bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic significance of calibrated integrated backscatter in patients submitted to transcatheter aortic valve implantation
Authors: Ferreira A , Teixeira R , Rio P , Timoteo A T , Branco L , Leal A , Varela F , Cacela D , Galrinho A , Ferreira R C
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

There is a reported association between calibrated integrated backscatter (cIB) and myocardial fibrosis, mostly noted in cardiomyopathies and aortic stenosis cases. But whether this measure of myocardial ultrasound reflectivity could help predict outcomes in patients submitted to transcatheter aortic valve implantation has not been previously tested.

Purpose

To demonstrate whether cIB may help differentiate patients undergoing transcatheter aortic valve implantation (TAVI) at risk of major cardiovascular events.

Methods

Consecutive patients submitted to transfemoral TAVI between October 2020 and December 2021 were routinely imaged by echocardiography in the five days peri-procedure. Calibrated integrated backscatter was obtained from the parasternal long-axis view (PLAX) by subtracting pericardial cIB intensity from myocardial septal and posterior wall average cIB. Patients with poor PLAX views were excluded from the study. All measurements of cIB were performed at end-diastole. The primary endpoint was the occurrence of major cardiovascular events at one year of follow-up.

Results

A total of 184 patients underwent a TAVI procedure during the study period. Of these, 159 had a reasonable acoustic window for cIB measurement and were included in the study. Patient mean age was 81.1±6.1 years, and 58% were female. At baseline, 81% of patients had preserved left ventricle function, the mean aortic mean gradient was 44.8±15.1 mmHg, and the mean Euroscore II was 5.55±3.75. No significant association was found between cIB and TAVI-related major acute complications (21.02±10.4 vs 19.8±7.1 dB, p = 0.544). There was also no significant correlation of cIB with major cardiovascular events (19.71±7.25 vs 20.39±10.47 dB, p = 0.478) or with valve safety (19.59±7.07 vs 18.84±10.32 dB, p = 0.709), defined accordingly to the Valve Academic Research Consortium-2 consensus, at one-year follow-up. There was, however, a positive association between cIB and all-cause mortality (19.24±7.06 vs 22.92±9.36, p = 0.021) at one-year follow-up, with deaths occurring due to multiple causes, mainly cardiovascular, infectious, and neoplastic. Measured cIB was also significantly higher in patients with a pre-TAVI estimated glomerular filtration rate of less than 30 mL/min/1.73m2 (22.42±7.17 vs 19.56±6.88 dB, p = 0.043).

Conclusion

Higher cIB was not associated with a higher risk of major cardiovascular events or with valve safety in patients submitted to TAVI, but it can potentially have prognostic value in differentiating patients at increased risk of all-cause mortality.
Right ventricular-pulmonary artery coupling ratio derived from 3D echocardiography - better predictor of outcome in patients with precapillary pulmonary hypertension
Authors: Radu D N , Enache R , Calin A , Beladan C C , Rosca M , Platon P , Predescu L , Coman I M , Popescu B A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In patients with pulmonary hypertension (PH), right ventricular (RV) function has a well-known prognostic value. Recent data suggest that right ventricular-pulmonary artery (RV-PA) coupling is an independent predictor of outcome in this setting. RV-PA coupling can be assessed invasively as the endsystolic/arterial elastance ratio or noninvasively using surrogates such as CMR-derived RV stroke-volume (SV) to endsystolic volume (ESV) ratio or 2D echocardiography-derived TAPSE/PASP ratio. Data regarding the 3D echocardiography-derived RV SV/ESV as parameter of RV-PA coupling in PH patients are scarce.

Purpose

To assess the RV-PA coupling as 3DE-RV SV/ESV ratio and its impact on clinical outcome in patients with precapillary PH compared with the validated 2DE-TAPSE/PASP.

Methods

Thirty-two patients (40±13 years, 27 women) with precapillary PH receiving vasodilator therapy and 25 controls of similar age and gender (37±9 years, 18 women) were studied. Clinical data, BNP levels and RV function parameters (TAPSE, free-RV wall S- and e’-wave, RV FAC, Tei index, RV-IVA, RVEF by 3DE) were assessed. RV global longitudinal strain (RV-GLS) was measured as the average of 6 segments and RV free wall strain as the average of 3 segments by speckle-tracking 2DE. RV-PA coupling was assessed as TAPSE/PASP and 3DE-RV SV/ESV ratios. PH patients were followed for 41 months (2–77). Cardiac death was the endpoint.

Results

PH patients had impaired 2DE and 3DE RV function parameters and RV-PA coupling compared to controls (p<0.001). At baseline, 3DE-RV SV/ESV and TAPSE/PAPS correlated with each other (r=0.51, p = 0.003) and both correlated with RV function parameters, but only SV/ESV correlated with BNP levels (Table) and WHO functional class (0.71±0.16 in class II, 0.66±0.21 in class III, 0.34±0.14 in class IV, p = 0.01). During follow-up, 5 patients died and these patients had at baseline higher BNP levels (LnBNP 5.91±1.62 vs 4.32±1.29, p = 0.02) and lower values of TAPSE (15±4 vs 18±3 mm, p = 0.03), S-RV (9.2±2.3 vs 11.1±1.8 cm/s, p = 0.04), RV free wall strain (−11.6±6.6 vs −18.1±5.3%, p = 0.02), RVEF (32±11 vs 40±7%, p = 0.04), and SV/ESV (0.49±0.22 vs 0.68±0.19, p = 0.05), but similar values for TAPSE/PASP (0.18±0.10 vs 0.20±0.05 mm/mmHg, p = 0.75).

