bluuebunny/crossref_metadata_2025 huggingface dataset:
Chemical Chartographisis: a contemporary perspective in molecular design and synthesis
Authors: Kostakis George E.
Published: November 2023

We introduce a contemporary perspective in molecular design and synthesis, named "Chemical Chartographisis".
Natureness‐preserving tone mapping operator based on improved guided filter and adaptive Gamma curve
Authors: Hu Chaoxuan , Liu Peipei , Qin Weifeng , Wang Shuo
Published: November 2023

Mapping high dynamic range (HDR) images to low dynamic range (LDR) display devices while performing enhancement processing is a challenging task. To address the issues of chromatic drift, the imbalance between preserving naturalness and enhancing details during the mapping process, this paper proposed a tone mapping operator (TMO) based on an improved guided filter with multi‐layered processing. Firstly, the operator tackled the problem of insufficient extraction of detail layer information in complex scene images by redefining the formula of the guided filter and introducing adaptive regularization parameters. This enhancement enabled more effective extraction of details compared to traditional fixed‐parameter guided filters. Secondly, the algorithm employed a centre‐surround approach to subdivide and processed the detail layers individually, effectively suppressing halos and artefacts. Thirdly, image entropy was utilized to guide the fusion and enhancement processing of the detail layers, preventing excessive or insufficient enhancement. Finally, this paper proposed an adaptive gamma correction algorithm and a chromatic consistency algorithm to improve overall contrast and hue saturation. The results demonstrate convincing performance in terms of subjective visual evaluation and image quality assessment.
Image restoration with group sparse representation and low‐rank group residual learning
Authors: Cai Zhaoyuan , Xie Xianghua , Deng Jingjing , Dou Zengfa , Tong Bo , Ma Xiaoke
Published: November 2023

Image restoration, as a fundamental research topic of image processing, is to reconstruct the original image from degraded signal using the prior knowledge of image. Group sparse representation (GSR) is powerful for image restoration; it however often leads to undesirable sparse solutions in practice. In order to improve the quality of image restoration based on GSR, the sparsity residual model expects the representation learned from degraded images to be as close as possible to the true representation. In this article, a group residual learning based on low‐rank self‐representation is proposed to automatically estimate the true group sparse representation. It makes full use of the relation among patches and explores the subgroup structures within the same group, which makes the sparse residual model have better interpretation furthermore, results in high‐quality restored images. Extensive experimental results on two typical image restoration tasks (image denoising and deblocking) demonstrate that the proposed algorithm outperforms many other popular or state‐of‐the‐art image restoration methods.
A real‐time critical‐scenario‐generation framework for defect detection of autonomous driving system
Authors: Xie Yizhou , Zhang Yong , Dai Kunpeng , Yin Chengliang
Published: November 2023

To find the most‐likely‐failure scenarios given a certain operation domain, a critical‐scenario‐based test is supposed as an effective method. However, for the state of the art, critical‐scenario‐generation approaches commonly based on random‐search and take amounts of computing resource, some of them are also inapplicable in real time. Moreover, the approaches sometimes fail to obtain critical results, which are strongly relevant to the choice of initial condition. In order to address the above challenges, the authors proposed a Real‐time Critical‐scenario‐generation framework in this paper. The authors proposed an aggressive‐driving algorithm based on the model predictive control method to lead the agent vehicle. The agent vehicle will be controlled to directly create critical scenarios for a black‐box target under test, and the real‐time critical‐scenario test can be brought into reality. A specially designed cost function is presented that guides scenarios to evolve towards the interested conditions, and a self‐adaptive coefficient iteration is designed that enables the approach to be applied within a wider range of initial conditions. The authors carried out both simulation and Vehicle‐in‐the‐Loop (VIL) test; in the VIL test, the authors’ approach improves 15.45% criticality of scenarios with around 9.7 times of efficiency, or improves 38.67% criticality with still around 1.7 times of efficiency with further iterations.
LSTM‐based deep learning framework for adaptive identifying eco‐driving on intelligent vehicle multivariate time‐series data
Authors: Yan Lixin , Jia Le , Lu Shan , Peng Liqun , He Yi
Published: November 2023

In the context of automated driving, the connected and automated vehicles (CAVs) technology unlock the energy saving potential. This paper develops an LSTM‐based deep learning framework for eco‐driving adaptive identification on Intelligent vehicle multivariate time series data. The framework can be adapted for Driver Assistance Systems (DAS) to reduce fuel consumption. Specifically, considering overtaking on rural road is a critical maneuver for operation and has potential to reduce consumption, a simulated driving experiment with 30 participants was conducted to collect the multivariate time series data of the overtaking operation behaviors in conditional automation driving. Driving behaviors were classified into eco‐driving operation behaviors and high fuel consumption operation behaviors based on fuel consumption calculated by using vehicle specific power (VSP). Significance analysis based on linear regression was adopted to identify operation behaviors, and an eco‐driving behavior identification model was established with the use of long short‐term memory (LSTM) for multivariate classification theory. Meanwhile, the other four classification algorithms were used to establish identification models for comparison. The results indicated that the gear position, lane position, the acceleration pedal depth, the clutch pedal depth, and the brake pedal depth had a significant influence on fuel consumption. The eco‐driving behavior identification model of overtaking demonstrated a high classification power and robustness with a classification accuracy of 89.16%. According to the simulation results, the developed adaptive identification model is with promising performance. The conclusions provide theoretical support for developing an adaptive strategy for connected eco‐driving.
Wireless sensing charging based on multi‐drone cooperation
Authors: Xu Guoxin , Zhao Jiawen , Wang Xuehe
Published: November 2023

