bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of two ultrasound contrast agents for left ventricular opacification
Authors: Becher HH , Mannani N , Choy M , Paterson I , Pituskin E , Choy J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Several ultrasound contrast agents have been approved and used for measurement of LV volumes and ejection fraction (EF). However, there has been no direct comparison between these agents.

Purpose

To compare different imaging parameters between two widely used ultrasound contrast agents for LV opacification when imaged with a low power contrast specific imaging modality

Methods

A retrospective study was performed using recordings of the local echocardiography registry for patients undergoing chemotherapy for cancer treatment.  Patients were included who underwent follow-up echocardiograms (3 months) with 2 different ultrasound contrast agents and had only minor changes in the LV ejection fraction (EF) between the studies (<5%). Qualitative and quantitative analysis of the contrast effect was performed in apical four- and two chamber views (4CV,2CV). For quantitative analysis of the LV opacification square regions of interest (ROI) were placed in the apical and basal regions of the ventricle in each echocardiographic recording and the arithmetic mean and standard deviation of pixel intensity within each ROI was recorded throughout the entire loop. Qualitative visual assessment was performed using a three step visual score in order to assess the endocardial border delineation, basal attenuation and apical swirling. Wilcoxon signed-rank test was used to compare the measurements obtained with different contrast agents.

Results

41 patients fulfilled the inclusion criteria. In all patients suitable recordings for measurement of LV volumes and EF were obtained. The mean + standard deviation of the EF was 61 + 9%. Both contrast agents provided intensive LV opacification in the basal and apical cavities. The video intensities (mean + standard deviation) in the apical and basal cavities were comparable across both contrast agents in the 2CV apical ROI (219.96 + 21.42 vs 224.69 + 20.23, p = 0.32), the 2CV basal ROI (114.55, 42.02 vs 112.79, 42.57, p = 0.81), the 4CV apical ROI (228.02, 17.80 vs 225.51, 20.37, p = 0.30), and the 4CV basal ROI (100.05, 41.11 vs 92.84, 42.54, p = 0.37). Visual assessment of endocardial delineation on end-diastolic and end-systolic frames revealed no statistical difference between the contrast agents.

Conclusion

In patients with normal LV function no clinically relevant differences were found between the two contrast agents regarding LV opacification and endocardial border delineation.
Speckle tracking echocardiography strain analysis for the assessment and monitoring of myocardial mechanics after pediatric cardiac surgery
Authors: Cantinotti M , Marchese P , Franchi E , Assanta N , Van Den Eynde J , Shelby K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Speckle-tracking echocardiography (STE) is a relatively new ultrasound technique that exploits acoustic reflections and artifacts within the ultrasonic window, with the aim of analyzing global myocardial deformation and segmenting. STE has proved to be more sensitive in identifying a myocardial dysfunction so gained increasing value in the evaluation of congenital heart diseases (CHD) even though its use, in pediatric cardiac surgery, is still limited. The present study aims to evaluate the global and left ventricular (LV) systolic impairment after pediatric cardiac surgery by STE strain (ε) analysis. 

Methods

We prospectively enrolled 120 children undergoing cardiac surgery for CHD. Echocardiography was performed at four different times: pre-operatively, 12-36 hours (Time-1), 3-5 days (Time-2), 6-8 days (Time-3). Images were obtained in the 4-2-and 3 apical chamber’s views to derive LV global and regional (basal/mid/apical) ε values.

Results. We collected data from 332 examinations in 120 children (mean age: 2.33 ±3.91, range: 0-16 years) at different post-operative times. 120 age-matched healthy children (3.1 ± 4.2 years) served as controls. All global, basal, and mid LVε values reduced after surgery; the lowest values were at Time-1 (p < 0.0001) but increased thereafter. At discharge, all global, basal, and mid LVε values persisted lower than pre-operatively and healthy children (p < 0.05). Instead, apical segments (lowest at baseline), increased after surgery (p < 0.0001), but remained lower compared to controls. LV ejection fraction (LVEF) decreased at Time-1 (p = 0.0003) but promptly recovered to Time-2, to standardize at Time-3.

Conclusions. Despite LVEF was normalized by the discharge, STE ε has shown a systolic impairment after cardiac surgery that disclosed a gradual improvement but still uncomplete normalization at discharge.

Regional STE differences revealed a discrepancy base-apex: apical segments, contrary to all the other regions, showed hypercontractility after surgery. The slower recovery of LVε values compared to LVEF, suggests that STE ε analysis may be more accurate in the follow-up of mild LV post-surgical impairment. Abstract Figure. LV ventricular ε values
Modeling of intra-arterial hemodynamics in main arteries atherosclerosis
Authors: Germanova O , Galati G , Germanov AV , Shchukin YV , Fedorina MA
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Aim. To study intra-arterial hemodynamics of the main arteries in atherosclerosis using the original device for modeling of intra-arterial circulation.

Material and methods. To study hemodynamics inside an arterial vessel, we used an original device developed by us for modeling of intra-arterial circulation (Document of invention № RU 202780 U1). The main part of the device is a prototype of an artery - a glass tube of a rotameter with a length of 365 mm, an inlet end with a diameter of 20 mm, an outlet end - 16.5 mm. Flexible silicone tubes are attached to the rotameter on both sides, with free ends connected to an electric pump, with various modes of work (imitation of pulse waves at the regular rhythm (RR), extrasystole (ES), atrial fibrillation (AF)). An aqueous solution of glycerin was introduced into a closed system diluted with water corresponding to the viscosity of the blood. A 5 mm long silk thread was alternately installed inside the tube, an intravascular piezoelectric crystal pressure sensor connected to an oscilloscope was injected with a dye - clerical ink. Plastic diaphragms 15 mm long with stenosis of the internal lumen of 50%, 70%, and 90% were alternately hermetically installed in the rotameter.