Conclusion

In PH patients, 3DE-RV SV/ESV ratio as parameter of RV-PA coupling is altered and correlates with clinical status and RV function parameters. Besides parameters of RV function and BNP levels, 3DE-RV SV/ESV ratio seems a better predictor than TAPSE/PASP in this setting.
Cardiac magnetic resonance features associated with the risk of cardiac arrest in patients with acute myocardial infarction
Authors: Szabo E , Benedek T , Kovacs I , Rat N , Bordi L , Parajko Z S , Rosca A , Mihaila T , Ion B , Benedek I
Published: June 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Research Grant number NR. 164 / 26 / 10.01.2023.

Background

Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). The role of different factors related to the site and severity of coronary occlusion in the pathogenesis of AMI-related cardiac arrest is still under investigation.

The aim of the study was to investigate the association between (1) different cardiac magnetic resonance (CMR) features associated with the location and severity of the myocardial injury, and (2) the risk of CA accompanying an AMI.

Methods

In total, 54 patients AMI undergoing post-AMI CMR imaging with delayed gadolinium enhancement were enrolled in the study. The study lot was divided into 2 groups: group 1–8 patients who survived a CA in the acute phase of AMI and group 2–46 patients, matched for age and gender, with AMI but without CA. In all patients, infarct mass, the proportion of high transmural extent, and scar mass at different myocardial segments were calculated using the QMap software (Medis BV).

Results

Compared to patients without CA, those with CA had a significantly higher infarct mass (47.9 +/- 38 g versus 23.3 g, p = 0.03), infarct mass % (26.9 +/ 17.3% vs 15.1 +/- 8.6 %, p = 0.02), and a higher degree of transmurality (29.28 +/- 20.2 % vs 14.1 +/- 9.2 %, p = 0.01). Location of myocardial injury at the level of latero-apical, anterolateral, and bazal anterior segments seemed to be more frequently associated with the risk of CA in the acute phase of AMI: infarct mass 33.9 +/- 30.6 g in group 1 vs 13.6 +/- 17.3 g in group 2, p = 0.02 for the latero-apical segment, 26.5 +/- 29.0 g in group 1 vs 8.9 +/- 12.8 g in group 2, p = 0.02 for the anterolateral segment, and 20.1 +/- 21.5 g in group 1 vs 7.8 +/- 14.7 g in group 2, p = 0.02 for anterobazal segment.

Conclusions

Myocardial mas, high transmural extent at CMR imaging, and a large myocardial injury identified by CMR at the level of the anterior and lateral ventricular segments seems to be associated with an increased risk of CA in the acute phase of AMI.
Automated analysis of echocardiograms at diagnosis is able to predict prognosis in ATTR cardiomyopathy
Authors: Ioannou A , Patel R K , Razvi Y , Hanger M , Martinez-Naharro A , Venneri L , Chi Lim S , Yoran H , Frost M , Lam C , Gillmore J D , Fontana M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is progressive and ultimately fatal cause of heart failure. ATTR-CM often displays characteristic echocardiographic features, and manual measurements of both stroke volume and longitudinal strain are independent predictors of mortality. We sought to investigate whether automated analysis of echocardiographic parameters at the time of diagnosis were able to predict prognosis in this population.

Methods

We analysed all consecutive patients between 2006–2021 who underwent an echocardiogram at the time of diagnosis, and analysed their echocardiograms using artificial intelligence software that has been developed and validated by Us2.ai.

Results

We identified 1972 patients with ATTR-CM (age: 75.6±8.7 years, male: 86.9%), comprising of 1329 wild-type ATTR-CM and 643 hereditary ATTR-CM (V142I = 376, T80A = 171, other = 96). Patients with V142I had an increased relative wall thickness (P<0.001) lower stroke volume indexed (P<0.001), and worse longitudinal strain (P<0.001) than patients with wild-type and T80A ATTR-CM. In a multi-variable analysis of echocardiographic parameters selected a priori (interventricular septal diameter, relative wall thickness, left and right atrial area indexed, biplane stroke volume indexed, full thickness longitudinal strain, and E/e’ lateral), left atrial area indexed (HR=1.08, 95%CI[1.02–1.14], P=0.005), biplane stroke volume indexed (HR=0.96, 95%CI[0.94–0.98], P<0.001) and full thickness longitudinal strain (HR=1.04, 95%CI[1.01–1.08], P=0.009) all remained independent predictors of mortality.

Conclusions

Automated of analysis echocardiograms using artificial intelligence demonstrated that patients with V142I had more advanced cardiac disease at diagnosis. Automated measurements produced by artificial intelligence software are able to predict prognosis and identify the same parameters as those identified using manual analysis as powerful independent predictors of mortality.
A strain-based LBBB classification predicts the degree of reverse remodeling and outcome in patients with cardiac resynchronization therapy
Authors: Duchenne J , Calle S , Aalen J , Galli E , Larsen C K , Mirea O , Puvrez A , De Buyzere M , Kongsgard E , Voros G , Penicka M , Donal E , Smiseth O A , Timmermans F , Voigt J U
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Research Foundation Flanders (FWO).

Introduction

Septal strain patterns measured by echocardiography reflect the gradual process of left bundle branch block (LBBB)-induced left ventricular (LV) remodeling. We investigated whether these strain stages also predict progressive volumetric response and outcome in cardiac resynchronization therapy (CRT) patients.

