with rheumatic diseases like Ankylosing Spondylitis and Psoriatic Arthritis. Ultrasound examination of the carotid artery can reveal signs of early asymptomatic stage of atherosclerosis.

Aim

The study aimed to investigate the cardiovascular risk factors and arterial stiffness in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) compared to healthy controls.

Patients and Methods: 180 participants, of which 109 with AS, 41 with PsA, and 30 healthy controls, were evaluated; 99 men and 81 women, (mean age 49±20). Cardiovascular risk was assessed using the Framingham score, SCORE2, and QRISK3 scales. Biochemical markers (cholesterol, triglycerides, LDL, HDL, ESR, CRP), hypertension, and smoking status were analyzed. Ultrasound examination of the carotid artery, using Aloka Prosound α7, with measurement of the carotid intima-media thickness (CIMT), beta stiffness, augmentation index (AI), pulse wave velocity (PWV), elastic modulus (Ep), and arterial compliance (AC), were analyzed. Statistical analyses included descriptive statistics, Pearson Chi-Square tests for categorical variables, and Mann-Whitney U and Kruskal-Wallis tests for continuous variables.

Results

All subjects were comparable in terms of age, hypertension, smoking status, lipid indices and risk scores. The ultrasound examination of the carotid artery revealed significant differences in carotid intima-media thickness (CIMT) between controls and patients with AS (p = 0.013) and PsA (p = 0.005), with elevated values in both patient groups, but no significant difference between AS and PsA (p = 0.370). Beta stiffness was markedly higher in both AS (p < 0.001) and PsA (p < 0.001) patients compared to controls, with no significant disparity between AS and PsA (p = 0.322). Pulse wave velocity (PWV) showed significant increases in AS (p < 0.001) and PsA (p = 0.001) patients compared to controls, but no variation between AS and PsA (p = 0.844). No significant differences were noted in the augmentation index (AI) across groups (p = 0.507). Elastic modulus (Ep) was significantly increased in AS (p < 0.001) and PsA (p = 0.001) patients compared to controls, with no significant difference between AS and PsA (p = 0.740). Arterial compliance (AC) did not show significant differences across groups (p = 0.094). (table.1).

Conclusion

This study reveals significant increase in parameters of arterial stiffness as a marker of premature atherosclerosis in patients with rheumatic diseases as ankylosing spondylitis and psoriatic arthritis in comparison with healthy subjects. Ultrasound examination of the carotid artery – indeces of PWV, AI, EP, AC, beta-stiffness, is an easy and accessible method for diagnosing early vascular impairment in rheumatic patients.
Effects of an exercise programme on cardiac changes in cancer therapy-related cardiac dysfunction (CTRCD): protocol of the cardiac health in breast cancer (CHiB) study
Authors: Schellenberg J , Kersten J , Kersten M , Buckert D , Beer M , Janni W , Kloempken S , Fink V , Leinert E , Kirsten J , Jerg A , Schulz S
Published: January 2025

Background

The five-year survival rate of breast cancer patients has improved due to early detection and advances in oncological therapy. However, these modern cancer treatments also mean that more and more patients may experience the long-term effects of their therapy and cancer therapy-related cardiac dysfunction (CTRCD). To date, there is no established primary prevention to minimise the occurrence of CTRCD.

Purpose

The Cardiac Health in Breast Cancer (CHiB) study is a two-arm, single-center, randomised (1:1) controlled trial investigating and describing the effects of an exercise programme on cardiac changes and cardiac involvement in breast cancer patients undergoing cardiotoxic therapy.

Methods

Forty-eight females with breast cancer will be randomised to a twelve-month intervention group (IG) or a control group (CG). The IG will receive a combination of supervised high-intensity interval training (HIT) and strength training (HIRT) for six months, while the CG will train alone according to general WHO guidelines. All participants receive a cardiac magnetic resonance imaging (CMR) and a cardiopulmonary exercise test (CPET) before the start of training (t1), after six months (t2) and after 12 months following the intervention (t3). The primary endpoint is the occurrence of symptomatic or asymptomatic CTRCD. Secondary endpoints include mitochondrial dysfunction, signs of cardiac inflammation (CMR), exercise capacity, average heart rate and heart rate variability (HRV), health-related quality of life, occurrence of fatigue, depression and anxiety.

Results

The study results could indicate a primary prevention strategy to avoid adverse side effects in future breast cancer therapies and lead to recommendations for physical activity during cancer treatment.

Conclusions

CHiB is the first randomised clinical trial to investigate the effects of a structured exercise programme on the incidence of CTRCD and cardiac inflammation in the treatment of breast cancer. The clinical results could be groundbreaking for research of cardiotoxic side effects and could also lead to recommendations for other types of cancer.
Standard and advanced echocardiographic analysis of patients with severe asthma
Authors: Mandoli G E , Vigna M , Cameli P , Pastore M C , Russo M , Pecoraro V , Focardi M , Bargagli E , Cameli M
Published: January 2025

Background

Asthma is considered an inflammatory disease. Recent treatments targeting IL-5, IL-4, and IL-13 offer clinical benefits for severe stage. Limited research exists on severe asthma effects on cardiac function.

Objective

To describe cardiac size and function in patients with severe asthma and compare it to healthy controls.

