bluuebunny/crossref_metadata_2025 huggingface dataset:
On application of deep learning to simplified quantum-classical dynamics in electronically excited states
Authors: Posenitskiy Evgeny , Spiegelman Fernand , Lemoine Didier
Published: July 2021

Deep learning (DL) is applied to simulate non-adiabatic molecular dynamics of phenanthrene, using the time-dependent density functional based tight binding (TD-DFTB) approach for excited states combined with mixed quantum–classical propagation. Reference calculations rely on Tully’s fewest-switches surface hopping (FSSH) algorithm coupled to TD-DFTB, which provides electronic relaxation dynamics in fair agreement with various available experimental results. Aiming at describing the coupled electron-nuclei dynamics in large molecular systems, we then examine the combination of DL for excited-state potential energy surfaces (PESs) with a simplified trajectory surface hopping propagation based on the Belyaev–Lebedev (BL) scheme. We start to assess the accuracy of the TD-DFTB approach upon comparison of the optical spectrum with experimental and higher-level theoretical results. Using the recently developed SchNetPack (Schütt et al 2019 J. Chem. Theory Comput.
15 448–55) for DL applications, we train several models and evaluate their performance in predicting excited-state energies and forces. Then, the main focus is given to the analysis of the electronic population of low-lying excited states computed with the aforementioned methods. We determine the relaxation timescales and compare them with experimental data. Our results show that DL demonstrates its ability to describe the excited-state PESs. When coupled to the simplified BL scheme considered in this study, it provides reliable description of the electronic relaxation in phenanthrene as compared with either the experimental data or the higher-level FSSH/TD-DFTB theoretical results. Furthermore, the DL performance allows high-throughput analysis at a negligible cost.
Two point-source interference: a study of the formation of concentric circular fringes
Authors: Thomas Joseph Ivin
Published: July 2021

In this short paper, the hyperbola-based analysis of wave interference recently developed by Thomas is employed to study the pattern of concentric circular fringes captured on a distant screen, when its plane is oriented orthogonal to the line joining two coherent point-sources. Newton’s rings are another instance of concentric circular fringes, generated with an extended source and a plano-convex lens-glass plate combination. The underlying geometry of the latter scenario, as described in the literature, allows for the estimation of two important physical parameters viz. the wavelength of light and the refractive index of a liquid medium. It is demonstrated here that the geometrical arrangement of the former scenario can in principle, be utilized to reach the same ends as well. Additionally, the hallmark distinguishing features of both types of circular fringe patterns are qualitatively and quantitatively elucidated.
Prevalence of Child Maltreatment during the COVID-19 Pandemic: A Cross-sectional Survey of Rural Hubei, China
Authors: Zhang Huiping , Li Yali , Shi Rui , Dong Peiyu , Wang Weiwei
Published: July 2021

The impact of lockdown measures in Wuhan, China during the coronavirus disease 2019 pandemic on child maltreatment remains unknown. The present study attempted to estimate the prevalence of child maltreatment during this period, to identify risk factors, and the influence of child maltreatment. A representative sample of 1,062 school-aged children in rural Hubei province was surveyed. Results indicated that the prevalence of family violence, physical violence, emotional abuse and neglect during the lockdown period were 13.9, 13.7, 20.2 and 7.3 percent, respectively, and that of lifetime prevalence were 17.0, 13.9, 14.6 and 6.9 percent, respectively. And most victims did not seek official help. Boys were more likely to experience physical violence. Children from separated/divorced families tended to report more emotional abuse. Those having family members with a history of drug abuse and mental illness were more likely to experience neglect during the lockdown period. All types of child maltreatment were positively associated with self-harm behaviours. These findings highlight the importance of identifying at-risk children immediately and implementing timely intervention programmes to prevent self-harm behaviours for social workers and health professionals.
Australian and New Zealand social workers adjusting to the COVID-19 pandemic
Authors: Alston Margaret , Irons Kelly , Adamson Carole , Boddy Jenny , Fronek Patricia , Briggs Lynne , Hay Kathryn , Howard Amanda , Rowlands Allison , Hazeleger Tricia , Foote Wendy
Published: July 2021

