bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic value of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography in infective endocarditis
Authors: San S , Ravis RE , Tessonier TL , Philip MP , Lavagna FL , Norscini GN , Oliver LO , Arregle FA , Martel HM , Torras TO , Renard RS , Ambrosi AP , Casalta CAC , Drancourt DM , Habib GH
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is commonly used for the diagnosis of infective endocarditis (IE), but its prognostic value remains unknown.

Objectives

 This study sought to assess the prognostic value of 18F-FDG PET/CT in prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE).

Methods

 This study prospectively included 173 consecutive patients (109 PVE and 64 NVE) with definite left-sided IE who had an 18F-FDG PET/CT and were followed-up for 1 year. The primary endpoint was a composite of major cardiac events: death, recurrence of IE, acute cardiac failure, nonscheduled hospitalization for cardiovascular indication, and new embolic event.

Results

 18F-FDG PET/CT was positive in 100 (58%) patients, 83% (n = 90 of 109) in the PVE, and 16% (n = 10 of 64) in the NVE group. At a mean follow-up of 225 days (interquartile range: 199 to 251 days), the primary endpoint occurred in 94 (54%) patients: 63 (58%) in the PVE group and 31 (48%) in the NVE group. In the PVE group, positive 18F-FDG PET/CT was significantly associated with a higher rate of primary endpoint (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.1 to 6.7; p = 0.04). Moderate to intense 18F-FDG valvular uptake was also associated with worse outcome (HR: 2.3; 95% CI: 1.3 to 4.5; p = 0.03) and to new embolic events in PVE (HR: 7.5; 95% CI: 1.24 to 45.2; p = 0.03) and in NVE (HR: 8.8; 95% CI: 1.1 to 69.5; p = 0.02). In the NVE group, 18F-FDG PET/CT was not associated with occurrence of the primary endpoint CONCLUSIONS: In addition to its good diagnostic performance, 18F-FDG PET/CT is predictive of major cardiac events in PVE and new embolic events within the first year following IE.

Primary Endpoint Occurrence: Univariate and Multivariate Analysis in PVE Univariate HR (95% CI) p Value Multivariate HR (95% CI) p Value Renal insufficiency at admission 2.16 (1.00-4.68) 0.05 CRP >100 mg/l 2.46 (1.04-5.89) 0.02 1.90 (1.10-3.40) 0.03 Staphylococcus aureus 2.70 (1.10-6.55) 0.03 Severe valvular regurgitation 2.55 (1.01-6.41) 0.05 1.20 (0.70-2.10) 0.68 Echographic complications 1.15 (0.54-2.46) 0.72 Vegetation length >10 mm 2.53 (1.19-4.60) 0.03 Positive 18F-FDG PET/CT 3.74 (1.30-10.80) 0.02 2.70 (1.10-6.70) 0.04 Moderate to intense 18FDG valvular uptake 2.70 (1.20-6.30) 0.02 2.30 (1.30-4.50) 0.03 Abstract Figure.
The strain-7 study: multimodal, multivendor, multifield strength, scan:rescan comparison of global longitudinal and circumferential strain in healthy volunteers
Authors: Nazir MS , Yazdani M , Draper JANE , Franks R , Lam S , Plein S , Kapetanakis S , Young A , Chiribiri A
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National Insitute for Health Research

Background

There is clinical and prognostic evidence for global longitudinal strain (GLS) and circumferential strain (GCS). A range of techniques exist: 2-dimensional echocardiography (2Decho), 3-dimensional echocardiography (3Decho) and Cardiovascular Magnetic Resonance (CMR).

Purpose

To investigate inter-study repeatability and inter-method comparison of GLS and GCS techniques.

Methods

Volunteers underwent same day scan

rescan 2Decho, 3Decho, 1.5T Siemens CMR (Cine imaging and Displacement encoding with stimulated echoes [DENSE]), 3T Siemens CMR (Cine Imaging and DENSE) and 3T Philips CMR (Tagging and Fast strain-encoding [fSENC]) imaging. Strain was quantified for 2Decho (EchoPAC), 3Decho (TomTec), Feature tracking (FT) for cine imaging (CircleCVI), CIM (University of Auckland) for DENSE and Tag, and Myostrain (Myocardial solutions) for fSENC.

Results

20(6F) volunteers, mean age 33 ± 7 years, mean LVEF 62 ± 4%. All GLS and GCS methods had excellent inter-study agreement (ICC > 0.75) with coefficient of variation (CoV) between 4-8% (Table 1). Median and IQR are presented in Figure 1.

Friedman’s test revealed statistically significant inter-method differences for GLS (χ2 = 66.4,p < 0.0001) and GCS (χ2 = 50.9,p < 0.0001). Post hoc analysis using Dunn’s test with Bonferroni correction demonstrated significant differences:

-GLS: 2Decho vs DENSE 1.5T (p = 0.001) and Myostrain 3T (p = 0.0116); 3Decho vs FT 3T (p = 0.049) and DENSE 1.5T (p < 0.0001); FT 1.5T vs DENSE 1.5T (p = 0.001) and Myostrain 3T (p = 0.01); FT 3T vs Myostrain 3T (p < 0.0001); DENSE 1.5T vs Tag 3T (p = 0.0008) and Myostrain 3T (p < 0.0001); Tag 3T vs Myostrain (p = 0.02).