In recent years, wireless charging technology is widely used for sensor charging. Though carts equipped with wireless charging tools were able to reach sensor nodes and continuously recharge them, their applications are limited and could not be used in many territories such as rugged mountainous terrain and severely damaged disaster areas. With the significant cost reduction of UAVs due to the mature technology, using UAVs to replace charging carts for wireless sensor networks is a future trend. In this study, the problem of energy replenishment and path planning for large‐scale wireless sensor networks by multiple UAVs is considered. First, sensor nodes are distributed evenly by using an improved k‐means clustering algorithm, modelling the problem of the UAV traversal over a certain range of sensors as a travelling salesman problem. Then, a heuristic algorithm is proposed to solve the path planning of UAVs and the hovering time at each sensor. The simulations show the effect of different charging ratios r on the number of non‐functional nodes and the loss of the UAV. The experimental results show that the proposed algorithm is able to plan a sensible path for the UAV, which leads to a smaller UAV energy loss and a smaller number of non‐functional nodes.
Pediatric Craniofacial Tumor Reconstruction
Authors: Parham Matthew J. , Ding Yang , Wang Daniel S. , Jiang Austin Y. , Buchanan Edward P.
Published: November 2023

Effective management of pediatric craniofacial tumors requires coordinated input from medical, oncologic, and surgical specialties. Reconstructive algorithms must consider limitations in pediatric donor tissue and account for future growth and development. Immediate reconstruction is often focused on filling dead space, protecting underlying structures, and ensuring skeletal symmetry. Staged reconstruction occurs after the patient has reached skeletal maturity and is focused on restoring permanent dentition. Reconstructive options vary depending on the location, size, and composition of resected tissue. Virtual surgical planning (VSP) reduces the complexity of pediatric craniofacial reconstruction and ensures more predictable outcomes.
Alcohol metabolism in alcohol use disorder: a potential therapeutic target
Authors: Lehner Taylor , Gao Bin , Mackowiak Bryan
Published: November 2023

Ethanol metabolism plays an essential role in how the body perceives and experiences alcohol consumption, and evidence suggests that modulation of ethanol metabolism can alter the risk for alcohol use disorder (AUD). In this review, we explore how ethanol metabolism, mainly via alcohol dehydrogenase and aldehyde dehydrogenase 2 (ALDH2), contributes to drinking behaviors by integrating preclinical and clinical findings. We discuss how alcohol dehydrogenase and ALDH2 polymorphisms change the risk for AUD, and whether we can harness that knowledge to design interventions for AUD that alter ethanol metabolism. We detail the use of disulfiram, RNAi strategies, and kudzu/isoflavones to inhibit ALDH2 and increase acetaldehyde, ideally leading to decreases in drinking behavior. In addition, we cover recent preclinical evidence suggesting that strategies other than increasing acetaldehyde-mediated aversion can decrease ethanol consumption, providing other potential metabolism-centric therapeutic targets. However, modulating ethanol metabolism has inherent risks, and we point out some of the key areas in which more data are needed to mitigate these potential adverse effects. Finally, we present our opinions on the future of treating AUD by the modulation of ethanol metabolism.
Bimekizumab safety in patients with moderate-to-severe plaque psoriasis: pooled data from up to 3 years of treatment in randomized phase III trials
Authors: Gordon Kenneth B , Langley Richard G , Warren Richard B , Okubo Yukari , Rosmarin David , Lebwohl Mark , Peterson Luke , Madden Cynthia , de Cuyper Dirk , Davies Owen , Thaçi Diamant
Published: November 2023

Background

Patients with psoriasis require long-term management; therefore, understanding the long-term safety of new treatments, such as bimekizumab (BKZ), is crucial.

Objectives

To evaluate BKZ’s 3-year safety profile in patients with moderate-to-severe plaque psoriasis.

Methods

Three years of safety data were pooled from three phase III trials (BE VIVID, BE READY and BE SURE) and their ongoing open-label extension (BE BRIGHT). Treatment-emergent adverse events (TEAEs) are reported using exposure-adjusted incidence rates (EAIRs) per 100 patient-years (PY).

Results

In total, 1495 patients received at least one BKZ dose; total BKZ exposure was 3876.4 PY. The overall EAIR of TEAEs was 175.5/100 PY and decreased with longer exposure to BKZ. The most commonly reported TEAEs were nasopharyngitis, oral candidiasis and upper respiratory tract infection (EAIRs of 15.0/100 PY, 10.1/100 PY and 6.5/100 PY, respectively); 99.3% of oral candidiasis events were mild or moderate in severity, none were serious and few led to discontinuation. EAIRs of other TEAEs of interest were low, including serious infections (1.2/100 PY), adjudicated inflammatory bowel disease (0.2/100 PY) and laboratory elevations in aspartate aminotransferase or alanine aminotransferase (> 5 × upper limit of normal: 0.6/100 PY).