Results. When imitating ES in the first post-extrasystolic contraction (1PEC), the speed of fluid flow through the diaphragms increased in the 1PEC in comparison with the RR. So, with a stenosis of 50%, the speed with a RR was 2.09 m/s, with an ES 0.03 m/s, with 1PEC 3.83 m/s; with 70% stenosis, the speed at RR 3.24 m/s, with ES 0.04 m/s, with 1PEC 5.26 m/s; with 90% stenosis, the speed at RR 8.96 m / s, with ES 0.10 m/s, with 1PEC 12.36 m/s. The pressure increased proportionally to the speed. We observed the appearance of reflected, standing waves in the edge zones of the diaphragm and a turbulent flow of liquid behind the diaphragm.

Conclusion. These changes in hemodynamics are characterized by the concept of "hydraulic shock". Intense mechanical effect of 1PEC pressure waves in the marginal zones of the diaphragm can contribute to the further growth and progression of atherosclerosis in arterial vessels. Abstract Figure.
Prognosis implications of quantified mitral regurgitation stratified by left atrial function in HFrEF population
Authors: Benfari G , Rossi L , Zanni A , Sticozzi C , Piepoli MF , Malagoli A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

The debate about the independent prognostic responsibility of functional mitral regurgitation (FMR) is still in turmoil. Growing findings about the predictive role of left atrial (LA) function are emerging in several scenarios.

PURPOSE

This study aims to define FMR linkage to cardiovascular (CV) outcomes and the interplay with LA function in a prospective cohort of consecutive heart failure patients with reduced ejection fraction (HFrEF).

METHODS

286 consecutive outpatients with chronic HFrEF were enrolled. FMR was quantified by effective regurgitant orifice area (EROA). Global peak atrial longitudinal strain (PALS) was measured by speckle tracking echocardiography (STE). The primary endpoint was defined as a composite of congestive HF hospitalization and CV death.

RESULTS

The majority (81%) of patients were men (mean age: 67 ± 11 years, mean LVEF: 32 ± 6%). The median global PALS was 17.7% ranging from 2.7% to 49.2%. FMR was quantifiable in 240 (84%) patients. During a median follow-up period of 6.4 (IQR 3.9-7.7) years, the primary endpoint occurred in 88 (31%) patients (35 HF admissions, and 53 deaths). EROA showed independent prediction for the primary endpoint (HR 1.30 [1.05-1.57], P = 0.01). The spline modeling of the risk by EROA values showed an excess event risk starting at about the EROA value of 0.1 cm2 (Figure 1). There was a remarkable graded association between the EROA strata, even if tested per 0.1 cm2 increase, and the risk of congestive HF hospitalization and CV death (P = 0.0004). Any FMR grade presenting with reduced LA function (PALS < 14%) was associated with dismal outcome (event rate of 63 ± 10% for EROA exceeding 0.3 cm2 and 49 ± 6% for EROA ≥0.1 cm2 at 5 years). Conversely, the presence of EROA ≥0.1 in the context of preserved global PALS showed a better outcome (Figure 2).

CONCLUSIONS

Our results refine the independent association between FMR and CV outcome among HFrEF outpatients. The risk of CV events starts at a low EROA value, reaching a severe level above the threshold of 0.3 cm2. Within a moderate EROA range, the LA function mitigates the clinical consequences of the mitral regurgitation, providing measurable proof of the interplay between the regurgitation and the LA compliance. Abstract Figure 1  Abstract Figure 2
Long-term follow-up of percutaneous balloon mitral valvuloplasty for mitral stenosis: an old but needed player
Authors: Ferreira V , Rodrigues I , Almeida Morais L , Cacela D , Bernardes L , Patricio L , Moura Branco L , Galrinho A , Leal A , Castelo A , Garcia Bras P , Viegas J , Cruz Ferreira R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

In the era of innovative transcatheter valve interventions, percutaneous balloon mitral valvuloplasty (PBMV) remains the primary treatment option in anatomic suitable patients. 

Purpose

This study aimed to evaluate longterm follow-up (FU) of PBMV and to determine predictors of MACE. 

Methods

Between 1991 and June 2021, 202 consecutive patients underwent PBMV in a single tertiary centre. Clinical data, echocardiographic parameters, and MACE (cardiovascular mortality, need for percutaneous or surgical mitral reintervention and hospitalization for heart failure) were analysed. Predictors of MACE were determined by Cox regression analysis. 

Results

Mean age was 47.3 ± 13.6 years, 89.6% female, 47.3% patients presenting atrial fibrillation. Mean Wilkins score was 7.6 ± 1.4, 51.5% had mild or moderate mitral regurgitation and mean pulmonary artery systolic pressure (PASP) of 46.7 ± 17.1 mmHg. Mean pre MVA and mean mitral valve (MV) gradient were 1.1 ± 0.2 cm2 and 10.8 ± 5.6 mmHg, respectively.  Successful PMBV was achieved in 89.1%. 