-GCS: 3Decho vs DENSE 1.5T (P = 0.0005), FT 1.5T (p < 0.001), FT 3T (P < 0.001) and Myostrain (p = 0.003); FT 1.5T vs Tag 3T (p = 0.001), FT 3T vs Myostrain 3T (p = 0.04).

Conclusion

There is excellent interstudy agreement for GLS and GCS methods. However, there are important inter-method differences in absolute values, that need to be considered for clinical application as a surveillance method and longitudinal studies.

Table 1 Acquisiton Post processing GLS CoV(%) GLS ICC GCS CoV(%) GCS ICC 2DEcho EchoPAC 4.88 0.80 - - 3DEcho TomTec 4.77 0.86 3.97 0.85 Siemens 1.5T cine FT CircleCVI 8.30 0.79 6.00 0.85 Siemens 3T cine FT CircleCVI 6.21 0.89 4.76 0.94 Philips 3T Tag CIM 6.15 0.89 5.86 0.88 Siemens 1.5T DENSE CIM 4.36 0.90 4.65 0.89 Philips 3T fSENC Myostrain 8.45 0.81 4.06 0.90 Interstudy agreement for the different GLS and GCS methods. Abstract Figure 1
Right ventricular apical and septal pacing: long term impacts on ventricular function
Authors: Mumin G , Celiker C
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): The costs of the study were afforded by the researchers.

Background

In patients requiring permanent pacemaker, in order to protect left and right ventricular functions the optimal pacing site has yet to be determined. Conflicting results exist about septal and apical pacing sites.

Aim

Our purpose was to evaluate the long term effects of right ventricular apical and septal pacing on left and right ventricular functions.

Methods

We scanned 378 patients from 2007 to 2012 who received a permanent pacemaker for the treatment of symptomatic bradyarrythmia. As exclusion criteria we identified the patients who did not have an echocardiography before the procedure, those who had co-morbidities which cause reduction in ventricular functions, ejection fraction <%45, patients who died and those who rejected our invitation. 54 women and 66 men were eligible for our study. To determine the patients’ New York Heart Association Class (NYHA) we questioned and did the physical examination. Lead position confirmed by fluoroscopy in two planes, and electrocardiograms were obtained. Finally, we compared the pre-procedural echocardiographic data with our up-to-date findings.

Results

In sixteen patients the lead placement was inferoseptal and in one hundred and four patients apical site. Median follow up was 9 years. The mean ejection fraction before the implantation was 58,86 ± 4,08 in the apical, and 56,37 ± 8,8 in the septal group (p < 0,05). The long term follow up showed that these values have been reduced, 56,66 ± 8,38 for the apical group and 51,33 ± 13,94 for the septal group, respectively (p < 0,05). Placing the right ventricular lead in both septal and apical site resulted in reduced tricuspid annular plane systolic excursion (from mean 2,25 to 2,18, (p < 0,05)), and in increased systolic pulmonary artery pressure (from 35,46 ± 9,93 to 39,84 ± 11,21 (p < 0,05)). There were no differences regarding the mitral and tricuspid insufficiencies, and diastolic functions before the implantation and long term follow up. These findings were independent of neither the etiology of implanting the pacemaker nor the underlying diseases.

Conclusion

These two selective ventricular pacing sites caused a reduction in both left and right ventricular functions. Despite the ejection fraction declines, most of these patients have a good quality of life, without symptoms and signs of heart failure. But certainly, there is emerging need for more randomized trials in order to describe the optimal RV pacing site. The main purpose must be preserving better ventricular functions in patients requiring permanent ventricular pacing.
Prognosis of atrial fibrillation radiofrequency ablation: Iodine-123-MIBG cardiac innervation imaging
Authors: Varlamova Y , Zavadovsky K , Kisteneva I , Sazonova S , Batalov R
Published: February 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation

BACKGROUND

To date, radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is a valuable treatment option. So far there are no clear predictors of the effectiveness of AF ablation. Nowadays, the association of cardiac sympathetic nervous system and the development and maintenance of AF has been showed. The association between сardiac sympathetic system impairment, assessed by 123I-MIBG scintigraphy and RFCA effectiveness was shown previously. However, the is lack of data concerning to prognostic value of MIBG scintigraphy in patients with different forms of AF – persistent (PAF) and long-standing persistent (LSPAF).

PURPOSE

To study the prognostic significance of 123I-MIBG scintigraphy in RFCA efficacy in patients with persistent and long-standing persistent AF.

METHODS

The study enrolled 36 patients with drug-resistant AF (both persistent (n = 20) and long-standing persistent (n = 16) forms).  All patients had comorbidity as chronic coronary syndrome and hypertension. A comparison group (n = 10) was also enrolled in the study. It includes patients with chronic coronary syndrome and arterial hypertension (without arrhythmia). All patients underwent 123I-MIBG and 99mTc-MIBI scintigraphy to evaluate the cardiac sympathetic activity and myocardial perfusion, respectively. Patients with AF performed RFCA. After of 1 year follow-up patients were examined for AF recurrence. The AF recurrence was considered to be an AF of at least 30 sec duration on a 12-lead ECG or on the Holter monitoring.