Methods

A population of adult patients with severe asthma referred to our echo lab for a cardiological evaluation before biological treatment were screened for the study. Comprehensive cardiac assessments, including two-dimensional imaging, M-mode analysis, tissue Doppler examinations, and speckle tracking echocardiography (STE) analysis, were conducted for all participants on the same day just before starting biological therapy for asthma. Exclusion criteria were previous cardiac surgery, coronary or non-coronary artery disease, more than moderate left heart valvular regurgitation, atrial fibrillation, active pacemakers, sub-optimal acoustic window. A population of sex- and age-matched healthy subjects was included as reference group. Kolmogorov-Smirnov test was used to verify normal distribution of variables. Continuous variables were compared using the unpaired t test for normally distributed variables and the nonparametric Mann-Whitney U test for non-normally distributed variables.

Results

A total of 34 patients diagnosed with asthma (mean age 58±13 years, 58% female) were included in the study. All the population had preserved left ventricular systolic and diastolic function. RV dimension, standard RV functional parameters (e.g tricuspid annular plane systolic excursion and S’) and all the deformation indices of LV and RV were similar between cases and controls. Interestingly, left atrial volumes were higher in asthmatic population with reduced longitudinal deformation, described by lower peak atrial longitudinal strain (see Table 1).

Conclusion

In this monocentric pilot study, severe asthma seemed to have influence on some left atrial function and dimension but not on RV size or longitudinal function. These results, requiring further validation, can be consequence of a systemic inflammatory status and gives insights into the potential role of echocardiography in the asthmatic population.

Table 1
Roles of right ventricular function in prognosis in different strictly defined phenotypes of tricuspid regurgitation
Authors: Tsai W C , Hu C H , Li W Y
Published: January 2025

Background

Right ventricular (RV) function is regarded as an important prognostic factor for significant tricuspid regurgitation (TR). Our previous study using a step-by-step approach to classified phenotypes of TR has shown different phenotypes of TR had different effects on RV function. We believed RV function also played different roles in diffident phenotypes for prognosis.

Methods

There were 670 patients (7.7%) exhibited moderate to severe TR in our echocardiography laboratory from January to June 2018. These participants were classified into 8 phenotypes by a step-by-step approach including primary TR, secondary TR related to RV instrumentation, related to left heart disease, related to congenital heart disease, related to pulmonary hypertension, related to RV myopathy, atrial TR, and true idiopathic TR. Combined outcome endpoints included death, heart failure, acute coronary syndrome, stroke, and new arrhythmia. RV function was measured by fractional area change (FAC) from apical 4 chamber view.

Results

After mean follow-up 43.2 ± 27.9 months, there were 28 participants lost follow-up. We included 4 major groups for analysis included primary TR (11.1%), secondary TR related to left heart disease (39.4%), related to pulmonary hypertension (15.4%), true idiopathic TR (13.5%). Different phenotypes demonstrated different rates of outcomes included 43.7% in primary TR, 58.1% in left heart disease, 51.5% in pulmonary hypertension, and 29.9% in true idiopathic TR. After multivariate COX regression analysis, independent factors for prognosis were different among these groups. Left ventricular ejection fraction (HR 0.950, 95% CI 0.905-0.998) but not RV FAC was independent prognostic factor in primary TR. Age (HR 1.019, 95% CI 1.004-1.034), eGFR (HR 0.985, 95% CI 0.977-0.993), and RV FAC (HR 0.978, 95% CI 0.964-0.992) were independent predictors for prognosis in secondary TR related to left heart disease. Age (HR 1.047, 95% CI 1.016-1.079), systolic pulmonary artery pressure (HR 1.014, 95% CI 1.003-1.025), and RV FAC (HR 0.972, 95% CI 0.947-0.999) were independent prognostic factors in TR related to pulmonary hypertension. In true idiopathic TR, only right atrial area (HR 1.124, 95% CI 1.015-1.245) was independent prognostic factor.

Conclusion

RV function as prognostic factor was only noted in TR related to left heart disease and pulmonary hypertension. Different phenotypes had different prognostic factors. TR should not be treated as a single disease.
Association of transaortic flow rate with outcomes in patients with moderate aortic stenosis
Authors: Kawada Y , Springhetti P , Tomaselli M , Portolan L , Penso M , Leonardi D , Clement A , Rota A , Scarsini R , Ribichini F , Muraru D , Benfari G , Badano L
Published: January 2025

Background

In patients with severe aortic stenosis (AS), the transvalvular flow rate (FR) is a key determinant of the prognostic value of the aortic valve area (AVA). However, the prognostic significance of FR in patients with moderate AS remains unclear.

Purpose

To assess the association with outcomes of FR in patients with moderate AS.

Methods

292 outpatients (mean age 80 ± 9 years, 45% female) with moderate degenerative AS (defined as AVA between 1 cm² and 1.5 cm²) underwent transthoracic echocardiography between January 2019 and July 2022 and were retrospectively included in this study. The FR was calculated using the derivation method [FRder= mean jet velocity (cm/s) x AVA(cm²)], and was validated in a random sample of 90 patients. In these patients, FR was also calculated using the direct method [FRdir = stroke volume (mL)/ejection time (s)]. The primary study endpoint was a composite of all-cause mortality and hospitalization for heart failure (HHF).

Results

After median follow-up of 19.3 (Interquartile-Range 12.3–26.0) months, 73 patients reached the primary endpoint, with 22 experiencing HHF and 51 deaths. Patients who met the combined endpoint had lower values of FRder compared to those who didn’t experience these outcomes (201±47 mL/s vs 225±48 mL/s). The FRder showed excellent correlation with FRdir (R²=0.93, p<0.0001) (Figure 1). The best threshold value for identifying patients at higher risk of experiencing adverse outcomes of FRder was determined to be 210 mL/s through spline curve analysis.