Methods

This prospective study enrolled consecutive CRT patients from 5 European centers who underwent echocardiographic examination with speckle-tracking strain analysis before CRT implantation. Dyssynchrony was assessed using septal strain curves, which were classified into 5 patterns (stage LBBB-0 to LBBB-4). The magnitude of reverse remodeling was determined at 1 year. The pre-defined outcome was death from any cause or heart transplantation.

Results

The study involved 267 patients (age 66±11 years; 69% men; 90% LBBB) with a mean LV ejection fraction (EF) of 30±7%. Across the stages, CRT resulted in a gradual volumetric response, ranging from almost no response in LBBB-0 patients (ΔLV end-systolic volume −9 ±21ml; ΔLVEF +4±8%) to super-response in LBBB-4 patients (ΔLV end-systolic volume −85 ±54ml; ΔLVEF +20±9%) (p<0.001 for both). Median follow-up was 49 months. LBBB-0 patients had worst outcome (log rank p = 0.002, Figure), with subsequent LBBB stages gradually showing more favorable outcome (log rank p = 0.045, Figure). There was a stepwise decrease in adverse events according to the staged LBBB classification. LBBB stages 1 to 4 predicted long-term survival without heart transplantation with respective hazard ratios of 0.61 (95% CI 0.25–1.50), 0.26 (95% CI 0.10–0.68), 0.29 (95% CI 0.11–0.77) and 0.13 (95% CI 0.04–0.51) compared to LBBB-0. After multivariable adjustment for baseline LVEF, ischemic heart disease and presence of an implantable cardioverter defibrillator, LBBB staging remained significantly associated with a decreased risk for adverse outcome (hazard ratio 0.69 (95% CI 0.51–0.92) per 1-stage increase).

Conclusions

Septal strain patterns are associated with the extent of reverse remodeling and outcome in CRT patients. The proposed LBBB classification provides pathophysiological insights in LBBB-induced LV dysfunction and may be helpful to identify patients who may benefit most from CRT implantation.
Can echocardiographic parameters effectively predict elevated pcwp in heart transplant patients?
Authors: Santos A R , Albuquerque F , Goncalves A , Moreira R I , Silva T P , Viegas J , Castelo A , Ferreira V , Bras P , Reis J , Mano T , Mendonca T , Sousa L , Soares R , Ferreira R C
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

PCWP measurement remains the gold standard for the diagnosis of Heart Failure with preserved ejection fraction. Nevertheless, right heart catheterization (RHC) is a last step procedure nowadays, with most of the patients diagnosed solely by transthoracic echocardiography (TTE) parameters, as it is widely available and not associated with the risks of the invasive procedures. Heart transplant (HT) patients, on the other hand, routinely perform RHC as follow-up for rejection surveillance, allowing frequent invasive hemodynamic assessment.

Purpose

Evaluate the association between TTE parameters and the invasively measured pulmonary capillary wedge pressure (PCWP) by RHC in HT patients.

Methods

A retrospective analysis of consecutive HT patients submitted to RHC between February 2016 and November 2021, who previously performed TTE, was made. The area under the curve (AUC) was performed to evaluate the association between several TTE parameters (left ventricular (LV) end-diastolic diameter (LV EDD), LV end-systolic diameter (LV ESD), LV ejection fraction (LV EF), interventricular septum wall thickness (ST), LV global longitudinal strain (GLS), left atrium volume index (LAVi), transmitral E/A ratio (E/A), LV E/e’ ratio (E/e’), E velocity deceleration time (DT), isovolumetric relaxation time (IV RT), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP)) and elevated PCWP (defined as >15mmHg). Statistical differences with a p-value <0.05 were considered significant.

Results

A total of 127 RHC were performed during the study period. Mean age was 50 years, 79% (n=100) were male, mean LV EF 58 ± 10% and mean BNP 808 ± 984 pg/mL. Mean PCWP was 12 ± 6 mmHg, with 28% (n=35) with a value higher than 15mmHg. AUC results of several TTE parameters for the prediction of elevated PCWP are depicted in Table 1. LV EF (AUC 0.702, p = 0.001) and GLS (AUC 0.768, p = 0.07) were significantly correlated with elevated PCWP, while the remaining parameters failed to do so.

Conclusion

In this HT group, several TTE indices commonly employed for non-invasive estimation of increased intraventricular pressures, including E/e', E/A ratio, LAVi, and sPAP, showed a poor correlation with elevated PCWP. GLS, a TTE parameter widely used to assess subclinical dysfunction were the parameter with the most robust association with elevated PCWP in this population, demonstrating that it has the potential to be used in routine clinical practice.
Prognostic value of lung ultrasound in patients who underwent open heart surgery due to aortic stenosis and mitral regurgitation
Authors: Jdid Mahmoud S , Morvai-Illes B , Csadi R , Monoki M , Varga A , Agoston G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Severe, native valvular heart diseases are frequently associated with heart failure (HF). The most frequent valvular lesions are aortic stenosis (AS) and mitral regurgitation (MR). Pulmonary congestion (PC) is a universal finding in patients with HF and is associated with poor prognosis. B-lines assessment with lung ultrasound (LUS) is a reliable, fast, and simple quantitative method to assess pulmonary congestion.

This study aimed to assess the short-term prognostic value of B-lines in patients with severe mitral regurgitation or aortic stenosis who underwent open heart surgery.