RESULTS

During the follow-up period, AF recurrences were reported in 7 (35%) PAF patients and in 8 (50%) LSPAF patients. According to multivariate analysis only a high pre-ablation washout rate of 123I-MIBG (WR) in PAF patients (OR: 1.668; 95% CI: 1.093–2.548) and large pre-ablation 123I-MIBG/99mTc-MIBI mismatch score in LSPAF patients (OR: 2.155; 95% CI: 1.192–3.897) were independent predictors of AF recurrence after RFCA. ROC analysis indicated that in PAF patients with higher WR ≥ 20.8% (AUC: 0.968; Sensitivity: 100 %; Specificity: 45%; p < 0.05) and LSPAF patients with larger 123I-MIBG/99mTc-MIBI mismatch score ≥ 12.5 % (AUC: 0.942; Sensitivity: 81 %; Specificity: 28 %; p < 0.05) had a higher risk of AF recurrence after RFCA.

CONCLUSION

In AF patients the incidence of arrhythmia recurrence after RFCA is associated with impaired cardiac sympathetic nervous activity. In PAF patients the values of 123I-MIBG washout rate can predict AF recurrence. In LSPAF patients innervation/perfusion mismatch has prognostic value in terms of AF recurrence.
Right ventricular stroke work index in adult patients with pulmonary arterial hypertension: - a comparison between echocardiography and right heart catheterization
Authors: Jumatate R , Ingvarsson A , Smith G , Roijer A , Ostenfeld E , Waktare J , Radegran G , Meurling C , Werther Evaldsson A
Published: February 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Swedish Society of Pulmonary Hypertension

Background

In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, constituting a negative prognostic factor.  In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) reflects right ventricular function and has been proposed to predict outcome in PAH. However, RVSWI assessed by echocardiography (ECHO) has not been thoroughly compared to measures with right heart catheterization (RHC) in adults. The aim of the present study was to therefore evaluate RVSWI derived by echocardiography (RVSWIECHO) vs. RHC (RVSWIRHC).

Methods

 Fifty-four consecutive treatment naïve adult patients with PAH, were retrospectively analysed. All patients performed echocardiography and RHC with a median time of 1 day [IQR 0-1 days]. RVSWIRHC was calculated as: (mean pulmonary arterial pressure (mPAP) – mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHO were evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2=(TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmPG) x SVIECHO and RVSWIECHO-4=(TRmPG–mRAPECHO) x SVIECHO. Vena cava inferior diameter and its collapsibility were used for estimation of mRAPECHO.. Pearson’s correlation coefficients were used and data was expressed as mean ± standard deviation.

Results

Mean RVSWIRHC was 1132 ± 352 mmHg*mL*m-2.  Mean RVSWIECHO-1-4 was: 1904 ± 568, 1732 ± 531, 1090 ± 366 and 918 ± 336 mmHg*mL*m-2, respectively. There was no significant difference between RVSWIRHC and RVSWIECHO-3 in mean values, although they exhibited the lowest correlation, but moderate (r = 0.66). The strongest correlation was demonstrated for  RVSWIECHO-2 (r = 0.78, p < 0.001), followed by a moderate correlation for  RVSWIECHO-1 and RVSWIECHO-4 (r = 0.75 and r = 0.69, p < 0.001). The absolute (relative) bias for RVSWIECHO-1 was  -772 ± 385 (-50 ± 20%) mmHg*mL*m-2, RVSWIECHO-2 -600 ± 339 (-41 ± 20%) mmHg*mL*m-2, RVSWIECHO-3 42 ± 286 (5 ± 25%) mmHg*mL*m-2 and for RVSWIECHO-4 214 ± 273 (23 ± 27%) mmHg*mL*m-2.

Conclusion

RVSWIECHO-3, using the mean tricuspid gradient and SVIECHO, showed no significant difference to RVSWIRHC, albeit a moderate correlation between the methods. RVSWIECHO-1, RVSWIECHO- 2 and RVSWIECHO-4 exhibited moderate to strong correlations to RVSWIRHC, but poor concordance between absolute values. The clinical utility of RVSWIECHO and RVSWIRHC in assessing RV function in relation to PAH prognosis, risk stratification and treatment response remains to be evaluated in a larger clinical context.
The role of obesity and adipokines in coronary microvascular dysfunction: a systematic review and meta-analysis
Authors: Spezia M , Bonato A , De Fortunato G , Bossi A , Glauber M
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with obesity present structural and functional changes in the heart and in the coronary circulation, which ultimately leads to an increased risk of cardiovascular disease. Obesity is associated with a low chronic state of inflammation which seems to be linked to a compromised coronary vasoreactivity, which is shown to be a forerunner and a long-term predictor of clinically relevant cardiovascular events.

Methods

A systematic review was performed by searching PubMed, Embase and Cochrane Library database. Selection criteria were applied leading to the inclusion of studies of any level of evidence published in peer-reviewed journals reporting clinical or preclinical results. Relative data were extracted and critically analysed. PRISMA guidelines were applied and risk of bias was assessed, as well as the methodological quality of the included studies. After this assessment, we excluded all the articles with serious risk of bias and/or low quality. Meta-analysis was conducted on the data collected regarding coronary blood flow (CFR) and hyperemic myocardial blood flow (MBF), while for the other parameters a descriptive analysis was performed.