During a mean FU of 12.0 ± 8.8 years, there were 25 deaths (12.4%) and 33.3% needed MV reintervention (6.5% underwent PBMV and 29.7% needed MV surgery). At univariate analysis, previous MV intervention [HR = 1.95 (1.02–3.72), p < 0.05],  Wilkins score [HR = 1.22 (1.01–1.47), p < 0.05],  pre mean MV gradient≥8 [HR = 0.62 (0.38–1.00), p < 0.05],  mean MV gradient after procedure [HR = 1.37 (1.19–1.58), p < 0.05] and PASP >45 mmHg [HR = 3.29 (1.13–9.55), p < 0.05] were predictors of MV reintervention. At multivariate analysis, pre mean MV gradient≥8 [HR = 0.17 (0.037–0.81), p < 0.05] and mean MV gradient after procedure were independent predictors of MV reintervention [HR = 1.74 (1.21–2.49), p < 0.05]. Wilkins score [HR = 1.29 (1.06–1.57), p < 0.05] and mean MV gradient after procedure [HR = 1.41 (1-21–1.63), p < 0.05] were independent predictors of MACE. Cumulative event-free survival at 10 and 20 years were 72.0 and 46.0%, respectively. 

Conclusions

PBMV remains a reliable and efficient therapeutic option of mitral stenosis, warranting event-free survival at 10 years in most patients selected for the procedure. Mean MV gradient after procedure was independent predictor of MV reintervention and MACE during follow-up. Abstract Figure.  Abstract Figure.
Pathophysiological mechanism of worsened clinical outcome by lowered left ventricular cardiac power output in heart failure
Authors: Aoyagi H , Tsujinaga S , Iwano H , Ishizaka S , Tamaki Y , Motoi K , Chiba Y , Murayama M , Nakabachi M , Nishino H , Yokoyama S , Sato T , Kaga S , Nagai T , Anzai T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac power output (CPO) is a measure of cardiac pumping function, and CPO during exercise is known to be a powerful prognostic marker of heart failure. Despite its prognostic significance, pathophysiological mechanism of the association between reduced CPO and worse clinical outcome is unknown. We hypothesized that reduced CPO is associated with worse outcome through the reduced exercise capacity and enhanced ventilatory response.

Methods

Cardiopulmonary exercise testing and exercise stress echocardiography were performed in consecutive 64 patients with chronic heart failure who admitted to our department for the management of heart failure [60 ± 14 years old, left ventricular (LV) ejection fraction 39 ± 16%, ischemic etiology 16%, brain natriuretic peptide 124 pg/ml (51-313)]. Peak oxygen uptake (peak VO2) and the lowest minute ventilation / carbon dioxide production ratio (VE/VCO2) were measured as a parameter of exercise tolerance and that of ventilatory response, respectively. LV ejection fraction was measured by disk summation method at peak exercise. By using Doppler images, E/e" at peak exercise was measured as a marker of LV filling pressure, and CPO normalized by LV mass was obtained as 0.222 × cardiac output × mean blood pressure / LV mass [W/100 g]. Cardiac events defined as hospitalization for heart failure, cardiac death, or implantation of a LV assist device after the examinations were recorded.

Results

CPO at rest was weakly correlated with peak VO2 (r = 0.25, p = 0.046) but not with VE/VCO2. In contrast, CPO at peak exercise was positively correlated with peak VO2 (r = 0.50, p < 0.001) and inversely correlated with VE/VCO2 (r=-0.40, p = 0.002). Moreover, CPO at peak exercise determined both peak VO2 (b = 0.50) and VE/VCO2 (β=-0.54) independently of LV ejection fraction and E/e" at peak exercise. During a median follow-up period of 1211 days, 12 cardiac events were observed. Each of reduced peak VO2 (hazard ratio 0.78, 95% confidence interval 0.66-0.90) and increased VE/VCO2 (hazard ratio 1.10, 95% confidence interval 1.02-1.18) was associated with worse clinical outcome.

Conclusions

In patients with chronic heart failure, CPO during exercise was associated with prognosis of heart failure through the reduced exercise capacity and enhanced ventilatory response.
Combined assessment of septal scar and septal flash by cardiac magnetic resonance identifies responders to cardiac resynchronization therapy
Authors: Kjellstad Larsen C , Duchenne J , Galli E , Aalen JM , Lederlin M , Bogaert J , Kongsgaard E , Linde C , Penicka M , Donal E , Voigt J-U , Smiseth OA , Hopp E
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority. Research grants of the University of Leuven.

Background

Left ventricular (LV) scar, particularly in the lateral wall and septum, reduces response rate to cardiac resynchronization therapy (CRT), whereas a dyssynchronous LV contraction pattern (septal flash) suggests good response. Lateral wall scar abolishes septal flash. Therefore, a combined approach of septal scar and septal flash may characterize the myocardial substrate responsive to CRT. Cardiac magnetic resonance (CMR) may assess both scar and contraction pattern.

Purpose

The present study aimed to determine if combined assessment of septal scar and septal flash by CMR as single image modality identifies responders to CRT.

Methods

We investigated all CRT recipients with available CMR from a prospective, multicenter study (n = 136), with both ischemic and non-ischemic heart failure. Septal scar was assessed by late gadolinium enhancement (LGE) from a stack of short axis slices (n = 128) and septal flash determined visually on ordinary cine sequences (n = 136). CRT response was defined as ≥15% reduction in LV end-systolic volume by echocardiography at 6 months follow-up. We also assessed heart transplantation or death of any cause 39 ± 13 months after device implantation.