Methods

A single-centre prospective cohort of 70 patients (66.4±10.6 years, 53.9% male) with severe AS (73%) and MR (27%) were consecutively enrolled. Comprehensive transthoracic echocardiography and LUS evaluation (8-sector assessment) were performed 48 hours before open heart surgery (aortic and mitral valve replacement). The relationship between PC and echocardiographic parameters was determined, and patients were followed up for 7.1±3.4 months to assess the composite endpoint of death and readmission due to HF.

Results

The number of B-lines correlated with left ventricular ejection fraction (r-0.549, p<0.0001), left atrial volume (r 0.566, p<0.0001), and right ventricular function indices such as TAPSE (TAPSE r −0.448, p<0.0001) and right ventricular coupling defined as TAPSE/PASP (r −0.596, p <0.0001). During the follow-up, 10 events were detected. The performance of the number of B-lines in the prediction of events showed 72.7% sensitivity and 84.5% specificity, with the best cut-off value at 21 B-lines. Having ≥ 21 B-lines was associated with a significantly worse event-free survival (Log-rank: 7.304, p < 0.05) Figure 1.

Conclusion

Pulmonary congestion detected by LUS reflects structural and functional damage related to severe valvular heart disease. Lung ultrasound is a promising tool to assess high-risk patients before open heart surgery.
Right ventricle involvement in cardiac transthyretin amyloidosis in SPECT/CT with [99mTc]Tc-DPD
Authors: Holcman K , Rubis P , Szot W , Dziewiecka E , Karabinowska A , Stepien A , Graczyk K , Mroz K , Sachajko Z , Podolec P , Kostkiewicz M
Published: June 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Pfizer Research Grant (ID#57165999).

Background

Transthyretin amyloid (ATTR) cardiomyopathy continues to be considered a rare disease; however, it is now more frequently diagnosed, partly due to advances in imaging techniques. Application of hybrid technique single-photon emission computed tomography and computed tomography (SPECT/CT) provides greater anatomic resolution, enabling the assessment of regional cardiac involvement.

Purpose

The aim of this prospective study was assessment of right ventricle involvement in patients with ATTR in SPECT/CT with [99mTc]Tc 3,3-disphono-1,2-propanodicarboxylic acid (DPD).

Methods

We present data based on evaluation of 100 patients, including 28 (group 1) index patients with ATTR and 72 (group 2) first-degree relatives who were studied between June 2020 and January 2023. Study protocol included clinical data, free light chain blood immunoglobulins and urine immunofixation, transthoracic echocardiography (TTE) with global longitudinal strain (GLS) analysis, SPECT/CT with [99mTc]Tc-DPD, genetic testing by an amplicon-based next-generation TTR sequencing approach, and in selected cases cardiac or soft tissue biopsy.

Results

In group 1 there were 39% patients diagnosed with hereditary ATTR (ATTRm) and 61% with ATTR wild type (ATTRwt). There were detected following types of TTR variants - Phe53Leu, Ala101Val, Glu112Lys, Glu109Lys, Glu122Lys, Glu82Lys. Overall, 26% first-degree relatives were diagnosed with pathogenic TTR variant and 7% had positive SPECT/CT with [99mTc]Tc-DPD. In group 2 there was a significant predominance of Phe53Leu variant among carriers. Importantly, among patients with positive SPECT/CT with [99mTc]Tc-DPD 78% presented also right ventricle uptake. Overall, right ventricle involvement was present in 80% of patients with ATTRm and 76% of patients with ATTRwt who presented left ventricle uptake (p>0.05).

Conclusions

Right ventricle involvement in cardiac transthyretin amyloidosis can be assessed in SPECT/CT with [99mTc]Tc-DPD. In presented group 78% of patients who had cardiac tracer uptake presented as well right ventricle involvement. There were no statistically significant differences in rates between the ATTRwt and ATTRm groups (p>0.05). Assessment of right ventricle involvement in cardiac transthyretin amyloidosis in SPECT/CT may in future translate into further enhancement of disease evaluation and improving prognosis in the group of patients.
Automatic measurements of left ventricular volumes and ejection fraction by artificial intelligence reduces time-consumption and inter-observer variability
Authors: Olaisen S , Smistad E , Espeland T , Hu J , Pasdeloup D , Ostvik A , Amundsen B , Aakhus S , Rosner A , Stylidis M , Holte E , Grenne B , Lovstakken L , Dalen H
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Norwegian University of Science and Technology.

Background

Left ventricular (LV) volumes and ejection fraction (EF) are the most used and studied parameters in echocardiography, but they are hampered with the tedious nature and limited reproducibility of manual measurements. We developed an artificial intelligence (AI) decision-support software that automatically calculates LV volumes and EF by identifying the view, timing, and endocardial border from echo images.

Purpose

Our aim was to investigate the impact of using the AI decision-support software for automatic measurements of LV volumes and EF compared to standard care in real-time and large databases.

Methods

We compared biplane three-cycle averaged AI measurements of LV volumes and EF to manual references in multiple samples: 1) Real-time AI-support during scanning of 50 consecutive patients compared to standard care (test-retest) by two of three experts, 2) comparison of test-retest variability in inter- and intra-observer scenarios in 40 subjects with test-retest datasets by separate observers and measurements by AI and four experienced observers, 3) an internal database of 1881 subjects with manual references by Simpson’s method, and 4) an external population of 849 subjects with manual references by semi-automatic tracking-based software. The influence on time consumption was tested in Sample 1. The influence on test-retest variability was tested in Sample 1 and 2, while the other samples were used to test the agreement with echocardiographic references.