Results

After applying the described criteria, we included 15 articles on human and animal literature assessed as medium or high quality. The data of 1399 patients were examined, 456 of which with obesity (BMI ≥ 30). A pooled effect size analysis shows that coronary flow reserve (CFR) is significantly reduced in patients with obesity [Random Effect (RE): -47.7%, 95% confidence interval (CI) -80.2% – -15.2%; n = 422]. Increased BMI is associated with reduced CFR. The same trend is found evaluating pharmacological induced stress MBF, which was reduced in patients with obesity [RE: -47.8%, 95% CI -73.7% – -21.8%; n = 409]. Nevertheless, MBF at rest did not show a significant difference in patients with obesity from our analysis [RE: 15%, 95% CI -24% - 53%; n = 409]. Pro-inflammatory adipokines secretion, as leptin and CRP, seems to correlate with a significant decrease of stress-induced MBF and reduced CFR.

Conclusions

Obesity is associated with a significant higher risk of coronary microvascular disfunction, which is reflected by diminished CFR and stress MBF. Systemic inflammation and the imbalance of adipokines related to obesity has been closely linked to a blunt coronary flow. CMD is a pre-clinical heart conditions that often remains undiagnosed. Further evidence is required to clear out the role of Obesity from a molecular point of view on the coronary endothelium.
Association between microvascular dysfunction and impaired myocardial deformation in hypertrophic cardiomyopathy
Authors: Aguiar Rosa S , Branco L , Thomas B , Fiarresga A , Lopes L , Galrinho A , Selas M , Silva F , Branco G , Pereira R , Barao A , Baquero L , Mota Carmo M , Cruz Ferreira R
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Objective

To analyze the relationship between coronary microvascular dysfunction (MCD) and left ventricular (LV) myocardial deformation in hypertrophic cardiomyopathy (HCM). 

Methods

Prospectively inclusion of HCM patients (P). MCD was assessed by CMR, during regadenoson-induced hyperemia. For perfusion assessment, the myocardium was divided into 32 subsegments (16 AHA segments subdivided into an endocardial and epicardial layer). Ischemic burden was calculated as the number of involved subsegments, assigning 3% of myocardium to each subsegment. Epicardial coronary artery disease was excluded by computed tomography or invasive coronary angiography.

LV myocardial deformation was evaluated by 2D and 3D speckle-tracking echocardiography (STE), including global longitudinal strain (GLS), peak systolic dispersion (PDS), global circumferential strain (GCS), global radial strain (GRS), area strain, twist and torsion.

Results

31 P enrolled (51%male,age57.8 ± 15.5years). Asymmetric septal hypertrophy was seen in 55%, apical in 29%, concentric in 16%,maximal wall thickness (MWT) of 20.5 ± 4.9mm; 26% with LVOT obstruction; LV ejection fraction 67.9 ± 7.9%.

In 2DSTE analysis, P with more ischemia (>20%of LV) presented more severe impaired GLS and greater PDS, comparing with patients with ≤20% of ischemia.

Similarly, 3DSTE imaging showed worse LV performance in P with greater ischemic burden, expressed by significant difference in GLS, GRS and area strain. GCS also trended to be worse in the presence of >20% of ischemia.

The stronger correlation was found between 2D GLS and ischemic burden (Pearson correlation factor 0.545; p = 0.002).

Conclusion

In HCM, the severity of ischemia secondary to MCD was associated with impairment in LV myocardial deformation evaluated by 2D and 3D STE.

Table 1. Echocardiography Ischemic burden (% of LV) 2D parameters ≤ 20% (n = 15) > 20% (n = 16) p-value GLS (%) -15.6 ± 2.7 -12.1 ± 4.7 0.016 PSD (ms) 73.2 ± 25.6 102.1 ± 57.6 0.150 3D parameters GLS (%) -10.3 ± 4.5 -7.3 ± 3.0 0.010 GCS (%) -12.6 ± 3.0 -10.1 ± 4.5 0.079 GRS (%) 30.8 ± 8.5 22.8 ± 11.4 0.035 Area strain(%) -20.8 ± 4.9 -15.8 ± 6.3 0.020 Twist (deg) 6.0 ± 4.8 4.1 ± 4.0 0.175 Torsion (deg/cm) 1.2 ± 0.9 0.8 ± 0.7 0.232
Prediction of long-term survival in haemoglobinopathies: insights from cardiac imaging and ferritin
Authors: Kamperidis V , Vlachou M , Pappa Z , Pantelidou D , Karamitsos T , Papadopoulou D , Kartas A , Vlachaki E , Giannakoulas G , Karvounis H
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Aims.The data on echocardiography, cardiac magnetic resonance (CMR) and ferritin predicting long-term survival in haemoglobinopathies are scarce. The current study evaluated the association of these parameters with the 10-years survival in haemoglobinopathies.

Methods.This prospective study included stable consecutive haemoglobinopathy patients .Demographics, ferritin, echocardiography and CMR parameters were prospectively collected.