Conclusions

In these analyses pooled across 3 years, no new safety signals were observed with longer exposure to BKZ. The vast majority of oral candidiasis events were mild or moderate in severity, as reported previously.
Cumulative exposure to metabolic syndrome affects the risk of psoriasis differently according to age group: a nationwide cohort study in South Korea
Authors: Jung Se Young , Han Kyungdo , Jung Jin Hyung , Park Hyunsun , Shin Dong Wook
Published: November 2023

Late-onset psoriasis is more associated with the cumulative metabolic syndrome burden in the oldest age group, suggesting the particular importance of managing metabolic syndrome in midlife and beyond.
CD3 downregulation identifies high-avidity human CD8 T cells
Authors: Clutton Genevieve T , Weideman Ann Marie K , Mischell Melissa A , Kallon Sallay , Conrad Shayla Z , Shaw Fiona R , Warren Joanna A , Lin Lin , Kuruc JoAnn D , Xu Yinyan , Gay Cynthia M , Armistead Paul M , G. Hudgens Michael , Goonetilleke Nilu P
Published: November 2023

CD8 T cells recognize infected and cancerous cells via their T-cell receptor (TCR), which binds peptide–MHC complexes on the target cell. The affinity of the interaction between the TCR and peptide–MHC contributes to the antigen sensitivity, or functional avidity, of the CD8 T cell. In response to peptide–MHC stimulation, the TCR–CD3 complex and CD8 co-receptor are downmodulated. We quantified CD3 and CD8 downmodulation following stimulation of human CD8 T cells with CMV, EBV, and HIV peptides spanning eight MHC restrictions, observing a strong correlation between the levels of CD3 and CD8 downmodulation and functional avidity, regardless of peptide viral origin. In TCR-transduced T cells targeting a tumor-associated antigen, changes in TCR-peptide affinity were sufficient to modify CD3 and CD8 downmodulation. Correlation analysis and generalized linear modeling indicated that CD3 downmodulation was the stronger correlate of avidity. CD3 downmodulation, simply measured using flow cytometry, can be used to identify high-avidity CD8 T cells in a clinical context.
Plasma circulating microRNAs associated with blood-based immune markers: a population-based study
Authors: Leonard Samantha , Karabegović Irma , Ikram M Arfan , Ahmad Shahzad , Ghanbari Mohsen
Published: November 2023

MicroRNAs (miRNAs) are small non-coding RNAs that post-transcriptionally regulate gene expression and different immune-related pathways. There is a great interest in identifying miRNAs involved in immune cell development and function to elucidate the biological mechanisms underlying the immune system, its regulation, and disease. In this study, we aimed to investigate the association of circulating miRNAs with blood cell compositions and blood-based immune markers. Circulating levels of 2083 miRNAs were measured by RNA-sequencing in plasma samples of 1999 participants from the population-based Rotterdam Study collected between 2002 and 2005. Full blood count measurements were performed for absolute granulocyte, platelet, lymphocyte, monocyte, white, and red blood cell counts. Multivariate analyses were performed to test the association of miRNAs with blood cell compositions and immune markers. We evaluated the overlap between predicted target genes of candidate miRNAs associated with immune markers and genes determining the blood immune response markers. First, principal component regression analysis showed that plasma levels of circulating miRNAs were significantly associated with red blood cell, granulocyte, and lymphocyte counts. Second, the cross-sectional analysis identified 210 miRNAs significantly associated (P < 2.82 × 10−5) with neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index. Further genetic look-ups showed that target genes of seven identified miRNAs (miR-1233-3p, miR-149-3p, miR-150-5p, miR-342-3p, miR-34b-3p, miR-4644, and miR-7106-5p) were also previously linked to NLR and PLR markers. Collectively, our study suggests several circulating miRNAs that regulate the innate and adaptive immune systems, providing insight into the pathogenesis of miRNAs in immune-related diseases and paving the way for future clinical applications.
Direct interhemispheric cortical communication via thalamic commissures: a new white matter pathway in the primate brain
Authors: Szczupak Diego , Schaeffer David J , Tian Xiaoguang , Choi Sang-Ho , Fang-Cheng  , Iack Pamela Meneses , Campos Vinicius P , Mayo J Patrick , Patsch Janina , Mitter Christian , Haboosheh Amit , Kwon Ha Seung , Vieira Marcelo A C , Reich Daniel S , Jacobson Steve , Kasprian Gregor , Tovar-Moll Fernanda , Lent Roberto , Silva Afonso C
Published: November 2023

Cortical neurons of eutherian mammals project to the contralateral hemisphere, crossing the midline primarily via the corpus callosum and the anterior, posterior, and hippocampal commissures. We recently reported and named the thalamic commissures (TCs) as an additional interhemispheric axonal fiber pathway connecting the cortex to the contralateral thalamus in the rodent brain. Here, we demonstrate that TCs also exist in primates and characterize the connectivity of these pathways with high-resolution diffusion-weighted MRI, viral axonal tracing, and fMRI. We present evidence of TCs in both New World (Callithrix jacchus and Cebus apella) and Old World primates (Macaca mulatta). Further, like rodents, we show that the TCs in primates develop during the embryonic period, forming anatomical and functionally active connections of the cortex with the contralateral thalamus. We also searched for TCs in the human brain, showing their presence in humans with brain malformations, although we could not identify TCs in healthy subjects. These results pose the TCs as a vital fiber pathway in the primate brain, allowing for more robust interhemispheric connectivity and synchrony and serving as an alternative commissural route in developmental brain malformations.
The Forgotten Rival of Marxism Today: The British Labour Party’s New Socialist and the Business of Political Culture in the Late Twentieth Century
Authors: Murphy Colm
Published: November 2023