Results

Used in real-time the AI measurements reduced total time-consumption by median (95% CI) 5.3 (4.8–6.5) minutes per patient (p <0.001). The test-retest variability for AI-measurements were superior to inter-observer scenarios (p <0.05) and non-inferior to intra-observer scenarios (p <0.025, one-sided, delta=46% increased variance). The agreement with echocardiographic references was good (Figure). The biases (AI minus reference) ranged −11.6 to 6.5 mL for end-diastolic LV volume and −5.5 to 0.3 %-points for EF.

Conclusion

Fully automatic AI measurements of LV volumes and EF reduced time-consumption with 5 minutes, reduced test-retest variability compared to inter-observer analyses, and showed acceptable agreement with manual measurements in a wide range of scenarios. Thus, implementation of real-time fully automatic measurements of LV volumes and EF during scanning may improve the everyday workflow and quality in the everyday clinic.
CMR reclassifies patients with suspected myocardial infarction with non-obstructive coronary arteries (MINOCA)
Authors: Bisaccia G , Liang K , Williams M G L , Leo I , Dastidar A , Sammut E , Johnson T , Bucciarelli-Ducci C
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Objectives

This study sought to assess the role of cardiac magnetic resonance (CMR) in investigating patients presenting with suspected acute coronary syndrome (ACS) and non-obstructed coronary arteries.

Methods

Consecutive patients presenting to a tertiary cardiology centre with suspected ACS and non-obstructed coronary arteries and referred for CMR were retrospectively identified. A comprehensive imaging protocol was performed to include cines, T2-weighted, and late gadolinium enhancement (LGE) sequences. Final CMR diagnosis was based on established patterns of tissue characterisation from myocardial oedema and LGE imaging, with patients grouped into five: myocardial infarction, myocarditis, Takotsubo syndrome, cardiomyopathy, and a normal CMR.

Results

A total of 888 patients were identified. The mean age across the cohort was 57 years (SD ±15.9 years) with 51% female patients. Median time to CMR from acute presentation was 21 days (Figure 1). Aetiology of presentation was uncertain in more than half of patients referred for CMR (483, 54.1%). Of patients with an initial uncertain aetiology, CMR was able to identify an underlying diagnosis in 74.9%. Diagnosis across the whole cohort was reclassified in 691 patients (77.8%), with overall diagnostic yield (CMR identified underlying aetiology for presentation) of 75.6%. (Figure 2).

Conclusions

In a large single-centre cohort of patients presenting with suspected ACS and non-obstructed coronary arteries, diagnostic yield with CMR was high at 76%. CMR reclassified nearly 80% of patients. Our results highlight the importance of CMR in the diagnostic pathway of suspected ACS and potential implications on clinical management.
LV and LA mechanics in pediatric HCM : a CMR study of phenotype-genotype correlation
Authors: Panaioli E , Volodia Dangouloff-Ros V D , Nathalie Boddaert N B , Damien Bonnet D B , Diala Khraiche D K
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Paediatric hypertrophic cardiomyopathy (HCM) is a leading cause of sudden death. The relationship between the genotype variation and phenotype expression has not been fully elucidated, with some studies showing association with an increased hypertrophy and MYH7 or multiple genetic variations. In HCM fibrosis and hypertrophy contribute to left ventricular (LV) mechanics’ alteration resulting in subendocardial dysfunction. The latter is associated with a decreased global longitudinal and radial strains (GLS, GRS), whereas epicardial thickening leads to preserved global circumferential strain (GCS) and LV twist. Children with HCM have reduced LA function, measurable by both volumetric and strain analysis and reduced LA mechanics are associated with poor exercise capacity. Feature tracking –cardiac magnetic resonance (FT-CMR) has enhanced the non-invasive assessment of myocardial deformation in HCM. The main aim of our study was to assess differences of LV and LA mechanics features on CMR between patients harbouring multiple pathogenic or likely pathogenic variants (MGv, n=16) or single genetic variations (SGv, n=35).

Methods

Our retrospective CMR study included 51 patients (1.7–18.8 years ago). CMR data were: LV and LA’s morphological values, late gadolinium enhancement (LGE) of LA and LV walls, LV feature tracking (FT) derived strain and LV twist (LVT). LV twist was calculated as the difference between basal and apical rotation. The LA feature FT derived strain, LA conduit function, reservoir function and pump function were computed.

Results

In MGv group, the indexed LV mass 108.8 +/-53.0 vs 74.3+/- 22.2 in SGv (p = 0.03). LGE was present in 51% patients of the whole cohort, with LGE in 64 % of MGv group. LV FT derived strain values and LA function were not statistically significant different between groups (MGv vs SGv: GLS −15.8+/−5.3 vs −18.7+/−4.8, GCS −27.8+/8 vs −31.1+/−8.6, GRS 44.7+/−24.6 vs 62.3+/−32). LVT was reduced in MGv group (0.04+/−7.6) vs (7.4+/−7.4) in SGv (p = 0.003). LA contractile function did not differ between the groups (MGv vs SGv: GLS LA 25.1+/−14.2 vs 27.6+/−13.5). LA reservoir, conduction and pump function did not differ between the groups. LVT was significantly correlated with the LA contractile function. An increased of LVT was associated with an increased LA GLS and EF (p = 0.011; p = 0.004).