Results. In total, 83 patients (mean age 38.4 ± 12.0 years, 46% male) with haemoglobinopathies were included and dichotomized based on their survival status after a follow-up of 9.8 ± 1.4 years. Patients who died were older (45.3 ± 11.6 vs 37.1 ± 11.7 years, p = 0.025), had higher ferritin levels (2498 vs 754 ng/ml, p = 0.001), higher right ventricular systolic pressure (RVSP) (41 ± 10 vs 31 ± 11mmHg, p = 0.001), more frequently elevated left ventricular (LV) end-diastolic pressure (70 vs 35%, p = 0.039) and lower CMR T2* values (23 ± 12 vs 35 ± 12ms, p = 0.007). Older age (HR: 1.053, p = 0.018), ferritin >2000ng/ml (HR: 3.517, p = 0.03), and >950ng/ml (HR: 11,135, p = 0.02), elevated LV end-diastolic pressure (HR: 3.977, p = 0.046), RVSP >34mmHg(HR: 10,134, p = 0.003), CMR T2* <20msec (HR: 4.900, p = 0.018) and <36msec (HR: 9.376, p = 0.035) were associated with increased all-cause mortality. A baseline model including age was created andit became more predictive of worse survival by adding RVSP >34mmHg than elevated LV end-diastolic pressure (C index 0.777 vs. 0.757 respectively) or ferritin >950ng/ml than >2000ng/ml (C index 0.805 vs. 0.770 respectively) or CMR T2*<36msec than <20msec (C index 0.825 vs. 0.810 respectively).

Conclusions. In haemoglobinopathy patients, RVSP >34mmHg, ferritin >2000ng/ml and CMR T2* <20ms were associated with worse long term survival.In the current era of advanced chelation therapy, aiming for ferritin <950ng/ml and CMR T2* >36ms appears to improve their prognosis.

Abstract Figure.
Cardiovascular magnetic resonance normal values for pulmonary arteries and ventricular volumes in paediatric patients with transposition of the great arteries after arterial switch operation
Authors: Voges I , Boll C , Caliebe A , Uebing A , Krupickova S
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The anatomy of the pulmonary arteries (PA) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) with Lecompte manoeuvre is different compared to healthy subjects and stenoses of the PA are known to occur. Cardiovascular magnetic resonance (CMR) imaging is an excellent imaging modality to assess PA anatomy in TGA patients. However, disease specific normal values for PA size do not exist. Furthermore, the impact of pulmonary artery size, age and gender on ventricular volumes and function is unknown. Therefore, we sought to establish disease specific normative ranges for PA dimensions as well as biventricular volumes and function.

Methods

70 CMR scans of paediatric patients with TGA after ASO with Lecompte manoeuvre (mean age 12.3 ± 3.6 years; range 5-18 years; 57 males) were included. Cine CMR sequences as well as contrast-enhanced magnetic resonance angiography (CE-MRA) data were used to measure pulmonary artery dimensions. Right and left PA were each measured at three locations during its course around the aorta. Ventricular volumes, mass and ejection fraction were measured from a stack of short axis cine images.

Results

Mean systolic and diastolic diameters of the MPA were 15.0 ± 2.3 mm (10.5 ± 2.7 mm/m²) / 13.2 ± 2.9 mm (9.2 ± 2.9 mm/m²) and mean cross-sectional MPA area was 286.7 ± 81.7 mm². Mean systolic and diastolic diameters for the RPA and LPA at the narrowest point were: RPA 10.5 ± 2.8 mm (7.8 ± 2.4 mm/m²)  / 8.1 ± 2.2 mm (6.0 ± 1.9 mm/m²); LPA 8.4 ± 2.8 mm (6.2 ± 2.1 mm/m²) / 7.4 ± 2.3 mm (5.4 ± 1.6 mm/m²). Mean values for biventricular volumes, ejection fraction and mass were as follows: 1) left  ventricular (LV) end-diastolic volume (EDV) 89.0 ± 20.3 ml/m² and end-systolic volume (ESV) 35.1 ± 11.7 ml/m², 2) right ventricular (RV) EDV 76.4 ± 15.4 ml/m² and ESV 32.4 ± 9.1 ml/m², 3) LV and RV ejection fraction 61.1 ± 6.5 % / 58.9 ± 6.1 % and 4) LV and RV mass 59.6 ± 15.2 g/m² / 23.3 ± 7.4 g/m². Separate centile charts for boys and girls for PA dimensions as well as biventricular volumes, mass and ejection fraction were created.