In 2020, social workers across the world responded to the global COVID-19 pandemic and the consequent strict lockdown procedures over several months. In many countries, including Australia and New Zealand, this virtual shutdown period necessitated a reframing of social work practice to incorporate factors including delivery of services via virtual means and more limited access for vulnerable clients. This article draws on the integration of two methods designed to address the research question: ‘How has social work practice in Australia and New Zealand been affected by COVID-19?’ These include (i) a narrative review of papers published during 2020 on social work practice and the COVID-19 pandemic and (ii) an online survey, undertaken from October to December 2020, of Australian and New Zealand social workers. The questionnaire data were analysed using Statistical Package for the Social Sciences (SPSS) and thematic analysis. The findings of this article details include the significant impacts of COVID-19 on practice, the increased needs of clients, including a rise in health issues, violence, homelessness and financial concerns, and the resulting critical changes to social work workloads. Social workers also reported greater use of technologies to deliver services and fears for their families and themselves if exposed to COVID-19.
Balance between competing spectral states in subthalamic nucleus is linked to motor impairment in Parkinson’s disease
Authors: Khawaldeh Saed , Tinkhauser Gerd , Torrecillos Flavie , He Shenghong , Foltynie Thomas , Limousin Patricia , Zrinzo Ludvic , Oswal Ashwini , Quinn Andrew J , Vidaurre Diego , Tan Huiling , Litvak Vladimir , Kühn Andrea , Woolrich Mark , Brown Peter
Published: July 2021

Exaggerated local field potential bursts of activity at frequencies in the low beta band are a well-established phenomenon in the subthalamic nucleus of patients with Parkinson’s disease. However, such activity is only moderately correlated with motor impairment. Here we test the hypothesis that beta bursts are just one of several dynamic states in the subthalamic nucleus local field potential in Parkinson’s disease, and that together these different states predict motor impairment with high fidelity.

Local field potentials were recorded in 32 patients (64 hemispheres) undergoing deep brain stimulation surgery targeting the subthalamic nucleus. Recordings were performed following overnight withdrawal of anti-parkinsonian medication, and after administration of levodopa. Local field potentials were analysed using hidden Markov modelling to identify transient spectral states with frequencies under 40 Hz.

Findings in the low beta frequency band were similar to those previously reported; levodopa reduced occurrence rate and duration of low beta states, and the greater the reductions, the greater the improvement in motor impairment. However, additional local field potential states were distinguished in the theta, alpha and high beta bands, and these behaved in an opposite manner. They were increased in occurrence rate and duration by levodopa, and the greater the increases, the greater the improvement in motor impairment. In addition, levodopa favoured the transition of low beta states to other spectral states. When all local field potential states and corresponding features were considered in a multivariate model it was possible to predict 50% of the variance in patients’ hemibody impairment OFF medication, and in the change in hemibody impairment following levodopa. This only improved slightly if signal amplitude or gamma band features were also included in the multivariate model. In addition, it compares with a prediction of only 16% of the variance when using beta bursts alone.

We conclude that multiple spectral states in the subthalamic nucleus local field potential have a bearing on motor impairment, and that levodopa-induced shifts in the balance between these states can predict clinical change with high fidelity. This is important in suggesting that some states might be upregulated to improve parkinsonism and in suggesting how local field potential feedback can be made more informative in closed-loop deep brain stimulation systems.
Tubulin methylation of lysine 40 by SETD2: a new way to tune neuronal functions?
Authors: Andrieux Annie , Sadoul Karin
Published: July 2021

This scientific commentary refers to ‘Neuronal SETD2 activity links microtubule methylation to an anxiety-like phenotype in mice’, by Koenning et al. (doi:10.1093/brain/awab200).
Evaluating Vaccine Efficacy Against Severe Acute Respiratory Syndrome Coronavirus 2 Infection
Authors: Lin Dan-Yu , Gu Yu , Zeng Donglin , Janes Holly E , Gilbert Peter B
Published: July 2021