Female sex [Odds Ratio (OR) 5.3 (C.I.95% 2.8-10.3), p<0.0001], chronic kidney disease (eGFR<60 ml/min) [OR 3.2 (C.I.95% 1.5-7.0), p=0.003], previous myocardial infarction (OR 3.9 [C.I. 95%1.7-8.6], p=0.001), stroke volume indexed (SVi) [OR 0.8 (C.I.95% 0.8-0.9), p<0.0001] and at least moderate tricuspid regurgitation (OR 2.9 [C.I. 95% 1.2-6.8], p=0.017) resulted independent predictors of FRder less than 210 mL/s.

At Cox multivariable regression analysis, FRder less than 210 mL/s resulted associated with events (adjusted Hazard Ratio 2.17 [C.I. 95% 1.14 – 4.12], p=0.018), after adjustment for age, coronary artery disease, left-ventricular ejection fraction, right-ventricular dysfunction and low flow state-defined as SVi <35 mL/m².

Conclusion

In patients with moderate degenerative AS under medical management, FRder less than 210 mL/s is independently associated with increased mortality and HHF at medium term follow-up. Further research is needed to determine whether patients with moderate AS and impaired flow rates might benefit from more intensive monitoring or earlier aortic valve replacement.

Figure 1
The role of cardiac magnetic resonance in cardiac arrest without initial underlying cause
Authors: Torremocha Lopez A , Cayetana Valbuena S , Dalmau Gonzalez-Gallarza R , Fernandez Gasso L , Refoyo Salicio E , Guzman Martinez G , Diaz Gonzalez L , Cuesta Lopez E , Rosillo Rodriguez S , Caro Codon J , Arbas Redondo E , Armada Romero E , Perez David E , Moreno Gomez J R
Published: January 2025

Introduction

The primary cause of sudden cardiac death is ischemic heart disease, but often we evaluate patients where this is excluded. Initial evaluation with echocardiogram may overlook certain morphological or functional alterations. Cardiac magnetic resonance (CMR) is recommended for survivors of cardiac arrest (CA) without a clear underlying cause (class I, level B). There is a lack of data from multicenter studies. Our aim is to assess whether CMR helps to clarify the aetiology of CA in our setting.

Methods

Retrospective observational study of survivors of CA with good neurological outcome with suspected cardiac cause admitted to Cardiology from October 2016 to April 2024. The patients did not show significant coronary lesions or those considered to be responsible for the arrest. CMR was performed for aetiological study and, on an individual basis, electrophysiology study, provocation test and/or genetics. Baseline characteristics and results of complementary tests were recorded.

Results

Thirty-two patients were included (figure 1). The average age was 50±9 years, over half were men (62,5%), and the majority had a shockable rhythm (87.5%). Genetic testing revealed a variant of uncertain significance or pathogenic in 40.6%. CMR found left ventricular (LV) systolic dysfunction in 31.3%, dilation in 18.8%, hypertrophy in 9.4%, and nonspecific morphological alterations in 9.4%. Similarly, right ventricular (RV) systolic dysfunction was observed in 9.4%, dilation in 6.3%, and morphological alterations in 6.3%. Diffuse fibrosis or interstitial disease was noted in 21.9%, edema in 18.8%, and late gadolinium enhancement in LV and/or RV in 40.6%. Figure 2 shows CMR diagnosis and final diagnosis based on initial suspicion. CMR reclassified 37.5% of patients and provided the diagnosis in 62.5% of patients.

Conclusions

CMR is a non-invasive test that constitutes a valuable tool in the context of initially non-ischemic CA, providing a comprehensive evaluation of cardiac structure, function, and tissue characterization. Routine use of CMR after CA decreases the percentage of patients classified as idiopathic ventricular fibrillation and reclassifies the diagnosis in more than a third, with consequences for the management and prognosis of the patient and their families.

Demographic data and complementary tests

Initial, CMR and final diagnosis
Can flax "milk" prevent chemotherapy mediated cardiotoxicity in women with breast cancer?
Authors: Jassal D , Arya V , Mackic L , Telles-Langdon S M , Cheung D Y C , Ledingham A , Haasbeek P , Desautels D , Gordon V , Graham J , Green S , Grenier D , Kim C , Thiessen M , Pitz M
Published: January 2025

Introduction

Cardio-oncology focuses on the prevention, diagnosis, and management of cancer patients who are at risk of developing cardiovascular complications as a result of their anti-cancer treatment. Amongst the various pharmacological therapies which may prevent anthracycline mediated cardiotoxicity in women with breast cancer, including renin-angiotensin system (RAS) antagonists, beta blockers, and statins, there has been an increased interest on the role of nutraceuticals in this setting. Although we recently demonstrated the cardioprotective role of dietary flaxseed (FLX) in the prevention of adverse cardiovascular remodeling in a chronic in vivo female murine model of anthracycline mediated cardiotoxicity, little is known on the effects of this dietary agent in the clinical setting.

Purpose

The aim of the "Can flax "milk" prevent chemotherapy mediated cardiotoxicity in women with breast cancer (CANFLAX-BC)" study was to investigate whether consumption of FLX "milk" can prevent cardiac dysfunction in women with breast cancer treated with anthracyclines.