Conclusion

We established disease specific CMR normal values for the PA dimensions as well as for ventricular volumes, mass and ejection fraction in paediatric patients with TGA after ASO. Our data will improve CMR image interpretation and may serve as a reference in future studies.
Pulsatile and resistive systolic loads as determinants of left ventricular remodelling after physical training
Authors: Torlasco C , D"silva A , Bhuva AN , Faini A , Augusto JB , Knott KD , Benedetti G , Scully P , Parati G , Lloyd G , Hughes A , Sharma S , Manisty C , Osculati G , Moon JC
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation Barts Cardiovascular Biomedical Research Centre

onbehalf

The Marathon Study Consortium

Introduction

Cardiovascular function depends on the inter-relation between heart and vasculature.  The contribution of aorta and peripheral vessels to the total systolic load of the left ventricle (LV) can be represented respectively by a "pulsatile" and a "resistive" component. We sought to understand their interrelation by exploring how LV remodelling occurred with altered load associated with an external stimulus (training). Methods: 237 untrained healthy male and female subjects volunteering for their first-time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided into 4 groups according to the variation (positive versus null or negative) in Total Arterial Compliance Index (TACi), representing the pulsatile component of the LV load, and in Systemic Vascular Resistance Index (SVRI), representing the resistive component of the LV load. Results: 138runners (age 21-69 years; F: 51%) completed the race. Data are reported for each variable as Δ mean [95% Confidence Interval]. In the whole cohort, training was associated with a small increase in LV mass index (+3g/m2, [0, 6 g/m2]), indexed LV end-diastolic volume (EDVi) (+3ml/m2, [-2, 5 3ml/m2]), in LV mass/LVEDV ratio (+0.02g/ml, [0.00, 0.04 g/ml]) and in TACi (+0.02ml/m2, [0.02, 0.38 ml/m2]). SVRi mildly fell (-43dyn·s/cm2[-103, 17dyn·s/cm2]). TACi increase was associated with LVEDVi increase and no change in LV mass/EDV (eccentric remodelling). On the other hand, both TACi reduction and SVRi increase were associated with increase in LV mass/EDV and no significant change in LVEDVi (concentric remodelling). A similar increase in LV mass was observed in all groups. See Table. Conclusion: Cardiac remodelling observed after mild, medium term, unsupervised training seems to be related to the modifications of aorta and peripheral vessels. In particular, a reduction in pulsatile load seems associated with eccentric LV remodelling, while an increase in both pulsatile and resistive with concentric LV remodelling. Further research is needed to understand the interaction between TACi and SVRi.

Table 1 LV EDVi (ml/m2) LV mass index (g/m2) LV mass/EDV TACi increase (n = 75) +4 [0, 9] +3 [0, 7] 0 [-0.03, 0.03] TACi decrease (n = 62) -1 [-6, 4] +3 [0, 8] 0.04 [0.01, 0.07] SVRi increase (n = 63) 0 [-4,4] +3 [0, 7] +0.03 [0, 0.06] SVRi decrease (n = 73) +3 [-3, 7] +3 [-1, 6] +0.01 [-0.02, 0.04]
Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient
Authors: Christ Torsten , Borck Robin , Dushe Simon , Sündermann Simon Harald , Falk Volkmar , Grubitzsch Herko
Published: February 2021

OBJECTIVES

The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years).

METHODS

All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed.

RESULTS

Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0–25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P < 0.001). Hospital mortality while reoperation was 7.4% in the stentless group and 0% in the mechanical group (P = 1.0)

CONCLUSIONS

Long-term morbidity and mortality of stentless and mechanical aortic valves were statistically not different besides a significantly higher reoperation rate after stentless AVR combined with a probably higher risk of in-hospital mortality. Thus, mechanical AVR should remain the procedure of choice in younger patients.
Laryngotracheal resection can be performed safely without a guardian Chin stitch—a single-centre experience including 165 consecutive patients
Authors: Schweiger Thomas , Evermann Matthias , Roesner Imme , Frick Anna-Elisabeth , Denk-Linnert Doris-Maria , Klepetko Walter , Hoetzenecker Konrad
Published: February 2021

OBJECTIVES

A tension-free anastomosis is crucial to minimize the risk of airway complications after laryngotracheal surgery. The ‘guardian’ chin stitch is placed to prevent hyperextension of the neck in the early postoperative period. This manoeuvre was introduced early in tracheal surgery and is now routinely performed by many airway surgeons. However, the evidence for or against is sparse.

METHODS

We performed a retrospective analysis of all adult patients receiving a (laryngo-)tracheal resection at our department from October 2011 to December 2019. According to our institutional standard, none of the patients received a chin stitch. Instead, a head cradle was used to obtain anteflexion of the neck during the first 3 days and patients were instructed to avoid hyperextension of the neck during the hospital stay. The postoperative outcome and the rate of anastomotic complications were analysed.

RESULTS

A total of 165 consecutive patients were included in this study. Median age at surgery was 53 years (18–80). Seventy-four patients received a tracheal resection, 24 a cricotracheal resection, 52 an extended cricotracheal resection including dorsal mucosectomy and 15 a single-stage laryngotracheal reconstruction. The median resection length was 25 mm (range 10–55 mm). One hundred and sixty-two out of 165 (98.2%) patients had an unremarkable postoperative course. One patient (0.6%) had partial anastomotic rupture after a traumatic reintubation, which required revision surgery and re-anastomosis. Two patients (1.2%) after previous radiation therapy (>60 Gy) developed a partial necrosis of the anastomosis, resulting in prolonged airleak and fistulation. At follow-up, bronchoscopy 3 months after surgery, 92.7% (127/137) of the patients had a proper anastomosis, 6.6% (9/137) had minor granuloma formations at the site of the anastomosis, which were all treated successfully by endoscopic removal. One patient received dilatation for restenosis (0.7%).