In recent years, historians of modern Britain have focused on reconstructing its ‘political culture’, drawing extensively upon print sources. This work routinely highlights the commercial pressures that shape some types of print media—especially popular newspapers—but is less attentive to others. This article argues for closer attention to the business and financial contexts of a broader spectrum of Britain’s political culture in the late twentieth century. Drawing on histories of publishing, it illustrates the importance of business through a case-study of party-political intellectual journals for the 1980s British left. No history of the 1980s is complete without reference to the Communist Party’s glamorous Marxism Today. However, scholars have overlooked one of its significant market competitors. In 1981, the Labour Party founded its own intellectual magazine, the New Socialist. Initially, it was highly successful, recording healthy circulation figures and attracting iconoclastic pieces by leading socialists. Its early commercial success shows that it has been unjustly neglected since. Yet unfavourable political winds and internal editorial divisions fatally overlapped with ruinous business decisions in a worsening financial environment. This precipitated the collapse of New Socialist in the later 1980s—just as its Eurocommunist rival declared the arrival of the ‘New Times’ and wrote itself into history books. Closer attention to business contexts thus returns New Socialist to histories of the left and provides a better map of its ideological debates during a transformative decade. It also situates the travails of the 1980s left within social and cultural trends over the twentieth century.
Is every teacher a teacher of oracy?
Authors: Moorghen Amanda
Published: November 2023

In this article I argue that oracy is disciplinary: it has both generic and subject-specific dimensions that need to be taught explicitly. As such, every educator has a responsibility for teaching students the oracy skills they need in their subject domain; and providing them with the opportunity to practise using them. It cannot be hidden within a single department (e.g. treated as part of ‘English’ only), or treated as an add-on (e.g. ‘academic skills’, taught a-contextually and without relation to subject-experts).
Safety and feasibility of robotic probe steering in echocardiography
Authors: Man J P , Prendergast J M , Schuuring M J , Chamuleau S A J , Bouma B J
Published: November 2023

Introduction

Work related injury is common in medical sonographers. A robotic arm designed to assist in a (transthoracic echocardiography) TTE might be a useful alternative to alleviate the muscle strain of sonographers.

Purpose

In this study the feasibility and safety of a robotic device intended to improve the ergonomics of TTE is tested.

Methods

A CE marked robotic device (LBR iiwa 7 R800, KUKA) mounted with a transthoracic echoprobe and an echo calibration phantom (UltraiQ General Purpose fantoom, Cablon medical) were used to assess the feasibility of robotic assistance. A predefined protocol was used to acquire images of the phantom in 6 standardized viewpoints of the robotically controlled echo probe with respect to the phantom. The probe was moved from a predefined standardized starting point to the first viewpoint, perpendicular to the surface of the phantom. The probe was subsequently rotated 20° and -20° along both its long and short axis, and 90° around its central axis to reach the other 5 viewpoints. Time to and maximum contact force during acquisition was measured. The maximum contact force used during a manual standard TTE acquisition was also measured using the same force sensor. All measurements were performed 3 times.

Results

The average time to reach the 1st viewpoint perpendicular to the surface of the phantom from above the phantom was 4.6s, the maximum contact force was 10.1N. The time used for rotation on the short axis of the probe was 4.1 s, with a maximum force of 11.8N. The time it took to rotate the probe 20° and -20° around its long axis to reach viewpoints 4 and 5 was 4.5s with a maximum force of 9.48N. The average time to rotate the probe 90° around its axis and reach the 6th viewpoint was 5.0 s, the maximum contact force at the rotated axis was 10.3N. The maximum contact force was 11.8N throughout all movements. The reference maximum contact force by manual TTE assessment on a human was 11.5N. The contact forces of the probe controlled by a robot on the phantom did not exceed the predefined maximum force throughout standardized movements used during a TTE assessment.

Conclusion

Robotically assisted TTE scanning was safe in terms of the applied force throughout image acquisition in all viewpoints and comparable with forces used during manual TTE. Imaging at target viewpoints used in a regular TTE assessment was feasible as all images were acquired within a reasonable timeframe. Further studies are needed to evaluate its effectiveness in transthoracic echocardiography in volunteers and patients.
Assessing left atrial size to predict mortality in the overweight and obese population
Authors: Madronio C , Low G , Nundlall N , Strange G , Playford D , Negishi K , Pathan F
Published: November 2023

Background

Left atrial (LA) size provides important prognostic information. A larger LA is associated with a higher risk of death or cardiovascular complications. LA size is generally measured by indexing LA volume to body surface area (BSA). For individuals with a higher BSA, particularly those with obesity, this may lead to an underestimation of true LA size. Alternate indexation methods of measuring LA size have been proposed for this population. There is limited data showing if these indices provide better prognostic value compared to the standard BSA indexation in the overweight and obese population.

Purpose

To determine and compare the performance of various LA size indices in predicting all-cause mortality.

Methods

We obtained data from the National Echocardiography Database of Australia (NEDA), a large, observational registry, capturing routinely acquired echocardiographic data from individuals with potential or established heart disease. Our study outcome was all-cause mortality and LA size was our predictor variable. We evaluated ten indices for LA size: LA volume (obtained at time of scan), and LA volume indexed to BSA, idealised BSA, height(^1, ^2, ^2.7, ^1.83), weight, body mass index (BMI), and estimated lean body mass. From the original NEDA dataset, we excluded observations with: missing values for LA volume, height, weight, and ejection fraction (EF); date of examination is after the census date; and indication of valvular disease. Finally, we selected only the earliest observation for each individual and obtained a sub-population with overweight and obesity for analysis (n = 113,786). We conducted a receiver operating characteristic (ROC) analysis and calculated the summary statistic of the area under the curve (AUC) to compare the accuracy of the ten LA size indices in predicting all-cause mortality.