Although interim results from several large, placebo-controlled, phase 3 trials demonstrated high vaccine efficacy (VE) against symptomatic coronavirus disease 2019 (COVID-19), it is unknown how effective the vaccines are in preventing people from becoming asymptomatically infected and potentially spreading the virus unwittingly. It is more difficult to evaluate VE against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than against symptomatic COVID-19 because infection is not observed directly but rather is known to occur between 2 antibody or reverse-transcription polymerase chain reaction (RT-PCR) tests. Additional challenges arise as community transmission changes over time and as participants are vaccinated on different dates because of staggered enrollment of participants or crossover of placebo recipients to the vaccine arm before the end of the study. Here, we provide valid and efficient statistical methods for estimating potentially waning VE against SARS-CoV-2 infection with blood or nasal samples under time-varying community transmission, staggered enrollment, and blinded or unblinded crossover. We demonstrate the usefulness of the proposed methods through numerical studies that mimic the BNT162b2 phase 3 trial and the Prevent COVID U study. In addition, we assess how crossover and the frequency of diagnostic tests affect the precision of VE estimates.
circExp database: an online transcriptome platform for human circRNA expressions in cancers
Authors: Zhao Min , Liu Yining , Qu Hong
Published: July 2021

Circular RNA (circRNA) is a highly stable, single-stranded, closed-loop RNA that works as RNA or as a protein decoy to regulate gene expression. In humans, thousands of circRNA transcriptional products precisely express in specific developmental stages, tissues and cell types. Due to their stability and specificity, circRNAs are ideal biomarkers for cancer diagnosis and prognosis. To provide an integrated and standardized circRNA expression profile for human cancers, we performed extensive data curation across 11 technical platforms, collecting 48 expression profile data sets for 18 cancer types and amassing 860 751 expression records. We also identified 189 193 differential expression signatures that are significantly different between normal and cancer samples. All the pre-calculated expression analysis results are organized into 132 plain text files for bulk download. Our online interface, circExp, provides data browsing and search functions. For each data set, a dynamic expression heatmap provides a profile overview. Based on the processed data, we found that 52 circRNAs were consistently and differentially expressed in 20 or more processed analyses. By mapping those circRNAs to their parent protein-coding genes, we found that they may have profoundly affected the survival of 10 797 patients in the The Cancer Genome Atlas pan-cancer data set. In sum, we developed circExp and demonstrated that it is useful to identify circRNAs that have potential diagnostic and prognostic significance for a variety of cancer types. In this online and reusable database, found at http://soft.bioinfo-minzhao.org/circexp, we have provided pre-calculated expression data about circRNAs and their parental genes, as well as data browsing and searching functions.

Database URL: http://soft.bioinfominzhao.org/circexp/
Executive Function Training for Deaf Children: Impact of a Music Intervention
Authors: Mason Kathryn , Marshall Chloe Ruth , Morgan Gary
Published: July 2021

Several studies have reported poor executive function (EF) development in deaf children with subsequent impacts on their social and academic attainment. This paper describes the results of a music-based EF intervention designed for deaf children and carried out in two sets of primary schools. This is the first classroom-based EF training study with deaf children, and it also incorporates a replication phase. The intervention was a within-subject crossover design, with 29 deaf children aged 7–11 years who participated in both an EF and an art class control activity, each lasting 10 hours over 5 weeks. Non-verbal EF skills were assessed at pre-test, the crossover point, and post-test. Findings indicated that the EF intervention led to an improvement in participants’ working memory and inhibitory skills in comparison with their performance on the same tasks after the control activity. The findings were not uniform for all EFs targeted nor for all cognitive ability levels in the sample. We discuss the implications of our findings for deaf children with different ability levels and for how EF interventions can be further improved.
Quality of life and symptom assessment in paraesophageal hernias: a systematic literature review of reporting standards
Authors: Patel Nikhil M , Puri Aiysha , Sounderajah Viknesh , Ferri Lorenzo , Griffiths Ewen , Low Donald , Maynard Nick , Mueller Carmen , Pera Manuel , van Berge Henegouwen Mark I , Watson David I , Zaninotto Giovanni , Hanna George B , Markar Sheraz R ,   the Para-Oesophageal hernia Symptom Tool (POST) Collaborative
Published: July 2021

Background

Paraesophageal hernias (PEH) present with a range of symptoms affecting physical and mental health. This systematic review aims to assess the quality of reporting standards for patients with PEH, identify the most frequently used quality of life (QOL) and symptom severity assessment tools in PEH and to ascertain additional symptoms reported by these patients not captured by these tools.