CONCLUSIONS

After sufficient mobilization of the central airways, postoperative anteflexion of the neck supported by a head cradle is sufficient to prevent excessive anastomotic tension and dehiscence. Considering the risk for severe neurological complications associated with the chin stitch, the routine use of this manoeuvre in laryngotracheal surgery should not be recommended.
Pareto-improving carbon-risk taxation
Authors: Kotlikoff Laurence , Kubler Felix , Polbin Andrey , Scheidegger Simon
Published: February 2021

Anthropogenic climate change produces two conceptually distinct negative economic externalities. The first is an expected path of climate damage. The second, the focus of this paper, is an expected path of economic risk. To isolate the climate-risk problem, we consider three mean-zero, symmetric shocks in our 12-period, overlapping generations model. These shocks impact dirty energy usage (carbon emissions), the relationship between carbon concentration and temperature and the connection between temperature and damages. By construction, our model exhibits a de minimis climate problem absent its shocks. However, due to non-linearities, symmetric shocks deliver negatively skewed impacts, including the potential for climate disasters. As we show, Pareto-improving carbon taxation can dramatically lower climate risk, in general, and disaster risk, in particular. The associated climate-risk tax, which is focused exclusively on limiting climate risk, can be as large as, or larger than, the carbon average-damage tax, which is focused exclusively on limiting average damage.
The role of computer-assisted systems for upper-endoscopy quality monitoring and assessment of gastric lesions
Authors: Lazăr Daniela Cornelia , Avram Mihaela Flavia , Faur Alexandra Corina , Romoşan Ioan , Goldiş Adrian
Published: February 2021

This article analyses the literature regarding the value of computer-assisted systems in esogastroduodenoscopy-quality monitoring and the assessment of gastric lesions. Current data show promising results in upper-endoscopy quality control and a satisfactory detection accuracy of gastric premalignant and malignant lesions, similar or even exceeding that of experienced endoscopists. Moreover, artificial systems enable the decision for the best treatment strategies in gastric-cancer patient care, namely endoscopic vs surgical resection according to tumor depth. In so doing, unnecessary surgical interventions would be avoided whilst providing a better quality of life and prognosis for these patients. All these performance data have been revealed by numerous studies using different artificial intelligence (AI) algorithms in addition to white-light endoscopy or novel endoscopic techniques that are available in expert endoscopy centers. It is expected that ongoing clinical trials involving AI and the embedding of computer-assisted diagnosis systems into endoscopic devices will enable real-life implementation of AI endoscopic systems in the near future and at the same time will help to overcome the current limits of the computer-assisted systems leading to an improvement in performance. These benefits should lead to better diagnostic and treatment strategies for gastric-cancer patients. Furthermore, the incorporation of AI algorithms in endoscopic tools along with the development of large electronic databases containing endoscopic images might help in upper-endoscopy assistance and could be used for telemedicine purposes and second opinion for difficult cases.
Impact of Nonpharmaceutical Interventions for Severe Acute Respiratory Syndrome Coronavirus 2 on Norovirus Outbreaks: An Analysis of Outbreaks Reported By 9 US States
Authors: Kraay Alicia N M , Han Peichun , Kambhampati Anita K , Wikswo Mary E , Mirza Sara A , Lopman Benjamin A
Published: February 2021

In April 2020, the incidence of norovirus outbreaks reported to the National Outbreak Reporting System dramatically declined. We used regression models to determine if this decline was best explained by underreporting, seasonal trends, or reduced exposure due to nonpharmaceutical interventions (NPIs) implemented for severe acute respiratory syndrome coronavirus 2 using data from 9 states from July 2012 to July 2020. The decline in norovirus outbreaks was significant for all 9 states, and underreporting and/or seasonality are unlikely to be the primary explanation for these findings. These patterns were similar across a variety of settings. NPIs appear to have reduced incidence of norovirus, a nonrespiratory pathogen.
A composite framework for supporting user emotion detection based on intelligent taxonomy handling
Authors: Cuzzocrea Alfredo , Pilato Giovanni
Published: February 2021

One of the most relevant issues of a social robot is its capability of catching the attention of a new acquaintance and empathize with her. The first steps towards a system which can be used by a social robot in order to be empathetic are illustrated in this paper. The system can analyze the Twitter ID of the new acquaintance, trying to detect the IAB (Interactive Advertising Bureau) Tier 1 categories that possibly can let arise in him/her a joyful feeling. Furthermore, it can retrieve news about that category and report them to the user, hopefully increasing his/her curiosity towards the system, improving the naturalness of the interaction. Moreover, the system is capable of querying Wikipedia in order to clarify any doubts that may arise in the user. A sample of a possible interaction is reported at the end of the paper.
A complete census of circumgalactic Mg ii at redshift z ≲ 0.5
Authors: Huang Yun-Hsin , Chen Hsiao-Wen , Shectman Stephen A , Johnson Sean D , Zahedy Fakhri S , Helsby Jennifer E , Gauthier Jean-René , Thompson Ian B
Published: February 2021