Results

In the overweight and obese population, all the LA indices had similar predicting accuracy for all-cause mortality (Figure 1). Raw LA volume and LA volume/BMI had slightly lower AUC: AUC [95% confidence interval] values were 0.61 [0.605-0.614] and 0.61 [0.607-0.616], respectively. Other indices, including LA volume/BSA, LA volume/weight and LA volume/height, had equivalent predictive accuracy (0.62∼0.63) for all-cause mortality (Figure 2).

Conclusion

Overall, all LA size indices performed similarly in predicting all-cause mortality in this overweight and obese population, except for LA volume/BMI. Our results found no superior indexation method (including allometric ones) to the current practice (i.e., LA volume/BSA) in this population.ROC curves of indicesAUC, 95% confidence intervals of indices
Treatment with sacubitril/valsartan and improvement of ventricular-arterial coupling in heart failure with reduced ejection fraction
Authors: Stegmann T , Parentin L , Schirmer S H , Hagendorff A , Laufs U , Lavall D
Published: November 2023

Background

Treatment with the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan (S/V) in patients with heart failure and reduced ejection fraction (HFrEF) reduces mortality and heart failure (HF) hospitalizations. The specific hemodynamic mechanisms underlying these beneficial effects are currently unclear.

Purpose

This study aimed to assess the effects of S/V treatment on left ventricular (LV) end-systolic elastance (Ees), effective arterial elastance (Ea), and the ventricular-arterial coupling ratio (Ea/Ees) in patients with HFrEF using non-invasive pressure-volume analysis.

Methods

117 patients with symptomatic HF and LVEF <40% in whom treatment with S/V was initiated were enrolled in this multicenter German prospective study. We used transthoracic echocardiography with simultaneous arm-cuff blood pressure measurements for non-invasive pressure-volume loop analyses. Primary endpoints were changes in Ees, Ea, and Ea/Ees ratio after six months of S/V treatment.

Results

The mean age was 65 (±13) years and 30% were female. In 54.7% of the patients, the etiology of HF was ischemic, and 45.3% was non-ischemic. 58.4% had first HF diagnosis at baseline. 102 patients with complete clinical and echocardiographic data at baseline and after six months of follow-up were analyzed. Among those, 62% were on target dose of S/V. Six months of S/V treatment resulted in a significant increase of Ees (0.66 mmHg/ml, IQR [0.45;0.94] vs. 0.78 mmHg/ml [0.57;1.10], p=0.001) and decrease of Ea (1.76 mmHg/ml [1.48;2.13] vs. 1.62 mmHg/ml [1.36;1.96], p=0.014). Hence, the Ea/Ees ratio significantly improved (2.52 [1.88;4.05] vs. 1.93 [1.50;2.63], p<0.001). In addition, LV volumes and pressure improved significantly with a regression of the LV end-systolic volume (LVESV: 142 ml [115;180] vs. 96 ml [65;124]), end-diastolic volume (LVEDV: 216 ml [179;247] vs. 165 ml [132;200]) and LV end-diastolic pressure (LVEDP: 19.6 mmHg [18.2;22.4] vs. 17.8 mmHg [16.6;19.9]), p<0.001 respectively. The LVEF increased from a median of 33% (27;37) to 43% (36;49), p<0.001.

NT-proBNP level decreased from (median) 1771 pg/ml [838;5211] to 724 pg/ml [300;1575] and mean 6-minute walking distance increased from 371m (±125) to 423 m (±122), p<0.001 respectively.

The percentage of patients with NYHA class III changed from 25.6% to 5.9%.

Conclusion

In a 6-months treatment period, initiation of sacubitril/valsartan in patients with heart failure and reduced ejection fraction was associated with reduction of LV volumes, improved LV function, reduction in afterload and fewer heart failure symptoms. These new data indicate that beyond reverse LV remodeling, improvement of LV contractility and ventricular-arterial coupling may contribute to the favorable clinical outcomes on treatment with sacubitril/valsartan in chronic heart failure.
Association between left atrial coupling index by echocardiography and left ventricular end diastolic pressure by left ventricular catheterization
Authors: Ravnkilde K , Olsen F J , Moegelvang R , Chantal De Knegt M , Galatius S , Pedersen S , Biering-Soerensen T
Published: November 2023

Background

Left atrial volumetric/mechanical coupling index (LACi) is a novel echocardiographic parameter combining important information regarding left atrial size and function in one variable. The association between LACi and invasive pressure measurements of diastolic function has not yet been investigated.

Purpose

We sought to investigate the association between LACi by echocardiography and left ventricular end-diastolic pressure (LVEDP) by left ventricular catheterization.

Methods

Patients suspected of coronary artery disease referred for angiography had simultaneous left heart catheterization performed for invasive pressure measurements and had an echocardiogram performed. LVEDP>12mmHg was considered elevated. LACi was calculated as the index of LAVI (left atrial maximal volume index) and mean peak tissue velocity at late diastole measured using tissue Doppler at the base of the left ventricle.