Conclusions

Patients with multiple genetic variants have a greater LV mass and altered LV mechanics with reduced LV twist. This study gives insights in phenotype- genotype correlation in paediatric HCM and warrants larger longitudinal studies to assess its clinical significance.
Prognostic impact of cardiac resynchronization therapy guided by phase analysis: a CZT study
Authors: Liga Riccardo , Startari Umberto , Spatafora Davide , Michelotti Erica , Gimelli Alessia
Published: June 2023

Aims

To evaluate whether phase analysis imaging may predict treatment response and long-term prognosis after cardiac resynchronization therapy (CRT).

Methods and results

Sixty-nine patients underwent myocardial perfusion imaging followed by CRT. Patients with ischaemic heart disease and non-ischaemic cardiomyopathy (NICM) were identified. Left ventricular (LV) mechanical dyssynchrony (LVMD) was assessed at phase analysis and the region of the latest mechanical activation was identified. LV pacing lead position was considered ‘concordant’ when located in the region of the latest mechanical activation, and ‘discordant’ otherwise. The ‘6 months post-CRT’/‘baseline’ ratio of LV ejection fraction was computed as a measure of CRT response. LVMD was revealed in 47/69 patients, 27 of whom (57%) had a concordant LV lead implantation. Only concordant pacing was associated with LV functional improvement (ejection fraction ratio: 1.28 ± 0.25 vs. 1.11 ± 0.32 in discordant stimulation, P = 0.028). However, this relationship persisted only in patients with NICM (P < 0.001), while it disappeared in those with ischaemic heart disease (P = NS). Twenty-eight events occurred during 30 ± 21 months follow-up. While discordant LV lead location was the major predictor of unfavourable prognosis (hazard ratio 3.29, 95% confidence interval 1.25–8.72; P = 0.016), this relationship was confirmed only in patients with NICM.

Conclusions

Phase analysis of myocardial perfusion imaging may guide CRT implantation, identifying patients who would most likely benefit from this procedure.
Long-term cardiovascular outcomes among immigrants and non-immigrants in cardiac resynchronization therapy: a nationwide study
Authors: Krøll Johanna , Kristensen Søren Lund , Jespersen Camilla H B , Philbert Berit , Vinther Michael , Risum Niels , Johansen Jens Brock , Nielsen Jens Cosedis , Riahi Sam , Haarbo Jens , Fosbøl Emil L , Torp-Pedersen Christian , Køber Lars , Tfelt-Hansen Jacob , Weeke Peter E
Published: June 2023

Aims

To date, potential differences in outcomes for immigrants and non-immigrants with a cardiac resynchronization therapy (CRT), in a European setting, remain underutilized and unknown. Hence, we examined the efficacy of CRT measured by heart failure (HF)-related hospitalizations and all-cause mortality among immigrants and non-immigrants.

Methods and results

All immigrants and non-immigrants who underwent first-time CRT implantation in Denmark (2000–2017) were identified from nationwide registries and followed for up to 5 years. Differences in HF related hospitalizations and all-cause mortality were evaluated by Cox regression analyses. From 2000 to 2017, 369 of 10 741 (3.4%) immigrants compared with 7855 of 223 509 (3.5%) non-immigrants with a HF diagnosis underwent CRT implantation. The origins of the immigrants were Europe (61.2%), Middle East (20.1%), Asia-Pacific (11.9%), Africa (3.5%), and America (3.3%). We found similar high uptake of HF guideline-directed pharmacotherapy before and after CRT and a consistent reduction in HF-related hospitalizations the year before vs. the year after CRT (61% vs. 39% for immigrants and 57% vs. 35% for non-immigrants). No overall difference in 5-year mortality among immigrants and non-immigrants was seen after CRT [24.1% and 25.8%, respectively, P-value = 0.50, hazard ratio (HR) = 1.2, 95% confidence interval (CI): 0.8–1.7]. However, immigrants of Middle Eastern origin had a higher mortality rate (HR = 2.2, 95% CI: 1.2–4.1) compared with non-immigrants. Cardiovascular causes were responsible for the majority of deaths irrespective of immigration status (56.7% and 63.9%, respectively).

Conclusion

No overall differences in efficacy of CRT in improving outcomes between immigrants and non-immigrants were identified. Although numbers were low, a higher mortality rate among immigrants of Middle Eastern origin was identified compared with non-immigrants.
Experimental estimates of germline mutation rate in eukaryotes: a phylogenetic meta-analysis
Authors: Wang Yiguan , Obbard Darren J
Published: June 2023

Mutation is the ultimate source of all genetic variation, and over the last 10 years the ready availability of whole-genome sequencing has permitted direct estimation of mutation rate for many non-model species across the tree of life. In this meta-analysis, we make a comprehensive search of the literature for mutation rate estimates in eukaryotes, identifying 140 mutation accumulation (MA) and parent–offspring (PO) sequencing studies covering 134 species. Based on these data, we revisit differences in the single-nucleotide mutation (SNM) rate between different phylogenetic lineages and update the known relationships between mutation rate and generation time, genome size, and nucleotide diversity—while accounting for phylogenetic nonindependence. We do not find a significant difference between MA and PO in estimated mutation rates, but we confirm that mammal and plant lineages have higher mutation rates than arthropods and that unicellular eukaryotes have the lowest mutation rates. We find that mutation rates are higher in species with longer generation times and larger genome sizes, even when accounting for phylogenetic relationships. Moreover, although nucleotide diversity is positively correlated with mutation rate, the gradient of the relationship is significantly less than one (on a logarithmic scale), consistent with higher mutation rates in populations with smaller effective size. For the 29 species for which data are available, we find that indel mutation rates are positively correlated with nucleotide mutation rates and that short deletions are generally more common than short insertions. Nevertheless, despite recent progress, no estimates of either SNM or indel mutation rates are available for the majority of deeply branching eukaryotic lineages—or even for most animal phyla. Even among charismatic megafauna, experimental mutation rate estimates remain unknown for amphibia and scarce for reptiles and fish.
Conformational comparisons of Pasteurella multocida types B and E and structurally related capsular polysaccharides
Authors: Richardson Nicole I , Ravenscroft Neil , Kuttel Michelle M
Published: June 2023