Results

In multivariate analysis including percentage septal scar (LGE), septal flash, QRS-duration and QRS-morphology, septal LGE and septal flash were the only independent predictors of CRT response (both p < 0.001). A combined approach of septal LGE and septal flash predicted CRT response with area under the curve 0.86 (95% confidence interval (CI): 0.78-0.94) and long-term survival without heart transplantation with hazard ratio 0.18 (95% CI: 0.05-0.61).

A practical approach to selection of CRT candidates by septal LGE and septal flash is illustrated in the present figure. As shown, absence of septal LGE indicated excellent response rate (93%) to CRT independent of other parameters. When septal LGE was present, however, overall response rate was substantially lower (58%), but presence or absence of septal flash separated responders from non-responders with high accuracy. This sequential approach correctly classified 86% of patients. Importantly, the approach was equally accurate in patients with intermediate QRS duration (130-150ms), where 93% of patients were correctly classified.

Conclusions

Combined assessment of septal LGE and septal flash by CMR as single image modality identifies CRT responders with high accuracy and predicts long-term survival. Abstract Figure.
Simple echocardiographic parameters could be helpful in the identification of new-onset atrial fibrillation in acute myocardial infarction
Authors: Raczkowska-Golanko M , Raczak G , Gruchala M , Danilowicz-Szymanowicz L
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

New-onset atrial fibrillation (NOAF) is a significant complication of acute myocardial infarction (AMI) associated with a poor prognosis. The knowledge of NOAF risk factors in nowadays AMI patients is still the subject of interest. Our study aimed to investigate which echocardiographic, additionally to other clinical, routinely checked parameters could impact NOAF occurrence in AMI.

Patients and methods

This single-center, retrospective study was conducted on all consecutive patients admitted to the University Clinical Center from January 2017 to December 2018 with an AMI diagnosis. Detailed medical history, routinely checked laboratory and echocardiography parameters, invasive and pharmacological treatment, as well as complications and in-hospital mortality, were taken into further analysis in NOAF detection.

Results

  NOAF was documented in 106 of 954 (11%) AMI patients and was significantly associated with in-hospital mortality [odds ratio [OR] 4.54, 95% confidence interval [CI] 2.50 – 8.33, p < 0.001). Left atrium size ≥ 41 mm and left ventricular ejection fraction (LVEF) ≤ 44 % were significantly associated with NOAF in univariate logistic analysis (OR 2.14 [1.37 – 3.33], p <0.001 and 2.99 [1.98 – 4.53], p < 0.001 respectively); whereas LVEF maintained their significance in multivariate analysis (OR 1.93 [1.12 – 3.12], p = 0.020). Age, B-type natriuretic peptide (BNP), C- reactive protein (CRP), high-sensitivity troponin I, total cholesterol, low-density lipoprotein cholesterol, potassium level, hemoglobin, leucocytes, and neutrophil to lymphocyte ratio, were another predictors of NOAF.

Conclusions

NOAF is a multifactorial, significant complication of AMI, leading to a worse prognosis. Simple echocardiographic parameters could be helpful in the identification of high-risk patients.
Systemic inflammation in the acute myocardial infarction can predict early negative left ventricular remodeling assessed by myocardial work analysis
Authors: Danet R , Rimbas RC , Bratu V , Magda S , Mihalcea D , Mihaila S , Lungeanu L , Velcea A , Gheorghiu L , Dragoi R , Corlan A , Schiopu A , Simionescu M , Vinereanu D
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): UEFISCDI

Background. Left ventricular (LV) remodeling after acute myocardial infarction (AMI) is an important predictor of heart failure (HF). Systemic inflammatory response in the acute phase of AMI is of particular interest, while the relation to the remodeling process is still under debate. New imaging techniques derived from speckle tracking echocardiography (STE), such as myocardial work (MW), are attractive tools since they can detect myocardial remodeling before decrease of global LVEF. However, there is insufficient data regarding MW in AMI patients, and its relation to the inflammatory process.

Methods. We assessed 57 patients (53 ± 9 years, 45 men, 64% smokers, 59% hypertensive, 54% with type 2 diabetes) with AMI, by clinical, 2D echo, and STE. Biomarkers panel was evaluated within the first 24 hours from admission: hsTpI and CRP. A second visit with clinical and echo assessment was performed at 6-8 weeks from the baseline visit. Exclusion criteria were unstable patients, non-sinus rhythm, significant valvular disease (>grade 2), other significant pathologies leading to decreased life expectancy, and low quality 2DE. At both visits, global longitudinal stain (GLS) and MW by 2DSTE were measured, on top of conventional echo parameters: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) (Figure 1: upper panel - an example of a patient with increase of GWE from baseline to visit 2 ; lower panel - an example of a patient with decrease of the GWE from baseline to visit 2).

Results. At baseline, myocardial necrosis by hsTpI significantly corelated with GLS (r = 0.44, p = 0.001) and MW (GWI: r=-0.44, p = 0.001; GCW: r=-0.40, p = 0.002), but not with LVEF. However, systemic inflammation by CRP did not correlate with LVEF or any of the STE parameters.  Interestingly, systemic inflammation by CRP significantly correlated with changes of MW between the two visits: for GWE r=-0.53, p < 0.001; and for GWW r = 0.48, p < 0.001 (Figure 2). A CRP level >28 mg/l was able to predict decrease of GWE from baseline to visit 2.