Results

Forty patients were prospectively included of whom 73% were male and the mean age was 65 years. Median LACi was 2.9 (2.0, 4.1), and a total of 25 (63%) patients had elevated LVEDP. In unadjusted regression analyses, LVEDP increased with 2.3 (0.5-4.0) mmHg per 1.0 increase in LACi (p=0.013) (Figure 1, top panel). This association remained unchanged after adjusting for age and vessel disease (VD). In univariable logistic regression model, a 0.1 increase in LACi was associated with an 8% higher probability of having elevated LVEDP (OR 1.08, 95%CI (1.01-1.15), p=0.021). (Figure 1, bottom panel). These findings were consistent in multivariable analyses. Similar findings were observed in sensitivity analyses restricted to patients with normal LA size (LAVI<34mL, n: 34) (OR 1.10, 95%CI (1.01-1.20), p=0.027, per 0.1 increase in LACi), which also remained unchanged after adjustment for age and VD.

Conclusion

LACi obtained by echocardiography is associated with LVEDP and with elevated LVEDP obtained by left ventricular catheterization. Even in those with normal LA size, higher LACi can indicate elevated filling pressure.
Rate of progression of tricuspid regurgitation and clinical implications
Authors: Arteagoitia Bolumburu A , Monteagudo Ruiz J M , Mahia P , Perez David E , Gonzalez T , Sitges M , Li C H , Capellades Olivella H , Alonso D , Carrasco F , Luna Morales M , Adeba A , De La Hera J M , Zamorano Gomez J L
Published: November 2023

Background

Tricuspid regurgitation (TR) is a prevalent valvular disease. Recent studies demonstrated that significant TR is associated with an increased mortality. However, information regarding the progression rate of TR is lacking, crucial for the correct clinical evaluation of such patients. Due to this fact, current guidelines fail to propose a scheduled follow-up programme in patients with significant TR; contrary to patients with left-sided valvular disease. The aim of this study is to examine the rates of TR progression and its clinical implications.

Objectives

To analyse the rate of progression of TR during follow-up and evaluate the impact of TR progression in hospitalizations due to heart failure (HF) or cardiovascular (CV) death.

Methods

1843 patients with at least moderate TR were prospectively followed up with consecutive echocardiographic studies and/or clinical evaluation. Clinical and echocardiographic features were recorded to assess their impact in TR progression. TR progression was defined as at least worsening of one grade according to Hahn and Zamorano classification based on Vena contracta width and effective regurgitant orifice area. The cumulative event rates were estimated with the Kaplan-Meyer method and compared by means of the log-rank test.

Results

Median follow-up time was 3.7 (IQR: 1.2 to 3.8) years. During the follow-up period, death occurred in 525 patients (28.5%); due to cardiovascular causes in 174 (9.4%) of them. Figure 1 shows the incidence of TR progression from moderate to at least severe TR during follow-up period. Moderate TR had 4.9%, 10.1% and 24.8% 1-year, 2-year and 3-year risk of progression to at least severe TR, respectively. The combined endpoint of cardiovascular mortality and hospitalization for heart failure was higher among progressors (23.5% vs. 37.7%; log rank P < 0.001, Figure 2).

Conclusions

Progression of TR is associated with an increased risk of hospitalizations and cardiovascular mortality. According to the rate of progression in our study, we support serial echocardiographic testing for these patients similar to that proposed by current guidelines for left-sided heart disease. However, we still need evidence of the impact of serial testing in TR.Incidence of TR progression from moderatKaplan Meier survival curves free from h
The effect of aortic valve replacement on 4D flow-measured flow displacement in patients with bicuspid and tri-leaflet aortic valves with severe aortic stenosis
Authors: Richards C , Alfuhied A , Parker A , Aslam S , Debiec R , Mccann G P , Singh A
Published: November 2023

Introduction

Eccentric outflow jet direction in the ascending aorta is correlated with the altered haemodynamic flow patterns thought to contribute to bicuspid aortic valve (BAV)-associated aortopathy.

Purpose

We aimed to analyse the impact of surgical aortic valve replacement (AVR) on outflow jet displacement in the ascending aorta, and determine if differences exist between individuals with BAV and tri-leaflet aortic valves (TAV).

Method

Four-dimensional flow-cardiac magnetic resonance imaging (4D Flow) of the aorta was performed in prospectively recruited patients with BAV and TAV and severe symptomatic aortic stenosis (AS), before and 12 months after AVR. Healthy individuals with BAV and TAV morphology, but no significant valve disease, were also recruited as controls. Outflow direction was calculated from the in-plane, normalised flow displacement (NFD), defined as the distance between the centre of the aortic lumen (Clum) and the centre of velocity (Cvel) of the forward flow and normalised to the lumen diameter (Figure 1). Mean NFDs were evaluated at peak systole on planes perpendicular to 25 equidistant nodes along the centreline between the aortic root to the level of the pulmonary artery bifurcation in all subjects using custom Matlab code.

Results

32 subjects with severe symptomatic AS (BAV n=11, TAV n=21; mean age 68±10 years) and 17 controls (BAV n=8, TAV n=9; mean age 57±7 years) were assessed (Table 1). In those with TAV, there were no differences in NFD between patients with severe AS pre-AVR compared to post-AVR, or compared to TAV controls. However, in BAV subjects, pre-AVR BAV patients with severe AS had a significantly higher mean NFD compared to BAV controls, and compared to pre-AVR TAV patients with severe AS. Post-AVR, there was no longer a significant difference in mean displacement between BAV vs TAV.