Methods

In this double-blinded, single centre, prospective randomized controlled clinical trial, women with breast cancer were randomized to oral consumption of either placebo oat fiber "milk" or FLX "milk" [each containing 30 grams of oat or flaxseed, respectively] for a total of 4 months while receiving anthracycline-based chemotherapy. Serial echocardiography was performed at baseline, 4-month, and 6-month follow-up.

Results

Between September 2021 and December 2023, a total of 21 women with early-stage breast cancer (EBC) (mean age 48±10 years, BMI 28±5 kg/m2) were enrolled in the CANFLAX-BC study. During the 4-month intake period, a total of 8 women received oat fibre "milk" and 13 women received FLX "milk", with a comparable adherence rate of approximately 70% for both groups. At baseline, 4-month, and 6-month follow-up, the LVEF was 68±4%, 69±3%, 66±4% for the oat fibre "milk" group, and 67±5%, 68±4%, 66±5% for the FLX "milk" group (no significant difference; Table 1, Figure 1A). Although the mean global longitudinal strain (GLS) was comparable between both groups at baseline, the GLS was significantly lower at -13.8±0.3% (4 months) and -15.1±0.3% (6 months) for the oat fibre "milk" group, as compared to a preserved GLS of -18.4±0.3% (4 months) and -18.5±0.2% (6 months) for the FLX "milk group (*p<0.05; Table 1, Figure 1B).

Conclusion

In women receiving anthracycline based chemotherapy for breast cancer, FLX "milk" consumption prevents early cardiotoxicity, as reflected by the preservation of GLS parameters.

Table 1

Figure 1
Prognostic utility of non-invasive left atrial stiffness index in patients with heart failure with preserved ejection fraction: insights from EASY-HFpEF study
Authors: Takahashi T , Kusunose K , Kikuchi S , Iwahashi N , Kinugasa Y , Dohi K , Takase H , Inoue K , Okumura T , Kitada S , Seo Y , Sata M , Ohte N
Published: January 2025

Background

It is known that an increase left atrial stiffness is associated with poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF).

Purpose

We evaluated the predictive utility of non-invasive left atrial stiffness index (LASI) in HFpEF patients, comparing it to other clinical prognostic indicators.

Methods

Patients were recruited from the EASY-HFpEF study, a multicenter prospective observational cohort study in Japan involving patients hospitalized with acute decompensated heart failure and a left ventricular ejection fraction of >40%. Among the patients in the study, those with registered echocardiographic image data of sufficient quality were analyzed for left atrial strain. The LASI was calculated as the ratio of E/e’ to the left atrial reservoir strain. The primary endpoint was a composite outcome of all-cause death and readmission due to heart failure during the 2-year follow-up period.

Results

We analyzed 95 patients, with a median age of 75 years and including 41% female patients. LASI was associated with an increased risk of composite outcome (adjusted HR 1.10 [95%CI; 1.04-1.17, P=0.001] per 0.1 increase). LASI was non-inferior in predictive ability compared to predictors such as B-type natriuretic peptide (BNP) and H2FPEF score. (AUCLASI=0.79, AUCBNP=0.80 [vs.AUCLASI, P=0.775], AUCH2FPEF =0.75 [vs.AUCLASI, P=0.342]) (Figure 1). The addition of LASI significantly improved the prognostic power of a model containing BNP and H2FPEF score (model of BNP+H2FPEF score, χ2=29.3; model of BNP+H2FPEF+LASI, χ2=40.5, P=0.004) (Figure 2).

Conclusion

Non-invasive LASI in HFpEF patients is associated with increased risks of all-cause mortality and heart failure readmission, its potential utility in predicting these adverse events.
The importance of lung ultrasound in diagnosing the causes of shortness of breath in patients with heart failure
Authors: Szyszkowska A , Olesiewicz T O , Plonska Korabiewska I P K , Tarasiuk E T , Knapp M K , Sobkowicz B O , Lisowska A L
Published: January 2025

Introduction

Heart failure is a progressive chronic disease affecting up to 10% of the population over the age of 70 in developed countries. It is associated with frequent hospitalizations and a poor prognosis. One of the main symptoms reported by patients with heart failure is dyspnea. In daily practice, there are problems with adequately diagnosing and treating patients with heart failure with preserved and mildly reduced ejection fractions (HFpEF and HFmrEF).

Purpose

This study aimed to assess the usefulness of lung ultrasound (LUS) in diagnosing heart failure with preserved and mildly reduced ejection fraction and determine its correlation with NTproBNP and echocardiographic markers.

Methods

The research was conducted on 143 patients hospitalized between 2018 and 2020, admitted due to shortness of breath, and diagnosed with HFpEF and HFmrEF. Venous blood was collected from all participants to obtain basic biochemical parameters and NTproBNP. Moreover, all participants underwent echocardiography and transthoracic lung ultrasound.

Results

Assessment of the number of B-lines on lung ultrasonography at admission was characterized by high diagnostic value indicating exacerbation of heart failure symptoms, both in patients with HFpEF and HFmrEF. There were no statistically significant differences in the number of B-lines in LUS at admission in patients with EF ≥ 50% and with EF 41-49%. The number of B-lines on lung ultrasound ≥ 14 was determined as a cut-off point, indicating an increased risk of death during the 2-year follow-up period. Factors that significantly impacted mortality in the study patient population were patient age and the difference between the number of B-lines on ultrasound at admission and at hospital discharge.