Conclusions. Magnitude of necrosis, expressed by hsTpI, corelates only with GLS and MW parameters, but not with LVEF. CRP level in the acute phase of AMI correlates with myocardial work changes, as an early marker of negative LV remodeling. Abstract Figure 1  Abstract Figure 2
Impact of type II diabetes on LV remodeling and function in patient with severe aortic stenosis
Authors: Seillier G , Pozzi M , Paillard M , Pierrard R , Chalabreysse L , Nouviant C , De-Bourguignon C , Givre L , Farha F , Vola M , Uhlrich W , Bessyre-Des-Horts T , Obadia JF , Bergerot C , Thibault H
Published: February 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): PHRC inter régional

Background

Type II diabetes (T2DM) can specifically cause left ventricular (LV) remodeling and systolic and/or diastolic abnormalities. This diabetic cardiomyopathy is associated with an increased risk of heart failure. T2DM is frequently associated with LV pressure overload as encountered in aortic stenosis (AS). The effect of T2DM on LV remodeling induced by AS remained unclear.

Purpose

We aimed to evaluate the impact of T2DM on left ventricular (LV) remodeling and function in patients with severe AS referred for aortic valve replacement.

Methods

We included patients with severe AS and no overt heart disease referred for aortic valve replacement. Patients with atrial fibrillation, left ventricular ejection fraction (LVEF) <50%, significant coronary stenosis or a more than mild associated valvular heart disease were excluded. Baseline ultrasound parameters were measured including 2D and 3D left ventricle mass (LVM), LVEF, posterior wall thickness (PWT) and global longitudinal strain (GLS). We also studied LV diastolic function and left ventricular filling pressure according to current guidelines.

Results

82 patients were included; 32 were diabetics. Hypertension and dyslipidemia were more frequent in T2DM patients. Aortic mean gradient, aortic valve area and cardiac index were similar between the two groups. There was no difference in valvuloarterial impedance indexed to height^2.04.

PWT, 3D LVM and 3D LVM index to height^2.7 were higher in T2DM patients (p = 0.03, p = 0.01 and p = 0.04, respectively). In multivariable analysis, after controlling for age, gender, BMI and hypertension, T2DM remained associated with a greater 3D LVM index (p= 0.04).

Diabetic patients also presented a worse LV systolic function with a lower absolute value of GLS compared to non-diabetics (15.1 ± 2.7 vs. 17.8 ± 2.0; p < 0.01). The association of T2DM with a decreased GLS remained significant in multivariate analysis (p < 0.01; Table 1). Estimated left ventricular filling pressure was not significantly affected by T2DM. However, there was a trend towards more patients with elevated LV filling pressure in T2DM group (40% vs 22% in non T2DM patients; p = 0.08).

Conclusion

T2DM increases LV hypertrophy and LV dysfunction in patients with severe AS.  Prognostic issues should be further assessed as it may encourage an earlier management of T2DM patients with severe AS. Abstract Figure. Parameters Associated with GLS
Evaluating the performance of unenhanced computed tomography in the diagnosis of pulmonary embolism
Authors: Hatami F , Ehsanbakhsh A , Valizadeh N , Khorashadizadeh N , Norouzirad F
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary embolism (PE) is the third most common cardiovascular pathology after coronary artery disease and stroke with an incidence rate of 1 per 1000 individuals. Computed tomography pulmonary angiography (CTPA) as the gold standard examination in the detection of PE is contraindicated or unavailable in certain cases.

Purpose

The current study aimed to assess the accuracy of unenhanced CT in the diagnosis of PE.

Methods

A total of 195 consecutive participants with clinical suspicion for PE were enrolled in this prospective cohort study between October 2020 and March 2021. All patients were examined with a 16 slice multidetector (MD) CT scanner before performing the CTPA. Scans were independently reviewed by two expert radiologists who were blinded to patients’ clinical and laboratory history for imaging variables including presence and location of PE, hyper/hypodense intraluminal signs, pulmonary trunk enlargement, peripheral wedge-shaped opacity, and pleural effusion. First unenhanced CT scan and then CTPA were independently reviewed on a picture archiving and communications system workstation.

Results

There were 82 (42.1%) men and 113 (57.9%) women with the mean age ± standard deviation of 56 ±0.24 years. Based on CTPA results, 47 (24.1%) of 195 patients had PE of which 28 (59.5%) patients had central PE and 19 (40.5%) patients had peripheral PE. However, only 20 cases (42.5%) were detected with PE on MDCT scans consisting of 17 cases with (85%) central emboli and 3 cases with (15%) peripheral emboli. Given intraluminal clot density, 12 (60%) patients had hyperdense signs, 3 (15%) patients had hypodense signs, and 5 (25%) patients had mixed hyper-hypodense signs. There was a significant difference between central and peripheral embolies detected by MDCT. Intraluminal sign had the highest specificity and sensitivity (98.6%, 42.5%, AUC:0.734) followed by pulmonary trunk enlargement (84.4%, 36.1%, AUC: 0.603), peripheral wedge-shaped opacity (72.9%, 34%, AUC: 0.535), and pleural effusion (58.7%, 40.4%, AUC: 0.496). Our results did not show a remarkable difference in secondary findings from the MDCT scan including pulmonary trunk enlargement, peripheral wedge-shaped opacity, and pleural effusion concerning the presence of PE. Pleural effusion as the most common secondary finding in patients with PE was found in 31 (68.8%) of them.