Pasteurella multocida, an encapsulated gram-negative bacterium, is a significant veterinary pathogen. The P. multocida is classified into 5 serogroups (A, B, D, E, and F) based on the bacterial capsular polysaccharide (CPS), which is important for virulence. Serogroups B and E are the primary causative agents of bovine hemorrhagic septicemia that is associated with significant yearly losses of livestock worldwide, primarily in low- and middle-income countries. The P. multocida disease is currently managed by whole-cell vaccination, albeit with limited efficacy. CPS is an attractive antigen target for an improved vaccine: CPS-based vaccines have proven highly effective against human bacterial diseases and could provide longer-term protection against P. multocida. The recently elucidated CPS repeat units of serogroups B and E both comprise a N-acetyl-β-D-mannosaminuronic acid/N-acetyl-β-D-glucosamine disaccharide backbone with β-D-fructofuranose (Fruf) side chain, but differ in their glycosidic linkages, and a glycine (Gly) side chain in serogroup B. Interestingly, the Haemophilus influenzae types e and d CPS have the same backbone residues. Here, comparative modeling of P. multocida serogroups B and E and H. influenzae types e and d CPS identifies a significant impact of small structural differences on both the chain conformation and the exposed potential antibody-binding epitopes (Ep). Further, Fruf and/or Gly side chains shield the immunogenic amino-sugar CPS backbone—a possible common strategy for immune evasion in both P. multocida and H. influenzae. As the lack of common epitopes suggests limited potential for cross-reactivity, a bivalent CPS-based vaccine may be necessary to provide adequate protection against P. multocida types B and E.
ChatGPT and the clinical informatics board examination: the end of unproctored maintenance of certification?
Authors: Kumah-Crystal Yaa , Mankowitz Scott , Embi Peter , Lehmann Christoph U
Published: June 2023

We aimed to assess ChatGPT’s performance on the Clinical Informatics Board Examination and to discuss the implications of large language models (LLMs) for board certification and maintenance. We tested ChatGPT using 260 multiple-choice questions from Mankowitz’s Clinical Informatics Board Review book, omitting 6 image-dependent questions. ChatGPT answered 190 (74%) of 254 eligible questions correctly. While performance varied across the Clinical Informatics Core Content Areas, differences were not statistically significant. ChatGPT’s performance raises concerns about the potential misuse in medical certification and the validity of knowledge assessment exams. Since ChatGPT is able to answer multiple-choice questions accurately, permitting candidates to use artificial intelligence (AI) systems for exams will compromise the credibility and validity of at-home assessments and undermine public trust. The advent of AI and LLMs threatens to upend existing processes of board certification and maintenance and necessitates new approaches to the evaluation of proficiency in medical education.
Using Omaha System data to explore relationships between client outcomes, phenotypes, and targeted home intervention approaches: an exemplar examining practice effectiveness for older women with circulation problems
Authors: Schwartz Cathy I , Farag Amany , Lopez Karen Dunn , Moorhead Sue , Monsen Karen A
Published: June 2023

Background

Improved health among older women remains elusive and may be linked to limited knowledge of and interventions targeted to population subgroups. Use of structured community nurse home visit data exploring relationships between client outcomes, phenotypes, and targeted intervention approaches may reveal new understandings of practice effectiveness.

Materials and Methods

Omaha System data of 2363 women 65 years and older with circulation problems receiving at least 2 community nurse home visits were accessed. Previously identified phenotypes (Poor circulation; Irregular heart rate; and Limited symptoms), 7 intervention approaches (High-Surveillance; High-Teaching/Guidance/Counseling; Balanced-All; Balanced-Surveillance-Teaching/Guidance/Counseling; Low-Teaching/Guidance/Counseling-Balanced Other; Low-Surveillance-Mostly-Teaching/Guidance/Couseling-TreatmentProcedure-CaseManagement; and Mostly-TreatementProcedure+CaseManagement), and client knowledge, behavior, and status outcomes were used. Client-linked intervention approach counts, proportional use per phenotypes, and associations with client outcome scores were descriptively analyzed. Associations between intervention approach proportional use by phenotype and outcome scores were analyzed using parallel coordinate graph methodology for intervention approach effectiveness.

Results

Percent use of intervention approach differed significantly by phenotype. The 2 most widely employed intervention approaches were characterized by either a high use of surveillance interventions or a balanced use of all intervention categories (surveillance, teaching/guidance/counseling, treatment-procedure, case-management). Mean outcome discharge and change scores significantly differed by intervention approach. Proportionally deployed intervention approach patterns by phenotype were associated with outcome small effects improvement.