Conclusions

Lung ultrasonography provides good diagnostic value in patients with HFpEF or HFmrEF and exacerbation of heart failure symptoms and may be considered as a prognostic marker in these groups of patients.

B-lines in LUS relative to NYHA class B-lines in LUS relative to risk of death
Left atrial function parameters in patients with a first episode of myocardial infarction: relationship with infarct size and serological inflammatory biomarkers
Authors: Islas F , Davila C , Martinez E , Gil-Abizanda S , Cachofeiro V , Poveda V , De Agustin J A , Luaces M , Olmos C
Published: January 2025

Aim

Left atrial (LA) function is linked with clinical events in different cardiovascular scenarios. Our aim was to evaluate the associated between LA function and different imaging and serological biomarkers in a cohort of patients with a first episode of acute myocardial infarction (AMI).

Methods

Prospective cohort of patients with a first episode of AMI treated with percutaneous revascularization in a tertiary care hospital in 2016. All patients underwent echocardiography and cardiac magnetic resonance and blood samples were taken for serological biomarkers analysis.

LA function was assessed by means of LA stiffness (E/e’ divided by LA reservoir strain) and LA volumetric-mechanical coupling index [LACI] (LA volume index divided by tissue Doppler a’).

Results

Mean age of patients in our cohort (n=41) was 57.5±10 years, and 38 (93%) were male.

64% of patients had single vessel coronary artery disease, and median LVEF eas 58% (55-62).

Regarding LA function, median LACI was 2.47 (1.99-3.14) and median LA stiffness was 0.27 (0.21-0.44), with 11 (26.8%) patients fulfilling criteria for high LA stiffness.

The correlation between these parameters and different imaging and serological biomarkers is shown in Figure 1. There was a significant correlation between LA stiffness and ventricular-arterial coupling, infarct size, and T1 native values.

LACI was associated with pulmonary artery systolic pressure, interleukin-6 and soluble CD-14 antigen. Both LA parameters were also significantly associated with left ventricular (LV) ejection fraction and LV global longitudinal strain (Figure 2).

Conclusions

In our cohort of patients with a first episode of AMI, echocardiographic parameters of LA function were significantly associated with LV function, infarct size and serological biomarkers of inflammation.

These parameters might serve as an additional tool for risk stratification in patients with ischemic cardiomyopathy.

Figure 1

Figure 2
Clinical significance of right ventricular - pulmonary arterial uncoupling in hypertrophic cardiomyopathy
Authors: Timoteo A , Aguiar Rosa S , Moura Branco L , Galrinho A , Rio P , Cruz Ferreira R
Published: January 2025

Background

Right ventricular (RV) – pulmonary arterial (PA) coupling represents the relationship between RV function and the afterload in the pulmonary vascular system. It is a non-invasive surrogate on how the RV is adapted to an increased afterload in the pulmonary circulation. In cases of exhaustion of compensatory RV remodeling, the ratio decreases and there is RV-PA uncoupling. Several studies reported the usefulness of this parameter in patients with heart failure, including in preserved ejection fraction. There is no evidence regarding the association between RV-PA coupling and hypertrophic cardiomyopathy (HCM). We aimed to evaluate this parameter in patients with HCM.

Methods

This prospective cohort study enrolled patients with HCM without obstructive epicardial coronary artery disease, that underwent a comprehensive evaluation. Echocardiography was used to assess RV-PA coupling as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). In addition, coronary flow reserve in the left anterior descending artery (CFR_LAD) was also evaluated: diastolic coronary flow velocity was measured in basal conditions and in hyperemia and CFR was calculated as the ratio of hyperemic and basal peak diastolic flow velocities. This was used as a surrogate marker of coronary microvascular dysfunction. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET). Cardiac magnetic resonance (CMR) was also performed to evaluate RV function (volumes and ejection fraction), and the extent of late gadolinium enhancement (LGE) in the left ventricle (LV).

Results

We enrolled 62 patients, with a mean age of 55 (15) years, 64% males. In 64% it was an asymmetrical septal hypertrophy phenotype, in 31% an apical hypertrophy, and in 27%, it was an obstructive HCM. Mean TAPSE/PASP was 0.556 (0.23) and median was 0.50. All patients had a normal LV ejection fraction. TAPSE/PASP showed a modest predictive accuracy for peak VO2 < 20 ml/Kg/min, a marker of decreased functional capacity (AUC 0.671, 95% CI 0.535 – 0.807, p=0.022), with the best cut-off set at 0.60 (sensitivity 85% and specificity 47%). By univariable linear regression analysis, peakVO2 was correlated with age, male gender, E/E’, indexed left atrial volume, indexed right ventricle end-systolic and end-diastolic volumes, CFR_LAD and TAPSE / PASP. The HCM phenotype or the presence of obstruction were not associated with peakVO2. Multivariable stepwise linear regression analysis showed that the independent predictors of peakVO2 were male gender (b-estimate: 0.305, p=0.002), age (b-estimate: - 0.323, p=0.002), RV indexed end-diastolic volume (b-estimate: 0.200, p=0.043) and TAPSE/PASP (b-estimate: 0.275, p=0.005).

Conclusion

In patients with HCM, RV-PA uncoupling is associated with a reduction in functional capacity. Therefore, it is a marker of disease severity.
Effect of antiretroviral treatment in myocardial function of treatment naive patients with HIV
Authors: Ikonomidis I , Katogiannis K , Pavlidis G , Thymis J , Katsanaki H , Kostelli G , Michalopoulou H , Vlachomitros D , Kavatha D , Antoniadou A
Published: January 2025

Background/Aim

HIV infection is related with cardiovascular adverse events. We investigated the effects of antiretroviral treatment in myocardial and vascular function of newly diagnosed patients with HIV.