Conclusion

Unenhanced MDCT has an acceptable performance to detect PE particularly central clots and should be considered as an alternative modality when CTPA is not available or indicated. Furthermore, the intraluminal sign is the main indicator of PE in MDCT images with the highest specificity and sensitivity. We recommend radiologists and other clinicians to be aware of intraluminal signs in case of unexpected PE.
Description of cardiovascular imaging abnormalities among hospitalized COVID-19 patients with elevated cardiac biomarkers
Authors: Manla Y , Khalouf A , Bonilla MF , Eltahlawy W , Bafadel A , Al Badarin F
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background and aims

Myocardial injury is commonly encountered among severely-ill COVID-19 patients. Underlying mechanisms, however, remain incompletely understood. Describing cardiovascular imaging (CVI) abnormalities in this population will provide additional insight into mechanisms of myocardial injury with COVID-19 and may potentially guide management for these patients. Therefore, we aimed to describe CVI abnormalities in COVID-19 patients with elevated  high-sensitivity cardiac troponin (hs-cTn).

Methods

Consecutive hospitalized COVID-19 patients (n = 694) between February and July 2020 were retrospectively identified, including 409 patients with available hs-cTn (≥14 ng/dL was considered abnormal) Abnormality with any CVI—including transthoracic echocardiography (TTE), cardiac CT angiography, cardiac MR or invasive coronary angiography (ICA)—were identified through review of electronic records.

Results

Hospitalized COVID-19 patients with abnormal hs-cTn (107/409; 26.2%) had more frequent utilization of CVI compared with those with normal hs-cTn (61.7% vs. 30.5%, OR:3.7, 95%CI [2.3,5.8]) or those without available hs-cTn data (61.7% vs. 29.9%, OR:3.8, 95%CI [2.4,6]). Most utilized CVI modalities were TTE (63/107; 58.9%) followed by ICA (6/107; 5.6%). Echocardiographic abnormalities detected include right or left ventricular systolic dysfunction (22%), pericardial effusion (11%), while coronary artery disease was identified in 83.3% of patients who underwent ICA.

Conclusion

In this single center experience, cardiac biomarker elevation in hospitalized COVID-19 patients was associated with a 3-fold increase in the likelihood of CVI utilization, most commonly TTE. Ventricular systolic dysfunction and severe coronary artery disease were commonly encountered in patients with abnormal hs-cTn. However, these results need to be interpreted in the context of inconsistent use of CVI in patients with elevated cardiac biomarkers, which may preclude arrival at definitive conclusions. Prospective studies with standardized use of CVI in high-risk COVID-19 patients are warranted to advance our understanding of cardiac toxicity with COVID-19.
Microbial ecology of the atmosphere
Authors: Šantl-Temkiv Tina , Amato Pierre , Casamayor Emilio O , Lee Patrick K H , Pointing Stephen B
Published: February 2022

The atmosphere connects habitats across multiple spatial scales via airborne dispersal of microbial cells, propagules and biomolecules. Atmospheric microorganisms have been implicated in a variety of biochemical and biophysical transformations. Here, we review ecological aspects of airborne microorganisms with respect to their dispersal, activity and contribution to climatic processes. Latest studies utilizing metagenomic approaches demonstrate that airborne microbial communities exhibit pronounced biogeography, driven by a combination of biotic and abiotic factors. We quantify distributions and fluxes of microbial cells between surface habitats and the atmosphere and place special emphasis on long-range pathogen dispersal. Recent advances have established that these processes may be relevant for macroecological outcomes in terrestrial and marine habitats. We evaluate the potential biological transformation of atmospheric volatile organic compounds and other substrates by airborne microorganisms and discuss clouds as hotspots of microbial metabolic activity in the atmosphere. Furthermore, we emphasize the role of microorganisms as ice nucleating particles and their relevance for the water cycle via formation of clouds and precipitation. Finally, potential impacts of anthropogenic forcing on the natural atmospheric microbiota via emission of particulate matter, greenhouse gases and microorganisms are discussed.
A new anisotropic poroelasticity model to describe damage accumulation during cyclic triaxial loading of rock
Authors: Lyakhovsky Vladimir , Panteleev Ivan , Shalev Eyal , Browning John , Mitchell Thomas M , Healy David , Meredith Philip G
Published: February 2022

Crustal rocks undergo repeated cycles of stress over time. In complex tectonic environments where stresses may evolve both spatially and temporally, such as volcanoes or active fault zones, these rocks may experience not only cyclic loading and unloading, but also rotation and/or reorientation of stresses. In such situations, any resulting crack distributions form sequentially and may therefore be highly anisotropic. Thus, the tectonic history of the crust as recorded in deformed rocks may include evidence for complex stress paths, encompassing different magnitudes and orientations. Despite this, the ways in which variations in principal stresses influence the evolution of anisotropic crack distributions remain poorly constrained. In this work, we build on the previous non-linear anisotropic damage rheology model by presenting a newly developed poroelastic rheological model which accounts for both coupled anisotropic damage and porosity evolution. The new model shares the main features of previously developed anisotropic damage and scalar poroelastic damage models, including the ability to simulate the entire yield curve through a single formulation. In the new model, the yield condition is defined in terms of invariants of the strain tensor, and so the new formulation operates with directional yield conditions (different values for each principal direction) depending on the damage tensor and triaxial loading conditions. This allows us to discern evolving yield conditions for each principal stress direction and fit the measured amounts of accumulated damage from previous loading cycles. Coupling between anisotropic damage and anisotropic compaction along with the damage-dependent yield condition produces a reasonable fit to the experimentally obtained stress–strain curves. Furthermore, the simulated time-dependent cumulative damage is well correlated with experimentally observed acoustic emissions during cyclic loading in different directions. As such, we are able to recreate many of the features of the experimentally observed directional 3-D Kaiser ‘damage memory’ effect.
On the use of the microtremor HVSR for tracking velocity changes: a case study in Campo de Dalías basin (SE Spain)
Authors: Seivane Helena , García-Jerez Antonio , Navarro Manuel , Molina Luis , Navarro-Martínez Francisco
Published: February 2022