Conclusion

Our observations suggest that the BAV morphology plays a predominant role in the abnormal eccentric flow displacement in the ascending aorta, which may be normalised following bioprosthetic valve replacement. This may have implications for monitoring aortas post-AVR in BAV subjects.
Application of a novel echocardiographic scoring system to estimate left ventricular filling pressure in aortic stenosis
Authors: Aoyagi H , Iwano H , Murayama M , Yokoyama S , Nishino H , Nakabachi M , Nakamura K , Tamaki Y , Motoi K , Kobayashi Y , Ishizaka S , Kaga S , Kamiya K , Nagai T , Anzai T
Published: November 2023

Background

Despite the increased number of aortic stenosis (AS) patients, non-invasive estimation of the left ventricular (LV) filling pressure (FP) is often challenging partly because of unavailability of E/e' due to the presence of mitral annular calcification (MAC). Recently, an echocardiographic scoring system to estimate LVFP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score was proposed. Because VMT score can be applied for patients with significant MAC, we hypothesized that VMT score could be an alternative parameter of E/e' in AS.

Purpose

To test whether VMT score could be used as an alternative marker of LVFP to E/e' in AS patients.

Methods

We enrolled consecutive 116 patients with at least moderate AS in sinus rhythm who underwent right heart catheterization and echocardiography within 7 days. Mean pulmonary artery wedge pressure (PAWP) was measured as invasive parameter of LVFP. LV diastolic dysfunction (DD) was graded according to the ASE / EACVI guidelines. Using two-dimensional echocardiographic images, time sequence of opening of mitral and tricuspid valves was assessed and scored to 0 to 2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). This was based on the phenomenon in which early-diastolic opening of the mitral valve becomes earlier than tricuspid valve with an increase in LV FP and pulmonary artery pressure. When the inferior vena cava was dilated, 1 point was added and VMT score was finally calculated as 0 to 3.

Results

Overall, PAWP was 12±7 mmHg and elevated (≥15 mmHg) in 29 patients. MAC was observed in 82 patients. Although E/e' was higher in patients with elevated PAWP than in those without (23±11 vs 18±8, P=0.007), its predictive ability to elevated PAWP was non-significant (c-index: 0.59, P=0.13), resulting in low specificity of DD grading to predict elevated LVFP (sensitivity: 79%, specificity: 36%). In contrast, VMT score predicted elevated LVFP with c-index of 0.74 (P<0.001). When VMT score was used instead of E/e', diagnostic accuracy of DD grading was improved (c-index: 0.57 vs 0.82, P<0.001).

Conclusion

VMT score could be an alternative marker of LVFP to E/e' in AS patients.
The prognostic value of left atrial strain in patients with low-flow, low-gradient aortic stenosis
Authors: Ozturk C , Happe M , Shamekhi J , Zimmer S , Nickenig G , Tiyerili V , Sedaghat A
Published: November 2023

Background

Left atrial (LA) function is known to be an independent prognostic parameter in patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of LA function on postinterventional outcomes in patients with severe low-flow, low-gradient aortic stenosis (LFLG AS) is unknown.

Objectives

We aimed to evaluate postinterventional changes and prognostic value of LA strain in patients with LFLG AS who underwent TAVR.

Methods

We retrospectively included 88 patients (79.66 ± 6.33, 37.5% female) with symptomatic LFLG AS who underwent TAVR at the Heart Center Bonn. LA global function and strain were comprehensively assessed by the postprocessing left atrial phasic strain analysis – LA reservoir strain, LA conduit strain, and LA contractile strain ­– using a commercially available postprocessing software at baseline and three years after the procedure. The apical four-, two-, and three-chamber views with sufficient image quality were used for strain analysis.

Results

Baseline LA strain was found to be impaired in all patients (reservoir: 13.17 ± 7.62 %; conduit: 6.7 ± 6.4 %; contractile: -1.7 ±1.5 %). All-cause mortality was 41 % three years after the procedure. In the overall collective, LA reservoir strain was increased at follow-up (13.17 ± 7.62 % to 15.21 ± 10.13 %, p= 0.049), whereas conduit and contractile strain remained unchanged (p > 0.05). According to the survival at follow-up, we divided the cohort into survivors and non-survivors. Baseline reservoir (14.55 ± 8.14 % vs 9.59 ± 5.23 %, p= 0.002) and conduit (7.66 ± 7.14 % vs 4.44 ± 4.1 %, p= 0.017) strain were significantly higher in survivors.

All LA strain parameters were significantly improved in survivors at follow-up. In contrast, non-survivors showed no relevant changes in LA strain parameters. In comparison of ROC curves, reservoir strain was found to be the best predictor for postinterventional survival after TAVR (reservoir AUC: 0.677, cutoff: 10 %, p = 0.007; conduit AUC: 0.642, cutoff: 3.7 %, p = 0.037; contractile AUC: 0.672, cutoff: -1,3 %, p = 0.008). Concordantly, we found that all LA strain parameters are independent predictors for three-year all-cause mortality after TAVR in cox regression analysis (reservoir OR: 0.89, p=0.005; conduit OR: 0.90, p=0.03, contractile OR: 0.71, p=0.029) in cox regression analysis. According to multivariate analysis, reservoir strain (OR: 0.91, p=0.05) and conduit strain (OR: 0.94, p=0.04) were found to be independent predictors for postinterventional survival. According to log-rank analysis, patients with a baseline reservoir strain < 10 % and a baseline conduit strain < 4 %) showed significantly higher mortality (p = 0.048).