Patients and methods: A total of 70 newly diagnosed HIV patients were enrolled. Patients were randomized to 4 different treatments which were descovy plus resolsta (emtricitabine/ tenofovir alafenamide), tivicay plus descovy (tenofovir alafenamide/ emtricitabine), genvoya (elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide) and descovy plus isentress (raltegravir). We measured at baseline and 12 months posttreatment: (a) Left Ventricular (LV) Global Longitudinal Strain (GLS), (b) LV Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE). At baseline, we compared the HIV patients with 35 healthy matched controls.

Results

At baseline patients with HIV had devastated myocardial function, endothelial function and endothelial glycocalyx compared with healthy controls.

Twelve months after intervention HIV patients improved myocardial function, as assessed by GLS, GWI and GCW as well as endothelial function as evaluated by decrease of PBR5-25.

Nevertheless, in HIV patients 12 months post treatment myocardial and endothelial function and endothelial glycocaylyx was impaired in comparison with healthy controls.

Conclusions

Treatment with antiretroviral therapy partially improves myocardial and arterial function 12 months post treatment.
Expanding the triglyceride range in clinical trials: therapeutic opportunities
Authors: Nordestgaard Ask T , Pradhan Aruna D , Everett Brendan M , MacFadyen Jean G , Bhatt Deepak L , Visseren Frank L J , Libby Peter , Santos Raul D , Nissen Steven E , Nordestgaard Børge G , Ridker Paul M
Published: January 2025

Background and Aims

Guidelines focus on individuals with triglycerides between 2.3 and 5.6 mmol/L (200 and 499 mg/dL). The hypotheses that triglycerides across the full biological range and within this constrained range associated with cardiovascular risk were re-assessed.

Methods

Multivariable-adjusted hazard ratios for major cardiovascular events and death according to baseline triglycerides among 119 573 individuals with triglycerides across the full biological range from the Copenhagen General Population Study, among 27 757 individuals with baseline triglycerides between 2.3 and 5.6 mmol/L from the Copenhagen General Population Study and the Women’s Health Study cohorts, and among 31 272 individuals with mild-to-moderate hypertriglyceridaemia from the PROMINENT, REDUCE-IT, and STRENGTH trials were calculated.

Results

Increasing triglycerides across the full range (0.3 to 11.2 mmol/L) were associated with an increasing risk of major cardiovascular events (N = 12 241). In the cohorts, combined hazard ratios [95% confidence interval (triglyceride range in mmol/L)] for major cardiovascular events (N = 3928) from lowest to highest triglyceride quartile were 1.0 [referent (range: < 2.5)], 0.95 [0.87–1.04 (range: 2.5 to <3.0)], 1.04 [0.95–1.13 (range: 3.0 to <3.6)], and 1.13 [1.04–1.23 (range: ≥ 3.6)]. In the three contemporary trials, the corresponding hazard ratios (N = 4265 cardiovascular events) from lowest to highest quartile were 1.0 [referent (ranges for PROMINENT/REDUCE-IT/STRENGTH: < 2.6/2.0/2.2)], 1.01 [0.93–1.10 (ranges: 2.6 to <3.1/2.0 to <2.5/2.2 to <2.7)], 1.05 [0.96–1.14 (ranges: 3.1 to <3.9/2.5 to <3.1/2.7 to < 3.5)] and 1.09 [1.00–1.19 (ranges: ≥ 3.9/3.1/3.5)]. In neither cohorts nor trials were triglycerides across this range strongly associated with risk of cardiovascular or all-cause death.

Conclusions

Individuals with mild-to-moderate hypertriglyceridaemia may not express the same magnitude of cardiovascular risk as that observed across the full range of plasma triglycerides. Future triglyceride-lowering therapy trials may want to consider enrolment across a wider range of triglyceride levels if there is no prior history of pancreatitis nor excessive alcohol intake.
Assessment of self-management questionnaire in diabetes mellitus (ASQ-DM-EX)—the validation of novel lived experience inventory
Authors: Swarna Nantha Yogarabindranath , Chung Ker-Rou , Suresh Hans Willard Nelson , Heng Venus Kai Ing , Yap Christina Gertrude , Tan Hui Lynn , Lau Chong Jie , Soh Kai Jun , Babu Rujul Suresh , Lim Jia Xin
Published: January 2025

Background

The optimal control of type 2 diabetes (T2D) is defined by the innate mastery of self-management behaviours. This study is designed to condense the lived experiences of people with T2D in relation to factors ‘exterior’ to themselves into a universal self-management inventory (Assessment of Self-Management Questionnaire in Diabetes Mellitus—External Reality; ASQ-DM-EX).

Methods

We collected responses to an online and physical survey from people living with T2D through a quantitative cross-sectional study. First, we tested the contextual validity and cultural preciseness of ASQ-DM-EX prototype through a preliminary pilot testing phase. These processes culminated in the development of a 91-item version of the questionnaire which was disseminated widely to evaluate the predictive strength of the ASQ-DM-EX.