The stability of the low-frequency peaks (<1 Hz) obtained in the passive seismic survey of Campo de Dalías basin (CDB) by applying the horizontal-to-vertical spectral ratio (HVSR) method was investigated. Three temporary seismic stations were installed in remote sites that enabled studying the stationarity of their characteristic microtremor HVSR (MHVSR) shapes. All stations began to operate in mid-2016 and recorded at least 1 yr of continuous seismic ambient noise data, having up to 2 yr in some. Each seismic station was counted with a monitored borehole in their vicinity, registering the groundwater level every 30 min. The MHVSR curves were calculated for time windows of 150 s and averaged hourly. Four parameters have been defined to characterize the shape of the MHVSR around the main peak and to compare them with several environmental variables. Correlations between MHVSR characteristics and the groundwater level are shown to be the most persistent. The robustness of MHVSR method for applications to seismic engineering was not found to be compromised since the observed variations were within the margins of acceptable deviations. The results of this study have widen the possibilities of the MHVSR method from being a reliable predictor for seismic resonance to also being an autonomous monitoring tool, especially sensitive to the S-wave modifications.
Saffronizing diplomacy: the Indian Foreign Service under Hindu nationalist rule
Authors: Huju Kira
Published: February 2022

Very little is known about how Indian diplomats have made sense of the change in political power in New Delhi since 2014, when the election of Hindu nationalist Prime Minister Narendra Modi signalled a radical break from the internationalist credo of the Nehruvian Congress establishment. Attending to this gap in knowledge, this article engages with the ongoing debate about the influence of Hindu nationalism on Indian diplomacy, but departs from the conventional emphasis on foreign-policy analysis or Modi's persona. Instead, it centres on the lived experience of career diplomats in the Indian Foreign Service to whom it falls to conduct everyday diplomacy under Hindu nationalist rule. This focus invites a broader question in the global age of populism: how do contemporary diplomatic services adjust to the arrival of nationalist governments? I suggest that the delays in internalization of nationalist norms and diplomatic practices are only partly a function of ideological misalignment between an internationalist bureaucracy and a nationalist government. What matters is also the extent to which the status of the social class represented by the bureaucrats is invalidated by the government's political project. Building its arguments on the back of 85 elite interviews and archival research in India, the article considers changes to diplomatic discourse, protocol, priorities and training, and details how Indian diplomats have adjusted to and resisted Hindu nationalism. It suggests that we study nationalist critiques of ‘cosmopolitan elites’ both as an ideological denunciation of internationalist commitments and as a social rejection of the elites who hold them.
Inadequate Response, Treatment Patterns, Health Care Utilization, and Associated Costs in Patients With Ulcerative Colitis: Retrospective Cohort Study Based on German Claims Data
Authors: Bokemeyer Bernd , Picker Nils , Wilke Thomas , Rosin Ludger , Patel Haridarshan
Published: February 2022

Background

Real-world data regarding response rates in ulcerative colitis treatment are rare, particularly for later lines of therapy. This study aimed to assess continuity of and changes to advanced therapies, as well as costs and specific indicators defining suboptimal therapy.

Methods

German claims data were retrospectively analyzed (January 2014 to June 2019). Patients with ulcerative colitis initiating an advanced therapy (adalimumab, golimumab, infliximab, tofacitinib, vedolizumab) were included. Inadequate response was indicated by therapy discontinuation, switch, escalation, augmentation, corticosteroid dependency, disease-related hospitalization, or surgery. Health care resource utilization (inpatient, outpatient, sick leaves, medication, aids, and remedies) and related costs were assessed from therapy initiation until discontinuation or loss to follow-up.

Results

Among 574 patients (median age, 39 years; female sex, 53.5%) who initiated advanced therapies, 458 (79.8%) received an antitumor necrosis factor therapy, 113 (19.7%) vedolizumab, and 3 (0.5%) tofacitinib. After 12 months, 75% had ≥1 indicator for suboptimal therapy. The median time to first indicated inadequate response was 4.8 months. Therapy discontinuation (38%), switching (26%), and prolonged use of steroids (36%) were common within the first year of treatment. In an unadjusted comparison, all-cause total costs per person-year were significantly higher in those who switched vs patients remaining on their therapy (€44,570 vs €36,807; P < .001).

Conclusions

Our study indicates a high prevalence of inadequate response to advanced therapies. Only 25% of patients showed adequate response within 12 months after therapy initiation. Frequent dose and treatment changes were observed. The economic impact of suboptimal therapy in ulcerative colitis is substantial, highlighting the ongoing need for improved treatment strategies.
Detection and Kinetics of Subgenomic Severe Acute Respiratory Syndrome Coronavirus 2 RNA Viral Load in Longitudinal Diagnostic RNA–Positive Samples
Authors: Deming Meagan E , Dong Tracy Q , Agrawal Vaidehi , Mills Margaret G , Huang Meei Li W , Greninger Alexander L , Jerome Keith R , Wener Mark H , Paasche-Orlow Michael K , Kissinger Patricia , Luk Alfred , Hoffman Risa M , Stewart Jenell , Kottkamp Angelica C , Bershteyn Anna , Chu Helen Y , Stankiewicz Karita Helen C , Johnston Christine M , Wald Anna , Barnabas Ruanne , Brown Elizabeth R , Neuzil Kathleen M
Published: February 2022

While detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by diagnostic reverse-transcription polymerase chain reaction (RT-PCR) is highly sensitive for viral RNA, the nucleic acid amplification of subgenomic RNAs (sgRNAs) that are the product of viral replication may more accurately identify replication. We characterized the diagnostic RNA and sgRNA detection by RT-PCR from nasal swab samples collected daily by participants in postexposure prophylaxis or treatment studies for SARS-CoV-2. Among 1932 RT-PCR–positive swab samples with sgRNA tests, 40% (767) had detectable sgRNA. Above a diagnostic RNA viral load (VL) threshold of 5.1 log10 copies/mL, 96% of samples had detectable sgRNA with VLs that followed a linear trend. The trajectories of diagnostic RNA and sgRNA VLs differed, with 80% peaking on the same day but duration of sgRNA detection being shorter (8 vs 14 days). With a large sample of daily swab samples we provide comparative sgRNA kinetics and a diagnostic RNA threshold that correlates with replicating virus independent of symptoms or duration of illness.
South–South Knowledge Production and Hegemony: Searching for Africa in Chinese Theories of IR
Authors: Carrozza Ilaria , Benabdallah Lina
Published: February 2022

There is a growing community of international relations (IR) scholars who argue for the importance of investigating Global South approaches to IR scholarship, making room for theories and concepts that challenge the discipline's Eurocentricity, and debating the merits and pitfalls of globalizing IR by including perspectives from various Global South locations. In addition to acknowledging this existing critical scholarship that aims at resisting mainstream epistemologies and methodologies of knowing and doing IR, this article's central contribution is to probe the epistemic hegemony and knowledge-production hierarchies that are emerging from within the Global South. The article does not seek to uncover the truth about the representation of Global South actors by Global South IR communities. Instead, it is interested in demonstrating how epistemic hegemony and knowledge-production hierarchies do not exist only in relationships of exclusion and Othering but also in relations of inclusion and Selving. We illustrate our argument with an analysis of the representations of “Africa” in China-based IR intellectual communities. We find that Chinese discourses on solidarity, friendship, community, and shared history lead to a narrative of sameness and Selving whereby Chinese postcolonial experiences are taken to be expandable and applicable to other developing states, making Chinese perspectives seem representative of others, thereby silencing and representing African voices at once.
Extracting seizure frequency from epilepsy clinic notes: a machine reading approach to natural language processing
Authors: Xie Kevin , Gallagher Ryan S , Conrad Erin C , Garrick Chadric O , Baldassano Steven N , Bernabei John M , Galer Peter D , Ghosn Nina J , Greenblatt Adam S , Jennings Tara , Kornspun Alana , Kulick-Soper Catherine V , Panchal Jal M , Pattnaik Akash R , Scheid Brittany H , Wei Danmeng , Weitzman Micah , Muthukrishnan Ramya , Kim Joongwon , Litt Brian , Ellis Colin A , Roth Dan
Published: February 2022

Objective

Seizure frequency and seizure freedom are among the most important outcome measures for patients with epilepsy. In this study, we aimed to automatically extract this clinical information from unstructured text in clinical notes. If successful, this could improve clinical decision-making in epilepsy patients and allow for rapid, large-scale retrospective research.

Materials and Methods

We developed a finetuning pipeline for pretrained neural models to classify patients as being seizure-free and to extract text containing their seizure frequency and date of last seizure from clinical notes. We annotated 1000 notes for use as training and testing data and determined how well 3 pretrained neural models, BERT, RoBERTa, and Bio_ClinicalBERT, could identify and extract the desired information after finetuning.

Results

The finetuned models (BERTFT, Bio_ClinicalBERTFT, and RoBERTaFT) achieved near-human performance when classifying patients as seizure free, with BERTFT and Bio_ClinicalBERTFT achieving accuracy scores over 80%. All 3 models also achieved human performance when extracting seizure frequency and date of last seizure, with overall F1 scores over 0.80. The best combination of models was Bio_ClinicalBERTFT for classification, and RoBERTaFT for text extraction. Most of the gains in performance due to finetuning required roughly 70 annotated notes.

Discussion and Conclusion

Our novel machine reading approach to extracting important clinical outcomes performed at or near human performance on several tasks. This approach opens new possibilities to support clinical practice and conduct large-scale retrospective clinical research. Future studies can use our finetuning pipeline with minimal training annotations to answer new clinical questions.
A real-time COVID-19 surveillance dashboard to support epidemic response in Connecticut: lessons from an academic-health department partnership
Authors: Suri Abhinav , Askari Melanie , Calder Jennifer , Branas Charles , Rundle Andrew
Published: February 2022

In response to the coronavirus disease-19 (COVID-19) pandemic, numerous institutions published COVID-19 dashboards for reporting epidemiological statistics at the county, state, or national level. However, statistics for smaller cities were often not reported, requiring these areas to develop their own data processing pipelines. For under-resourced departments of health, the development of these pipelines was challenging, leading them to rely on nonspecific and often delayed infection statistics during the pandemic. To avoid this issue, the Stamford, Connecticut Department of Health (SDH) contracted with the Columbia Mailman School of Public Health to develop an online dashboard that displays real-time case, death, test, vaccination, hospitalization, and forecast data for their city, allowing SDH to monitor trends for specific demographic and geographic groups. Insights from the dashboard allowed SDH to initiate timely and targeted testing/vaccination campaigns. The dashboard is widely used and highlights the benefit of public-academic partnerships in public health, especially during the COVID-19 pandemic.