Discussions and Conclusions

The Omaha System taxonomy supported the management and exploration of large multidimensional community nursing data of older women with circulation problems. This study offers a new way to examine intervention effectiveness using phenotype- and targeted intervention approach-informed structured data.
Screening Mammography Utilization in the United States
Authors: Funaro Kimberly , Niell Bethany
Published: June 2023

Breast cancer is the second leading cause of cancer mortality in adult women in the United States. Screening mammography reduces breast cancer mortality between 22% and 48%; however, screening mammography remains underutilized. Screening mammography utilization data are available from insurance claims, electronic medical records, and patient self-report via surveys, and each data source has unique benefits and challenges. Numerous barriers exist that adversely affect the use of screening mammography in the United States. This article will review screening mammography utilization in the United States, explore factors that impact utilization, and briefly discuss strategies to improve utilization.
The survival and growth of honey bee (Hymenoptera: Apidae) colonies overwintered in cold storage: the effects of time and colony location
Authors: DeGrandi-Hoffman Gloria , Corby-Harris Vanessa , Graham Henry , Watkins-deJong Emily , Chambers Mona , Snyder Lucy
Published: June 2023

For over a decade, high percentages of honey bee colonies have been perishing during the winter creating economic hardship to beekeepers and growers of early-season crops requiring pollination. A way to reduce colony losses might be moving hives into cold storage facilities for the winter. We explored factors that could affect the size and survival of colonies overwintered in cold storage and then used for almond pollination. The factors were when hives were put into cold storage and their location prior to overwintering. We found that colonies summered in North Dakota, USA and moved to cold storage in October were larger after cold storage and almond pollination than those moved in November. Colony location prior to overwintering also affected size and survival. Colonies summered in southern Texas, USA and moved to cold storage in November were smaller after cold storage and almond pollination than those from North Dakota. The colonies also were smaller than those overwintered in Texas apiaries. Fat body metrics of bees entering cold storage differed between summer locations. North Dakota bees had higher lipid and lower protein concentrations than Texas bees. While in cold storage, fat bodies gained weight, protein concentrations increased, and lipids decreased. The decrease in lipid concentrations was correlated with the amount of brood reared while colonies were in cold storage. Our study indicates that in northern latitudes, overwintering survival might be affected by when colonies are put into cold storage and that colonies summered in southern latitudes should be overwintered there.
Reference genome of California walnut,Juglans californica, and resemblance with other genomes in the order Fagales
Authors: Fitz-Gibbon Sorel , Mead Alayna , O’Donnell Scott , Li Zhi-Zhong , Escalona Merly , Beraut Eric , Sacco Samuel , Marimuthu Mohan P A , Nguyen Oanh , Sork Victoria L
Published: June 2023

Juglans californica, California walnut, is a vulnerable small tree that is locally abundant but restricted to woodland and chaparral habitats of Southern California threatened by urbanization and land use change. This species is the dominant species in a unique woodland ecosystem in California. It is one of 2 endemic California walnut species (family Juglandaceae). The other species, Northern California black walnut (J. hindsii), has been suggested controversially to be a variety of J. californica. Here, we report a new, chromosome-level assembly of J. californica as part of the California Conservation Genomics Project (CCGP). Consistent with the CCGP common methodology across ~150 genomes, we used Pacific Biosciences HiFi long reads and Omni-C chromatin-proximity sequencing technology to produce a de novo assembled genome. The assembly comprises 137 scaffolds spanning 551,065,703 bp, has a contig N50 of 30 Mb, a scaffold N50 of 37 Mb, and BUSCO complete score of 98.9%. Additionally, the mitochondrial genome has 701,569 bp. In addition, we compare this genome with other existing high-quality Juglans and Quercus genomes, which are in the same order (Fagales) and show relatively high synteny within the Juglans genomes. Future work will utilize the J. californica genome to determine its relationship with the Northern California walnut and assess the extent to which these 2 endemic trees might be at risk from fragmentation and/or climate warming.
Functional response of 3 green lacewing species (Neuroptera: Chrysopidae) toLeucoptera coffeella(Lepidoptera: Lyonetiidae)
Authors: Dami Bruno Gomes , Dos Santos Josy Aparecida , Barbosa Enes Pereira , Rodriguez-Saona Cesar , Vacari Alessandra M
Published: June 2023

Green lacewings (Neuroptera: Chrysopidae) are predators commonly found in coffee plantations in Brazil that can serve as important biological control agents against insect pests such as the coffee leaf miner, Leucoptera coffeella (Lepidoptera: Lyonetiidae). However, the efficacy of different lacewing species in controlling L. coffeella needs to be evaluated before they are used in augmentative biological control programs. Here, laboratory experiments were conducted to investigate the effects of the L. coffeella developmental stage on the functional response of 3 species of green lacewings: Chrysoperla externa, Ceraeochrysa cincta, and Ceraeochrysa cornuta. The attack rate, handling time, and the number of prey attacked during 24 h with different densities (1, 2, 4, 8, 16, 32, and 64 individuals) of either L. coffeella larvae or pupae were recorded for each of the 3 lacewing species. Based on logistic regression models, all 3 predators showed a Type II functional response when consuming both larvae and pupae of L. coffeella. All 3 species also had similar attack rates (0.0091 larva/h and 0.0095 pupa/h), handling times (3.5 and 3.7 h for larvae and pupae, respectively), and estimated number of prey attacked during the observation period (6.9 larvae and 6.6 pupae) for L. coffeella larvae and pupae. Therefore, our laboratory studies show that the 3 green lacewings Ch. externa, Ce. cincta, and Ce. cornuta have potential for the biological control of L. coffeella, although these results need to be confirmed under field conditions. These findings have implications for the selection of lacewings for augmentative L. coffeella biocontrol.