This paper presents a survey of Mg ii absorbing gas in the vicinity of 380 random galaxies, using 156 background quasi-stellar objects (QSOs) as absorption-line probes. The sample comprises 211 isolated (73 quiescent and 138 star-forming galaxies) and 43 non-isolated galaxies with sensitive constraints for both Mg ii absorption and H α emission. The projected distances span a range from d = 9 to 497 kpc, redshifts of the galaxies range from z = 0.10 to 0.48, and rest-frame absolute B-band magnitudes range from MB = −16.7 to −22.8. Our analysis shows that the rest-frame equivalent width of Mg ii, Wr(2796), depends on halo radius (Rh), B-band luminosity(LB), and stellar mass (Mstar) of the host galaxies, and declines steeply with increasing d for isolated, star-forming galaxies. At the same time, Wr(2796) exhibits no clear trend for either isolated, quiescent galaxies or non-isolated galaxies. In addition, the covering fraction of Mg ii absorbing gas 〈κ〉 is high with 〈κ〉 ≳ 60 per cent at <40 kpc for isolated galaxies and declines rapidly to 〈κ〉 ≈ 0 at d ≳ 100 kpc. Within the gaseous radius, the incidence of Mg ii gas depends sensitively on both Mstar and the specific star formation rate inferred from H α. Different from what is known for massive quiescent haloes, the observed velocity dispersion of Mg ii absorbing gas around star-forming galaxies is consistent with expectations from virial motion, which constrains individual clump mass to $m_{\rm cl} \gtrsim 10^5 \, \rm M_\odot$ and cool gas accretion rate of $\sim 0.7\!-\!2 \, \mathrm{ M}_\odot \, \rm yr^{-1}$. Finally, we find no strong azimuthal dependence of Mg ii absorption for either star-forming or quiescent galaxies. Our results demonstrate that multiple parameters affect the properties of gaseous haloes around galaxies and highlight the need of a homogeneous, absorption-blind sample for establishing a holistic description of chemically enriched gas in the circumgalactic space.
On the origin of nitrogen at low metallicity
Authors: Roy Arpita , Dopita Michael A , Krumholz Mark R , Kewley Lisa J , Sutherland Ralph S , Heger Alexander
Published: February 2021

Understanding the evolution of the N/O ratio in the interstellar medium (ISM) of galaxies is essential if we are to complete our picture of the chemical evolution of galaxies at high redshift, since most observational calibrations of O/H implicitly depend upon the intrinsic N/O ratio. The observed N/O ratio, however, shows large scatter at low O/H, and is strongly dependent on galactic environment. We show that several heretofore unexplained features of the N/O distribution at low O/H can be explained by the N seen in metal-poor galaxies being mostly primary nitrogen that is returned to the ISM via pre-supernova winds from rapidly rotating massive stars (M ≳ 10 M⊙, v/vcrit ≳ 0.4). This mechanism naturally produces the observed N/O plateau at low O/H. We show that the large scatter in N/O at low O/H also arises naturally from variations in star-formation efficiency. By contrast, models in which the N and O come primarily from supernovae provide a very poor fit to the observed abundance distribution. We propose that the peculiar abundance patterns we observe at low O/H are a signature that dwarf galaxies retain little of their SN ejecta, leaving them with abundance patterns typical of winds.
Regulation, Diversity and Evolution of Boron Transporters in Plants
Authors: Onuh Amarachukwu Faith , Miwa Kyoko
Published: February 2021

Boron (B) is an essential trace element in plants, and borate cross-linking of pectic polysaccharide rhamnogalacturonan-II (RG-II) in cell walls is required for normal cell growth. High concentrations of B are toxic to cells. Therefore, plants need to control B transport to respond to B conditions in the environment. Over the past two decades, genetic analyses of Arabidopsis thaliana have revealed that B transport is governed by two types of membrane transport molecules: NIPs (nodulin-26-like intrinsic proteins), which facilitate boric acid permeation, and BORs, which export borate from cells. In this article, we review recent findings on the (i) regulation at the cell level, (ii) diversity among plant species and (iii) evolution of these B transporters in plants. We first describe the systems regulating these B transporters at the cell level, focusing on the molecular mechanisms underlying the polar localization of proteins and B-dependent expression, as well as their physiological significance in A. thaliana. Then, we examine the presence of homologous genes and characterize the functions of NIPs and BORs in B homeostasis, in a wide range of plant species, including Brassica napus, Oryza sativa and Zea mays. Finally, we discuss the evolutionary aspects of NIPs and BORs as B transporters, and the possible relationship between the diversification of B transport and the occurrence of RG-II in plants. This review considers the sophisticated systems of B transport that are conserved among various plant species, which were established to meet mineral nutrient requirements.
Observational study of adult respiratory infections in primary care clinics in Myanmar: understanding the burden of melioidosis, tuberculosis and other infections not covered by empirical treatment regimes
Authors: Warrell Clare E , Phyo Aung Pyae , Win Mo Mo , McLean Alistair R D , Watthanaworawit Wanitda , Swe Myo Maung Maung , Soe Kyaw , Lin Htet Naing , Aung Yee Yee , Ko Chitmin Ko , Waing Cho Zin , Linn Kaung San , Aung Yadanar Phoo Wai , Aung Ne Myo , Tun Ni Ni , Dance David A B , Smithuis Frank M , Ashley Elizabeth A
Published: February 2021

Background

Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms.

Methods

A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing.

Results

Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients.

Conclusions

TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population.