Results

All constructs within ASQ-DM-EX showed internal consistencies within good to excellent range (Cronbach’s ⍺ = 0.70–0.94), except for the Influence construct (Cronbach’s ⍺ = 0.33). An increase in ASQ-DM-EX scores was associated with a reduction in HbA1c control (r = −0.17, P < 0.05). The ASQ-DM-EX model had excellent goodness-of-fit [root mean square error of approximation < 0.01; comparative fit index = 1.00; Tucker–Lewis index = 1.00].

Conclusion

The ASQ-DM-EX is a novel and holistic inventory that broadens the scope of diabetes assessment absent from contemporary self-management tools.
Rescaling Geoeconomics: The Role of Local Illicit Authority in Global Megaprojects
Authors: Idler Annette , Voyvodic Clara
Published: January 2025

Abstracts

This article examines the influence of violent non-state actors (VNSAs) on the construction of large-scale infrastructure projects in conflict-affected territories. Recentering such territories, it challenges state-centric geoeconomic narratives, which often overlook the significant role of local illicit authorities in shaping project outcomes. The study demonstrates how geoeconomic ambitions, such as regional or global influence and energy security, depend on negotiating with local actors in contested territories. The findings reveal the blurred boundaries between domestic and international authority in these regions and suggest that megaprojects must account for multi-scalar authority dynamics. We illustrate our argument by analyzing the construction of two megadam projects: the Hidroituango Dam in Colombia's Antioquia Department and the Myitsone Dam in Myanmar's Kachin State. Drawing on original evidence collected during extensive fieldwork comprising semi-structured interviews and observations in these two conflict-affected regions, we show that the Revolutionary Armed Forces of Colombia and Myanmar's Kachin Independence Army, respectively, exercised authority in regions where the state's monopoly on violence was limited. These VNSAs obstructed or facilitated megaprojects based on tactics including extortion and community representation.
Stress interaction and crack penetration mechanism between slit charge blasting holes in high in-situ stress rock mass
Authors: Sui Zhe , Yang Liyun , Xu Jiye , Li Cui , Chen Tao , Ding Chenxi
Published: January 2025

The research primarily focuses on the stress interaction between boreholes in slit charge blasting and the crack penetration mechanism. It thoroughly explores the impact of these stress interaction on crack propagation and analyzes the blasting stress wave evolution between boreholes and characteristics crack propagation characteristics. First, numerical simulation was run to look into the inter-borehole stress interaction mechanisms. Results indicate that stress wave interaction between boreholes promotes the formation and extension of radial directional cracks. However, interactions between the stress fields at crack tips and the stress wave from adjacent boreholes, as well as between crack tip stress fields themselves, negatively affect the connectivity of radial cracks between boreholes. Furthermore, the study also examines how in-situ stress and borehole spacing affect crack connectivity between boreholes. Simulation findings indicate that in-situ stress weakens hoop tensile stress between boreholes, hindering crack connectivity and suppressing the slit charge's directed blasting impact. Reducing borehole spacing can improve crack connectivity between boreholes. However, reducing spacing can negatively impact the directional blasting effect, potentially compromising surrounding rock stability. Finally, Response Surface Methodology (RSM) was used to analyze the effects of borehole spacing and in-situ stress on crack penetration, and a predictive model was constructed. Based on this, the study provides a theoretical foundation and scientific reference for the optimization of slit charge blasting parameters under high in-situ stress conditions.
PD15, a steroidal saponin, induces apoptosis of HCT116 colorectal cancer cells via suppressing the Akt/GSK3β pathway
Authors: Yao Minna , Ding Yi , Sun Yang , Gao Kai , Li Ruili , Zhang Wei , Li Weiwei , Wang Yanhua , Qiao Yi , Tang Haifeng , Wang Jingwen
Published: January 2025

Objectives

PD15, a novel natural steroidal saponin extracted from the rhizomes of Paris delavayi Franchet, has demonstrated a strong cytotoxic effect against HepG2 and U87MG cells. However, its therapeutic effects on colorectal cancer (CRC) and the underlying molecular mechanisms remain unclear.

Methods

MTT assay, clonogenic assay, Hoechst 33258 staining, flow cytometry, molecular docking, and western blot were used to investigate the mechanism of PD15 in HCT116 cell lines. Additionally, the anti-CRC effects of PD15 were evaluated in vivo using HCT116 xenograft models.

Key findings

PD15 significantly inhibited cell proliferation and induced G0/G1 phase arrest in HCT116 cells. Furthermore, PD15 upregulated cleaved Caspase 3 and 9, cleaved PARP, and Bax expression levels while downregulating Bcl-2, leading to apoptosis. Further experiments revealed that PD15 downregulated the protein expression of p-Akt and p-GSK3β, with LY294002 (a PI3K/Akt inhibitor) enhancing PD15-induced apoptosis and its effects on Akt/GSK3β-associated proteins. In addition, molecular docking demonstrated that PD15 exhibited strong binding affinity with Akt and GSK3β. Critically, PD15 inhibited CRC growth in vivo without causing apparent toxicity in mice.