Conclusion

Using LA strain parameters might optimize risk stratification and better decision-making with sufficient patient selection in this vulnerable cohort.
Diagnostic accuracy of apical sparing pattern in transthyretin-derived cardiac amyloidosis assessed by two-dimensional strain echocardiography
Authors: Suzuki W , Kikuchi S , Kawada Y , Ito T , Kitada S , Goto T , Amano T , Seo Y
Published: November 2023

Background

Cardiac amyloidosis (CA) is a rapidly progressive disease that portends poor prognosis. Recently, transthyretin-derived CA (ATTR-CA) has attracted attention due to the emergence of specific drugs, and its simple and accurate diagnosis is required. Apical sparing pattern of regional longitudinal strain (LS) distribution has been known as specific echocardiographic finding for CA. However, its diagnostic significance is unclear when limited to ATTR-CA.

Aims

This study aimed to investigate the diagnostic accuracy of apical sparing pattern to distinguish ATTR-CA from other left ventricular hypertrophic diseases.

Methods

This was a retrospective study evaluating 32 patients underwent endomyocardial biopsy for differentiation of left ventricular hypertrophy from November 2018 to August 2022. Based on clinical data, patients were classified into 9 patients in ATTR-CA, 14 patients in hypertrophic cardiomyopathy (HCM), and 9 patients in hypertensive heart disease (HHD). In addition to routine echocardiographic findings, left ventricular LS analysis was performed. Relative regional strain ratio (RRSR) as an index of apical sparing pattern was measured as the average of apical LS divided by the sum of the average of mid and basal LS values.

Results

RRSR in ATTR-CA group was significantly higher than in HCM and HHD groups (0.96 vs. 0.68 vs. 0.72, P=0.004) (Table). In the receiver-operating characteristic analysis of RRSR for differentiating ATTR-CA from HCM and HHD, the optimal cut-off value of RRSR for the diagnosis of ATTR-CA was 0.93 (sensitivity 67%, specificity 96%, area under the curve 0.84) (Figure).

Conclusions

Apical sparing pattern may have acceptable accuracy in diagnosing ATTR-CA versus other left ventricular hypertrophic diseases, but the relatively low sensitivity may be a clinical limitation.Table:Echocardiographic dataFigure
Left ventricular speckle-tracking-derived mechanical dispersion in patients with transthyretin amyloidosis and their first-degree relatives
Authors: Holcman K , Rubis P , Stepien A , Graczyk K , Dziewiecka E , Karabinowska A , Mroz K , Sachajko Z , Kurek M , Keska M , Podolec P , Kostkiewicz M
Published: November 2023

Background

Mechanical dispersion has shown to predict ventricular (LV) arrhythmias and sudden cardiac death in populations with established cardiac diseases, such as cardiomyopathies and heart failure. Transthyretin amyloid (ATTR) cardiomyopathy arises from deposition of misfolded, insoluble transthyretin (TTR) in extracellular matrix. The disease impacts profoundly cardiac tissue architecture and its mechanical properties.

Purpose

The aim of this prospective study was assessment of LV speckle-tracking-derived mechanical dispersion in patients with ATTR cardiomyopathy and their first-degree relatives.

Methods

We present data based on evaluation of 85 patients, including 34 (group 1) index patients with ATTR and 51 (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, hybrid technique single-photon emission computed tomography and computed tomography (SPECT/CT) with [99mTc] Tc 3,3-disphono-1,2-propanodicarboxylic acid (DPD), genetic testing by an amplicon-based next-generation TTR sequencing approach, and in selected cases cardiac or soft tissue biopsy. Mechanical dispersion was calculated manually from GLS measurements and defined as the standard deviation (SD) of contraction duration from R on the electrocardiogram (ECG) to peak negative longitudinal strain of all LV segments.

Results

In group 1 patients were older (66.6±11 vs. 50.7±14) and presented with higher New York Heart Association (NYHA) class (2.4± 1 vs. 1.1± 0.6) (p<0.05). Overall, there were detected following types of TTR variants - Phe53Leu, Ala101Val, Glu112Lys, Glu109Lys, Glu122Lys, Glu82Lys. Compared to group 2, group 1 presented with higher N-terminal (NT)-pro hormone BNP (NT-proBNP) value (5859±7320 vs. 281±990 pg/ml), greater intraventricular septum thickness (19±4 vs. 12±3 mm) and LV mass index values (199±69 vs.111±42 g/m2), impaired LV ejection fraction (44±13 vs. 59±10 %) and GLS (-12.7±6 vs. -18.7±4 %) (p<0.05). Moreover, patients with ATTR cardiomyopathy had significantly higher value of LV speckle-tracking-derived mechanical dispersion compared to their first-degree relatives (96.2±22.3 vs. 77.9±23.3 ms, p=0.0007).

Conclusions

Patients with ATTR cardiomyopathy present with significantly higher LV mass index value, impaired GLS and higher value of LV speckle-tracking-derived mechanical dispersion compared to their first-degree relatives (p<0.05). Assessment of LV speckle-tracking-derived mechanical dispersion may in future translate into further enhancement of disease evaluation and improving prognosis in the group of patients.