Conclusions

These findings indicate that PD15 could trigger apoptosis by suppressing the Akt/GSK3β signaling pathway in HCT116 cells.
Surgical management of giant retroperitoneal liposarcoma: a case report and review of the literature
Authors: Hassani Mohammed , Deflaoui Tarik , Derkaoui Anas , Akil Yassir , Lakhloufi Mohammed , Jidou Ahmed Vadel , Ouahabi Safae , Guellil Abdelali , Jabi Rachid , Bouziane Mohammed
Published: January 2025

Liposarcoma is a rare malignant tumor of mesenchymal origin. It accounts for ~7% of all mesenchymal sarcomas and 1% of cancers in general. Its incidence does not exceed 2.5 cases per million inhabitants per year. This tumor is generally locally invasive, often diagnosed at an advanced stage, and can grow to a considerable size and weight, culminating in a locally advanced form. We report a case of a 65-year-old patient with retroperitoneal liposarcoma treated by open surgical resection. The patient was admitted for the management of an abdomino-pelvic mass measuring 40 × 27 × 17 cm, progressively evolving over 5 years. The diagnosis was established by computed tomography scan. The postoperative course was uneventful, and after 1 year of chemotherapy, the patient died of respiratory distress.
Investigating how reproductive traits in rice respond to abiotic stress
Authors: Liberatore Claudia Maria , Biancucci Marco , Ezquer Juan Ignacio , Gregis Veronica , Di Marzo Maurizio
Published: January 2025

Oryza sativa is one of the most important crops and a food source for billions of people. Anthropic global warming, soil erosion, and unstable environmental conditions affect both its vegetative and reproductive growth, and consequently the final yield of its cultivation. The reproductive phase starts with the transition of apical meristem from vegetative to reproductive, which develops into a panicle, proceeds through the differentiation of the floret, and, after fertilization, the filling of the grain. The physiological events that occur during these stages influence the ability of new seeds to respond to stresses during the future seed germination phase, a key step for successful seedling growth and future plant establishment.

This review explores the impacts of different abiotic stresses on the physiological and molecular pathways of the reproductive growth.
Discovery of high-frequency quasi-periodic oscillation in short-duration gamma-ray bursts
Authors: Yang Xing , Lü Hou-Jun , Rice Jared , Liang En-Wei
Published: January 2025

Rapidly rotating newborn magnetars, which originate from binary neutron star (NS) mergers and serve as the central engines of short gamma-ray bursts (GRBs), may leave some imprints on their prompt gamma-ray light curves even though they are far from their radiating fireballs. A high-frequency quasi-periodic oscillation (QPO) would be a unique feature for the magnetar central engine, especially a hypermassive magnetar. By conducting a systematic analysis of the prompt gamma-ray light curves from 605 short GRBs observed by Fermi/Gamma-ray Burst Monitor, we have identified such QPO signals in three GRBs (e.g. GRB 120323A, GRB 181222B, and GRB 190606A). The QPOs that peaked at $1258^{+6}_{-6}$ Hz for GRB 120323A, $623^{+4}_{-4}$ Hz for GRB 181222B, and $1410^{+4}_{-5}$ Hz for GRB 190606A are all with a confidence level above $5.2 \sigma$. The high-frequency QPO signals of those three short GRBs may be caused by a hypermassive magnetar acting as the central engine in a binary NS merger of a binary NS.
169. Universal Immunization Strategy Against Respiratory Syncytial Virus (RSV) Prevention in Chile with Nirsevimab during the 2024 Winter Season: First Southern Hemisphere Nationwide Effectiveness Data
Authors: Torres Juan P , Saure Denis , O´Ryan Miguel , Goic Marcel , Thraves Charles , Trigo Natalia , Diaz Gonzalo , Pacheco Jorge , Burgos Javiera , Aguilera Patricio , Basso Leonardo
Published: January 2025

Background

Nirsevimab for infant RSV prevention was introduced in some Northern Hemisphere countries during 2023. Chile was first to implement a universal countrywide immunization strategy following cost-effectiveness projections in the Southern Hemisphere. This strategy included all newborns born after April 1st, 2024, and infants born after October 1st, 2023. We report the first national-level impact results of this strategy up to the midwinter period.

Methods

Lower respiratory tract infections (LRTIs) attributed to RSV, causing intensive care (PICU) and overall hospitalizations, is being collected from integrated national databases. For effectiveness, individual hospitalization records are imputed to RSV by best matching ICD-10 codes to the national sentinel program and consolidated hospitalization records. Statistical analyses at different aggregation levels are being conducted to estimate the impact of nirsevimab. Detailed patient-level information is being collected to compare LRTI hospitalizations among those receiving or not nirsevimab using the Cox proportional hazards model. Effectiveness was estimated as (1 – hazard rate) ×100, and 95%CIs were obtained from the Cox model (NCT06511687).

Results

By epidemiological week 23 (mid-June 2024), nirsevimab coverage was 98% and 83% for in-season newborns and the infant catch-up group, with a total of 95,373 doses administered, from a total of 160,000 doses projected up to September 30. Effectiveness was 86% (95%CI 65-95%, 24 cases) and 75% (95%CI 64-83%, 141 cases) against PICU and overall RSV-associated hospitalizations, respectively. Among immunized and non-immunized elegible infants, days of stay were 3.95 (SD 2.46) and 7.87 (SD 6.83) (p=0.31) in the PICU and 3.23 (SD 2.02) vs 4.24 (SD 3.57) (p=0.008) in the pediatric ward, respectively. To date, no RSV deaths have been reported in Chile, compared to 13 cases in 2023. Nirsevimab associated serious adverse events have not been observed.

Conclusion

The nirsevimab-based nationwide immunization program is providing over 75% prevention against RSV associated PICU and overall hospitalizations in Chile, with an optimal safety profile. These results may encourage other similar countries to advance RSV prevention efforts (GRANT ANID PIA AFB230002 ISCI).

Disclosures

Juan P. Torres, Medical Doctor, PhD, Pfizer: Honoraria|Sanofi: Honoraria