Methods

A systematic literature review according to PRISMA protocols was carried out following a literature search of MEDLINE, Embase and Cochrane databases for studies published between January 1960 and May 2020. Published abstracts from conference proceedings were included. Data on QOL tools used and reported symptoms were extracted.

Results

This review included 220 studies reporting on 28 353 patients. A total of 46 different QOL and symptom severity tools were used across all studies, and 89 different symptoms were reported. The most frequently utilized QOL tool was the Gastro-Esophageal Reflux Disease-Health related quality of life questionnaire symptom severity instrument (47.7%), 57.2% of studies utilized more than 2 QOL tools and ‘dysphagia’ was the most frequently reported symptom, in 55.0% of studies. Notably, respiratory and cardiovascular symptoms, although less common than GI symptoms, were reported and included ‘dyspnea’ reported in 35 studies (15.9%).

Conclusions

There lacks a QOL assessment tool that captures the range of symptoms associated with PEH. Reporting standards for this cohort must be improved to compare patient outcomes before and after surgery. Further investigations must seek to develop a PEH specific tool, that encompasses the relative importance of symptoms when considering surgical intervention and assessing symptomatic improvement following surgery.
Long-term prognostic value of stress CMR-related coronary revascularization to predict death: a large registry with > 200,000 patient-years of follow-up
Authors: Pezel T , Unterseeh T , Garot P , Hovasse T , Sanguineti F , Toupin S , Morisset S , Champagne S , Garot J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

While the benefit of coronary revascularization in patients with stable coronary artery disease (CAD) is debated, data assessing the potential interest of stress CMR to guide coronary revascularization are limited.

PURPOSE

To assess the long-term prognostic value of stress CMR-related coronary revascularization in consecutive patients from a large registry.

METHODS

Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range: 5.0-8.0) included all consecutive patients referred for stress CMR. Stress CMR-related coronary revascularization was defined by any coronary revascularization performed within 90 days after CMR. The primary outcome was all-cause death based on the electronic National Death Registry.

RESULTS

Among the 31,752 consecutive patients (mean age 63.7 ± 12.1 years and 65.7% males), 2,679 (8.4%) died at 206,453 patient-years of follow-up. Inducible ischemia and late gadolinium enhancement (LGE) by CMR were associated with death (both p < 0.001). In multivariable Cox regression, inducible ischemia and LGE were independent predictors of death (HR = 1.61; 99.5%CI 1.41-1.84; HR = 1.62; 99.5%CI 1.41-1.86, respectively; p < 0.001). CMR-related coronary revascularization was an independent predictor of greater survival (HR: 0.66; 99.5%CI: 0.52-0.84; p < 0.001). CMR-related revascularization was associated with a lower incidence of death in patients with severe inducible ischemia (p < 0.001), but showed no benefit in patients with mild or moderate ischemia (p = 0.109).

CONCLUSIONS

In this large observational series of consecutive patients, stress perfusion CMR had important incremental long-term prognostic value to predict death over traditional risk factors. CMR-related revascularization was associated with a lower incidence of death in patients with severe ischemia.
Long-term prognostic value of stress CMR in patients with history of percutaneous coronary intervention
Authors: Pezel T , Hovasse T , Kinnel M , Sanguineti F , Champagne S , Toupin S , Unterseeh T , Garot P , Garot J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Recurrence of cardiovascular (CV) events remains a substantial cause of mortality and morbidity among patients with previous coronary revascularization.

PURPOSE

The aim was to assess the prognostic value of stress cardiovascular magnetic resonance (CMR) parameters and CMR-based revascularization in patients with history of percutaneous coronary intervention (PCI).

METHODS

Between 2011 and 2014, consecutive patients with history of PCI referred for stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Patients with prior coronary artery bypass graft were excluded. CMR-related coronary revascularization was defined as any revascularization occurring within 90 days after CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic value of each parameter.

RESULTS

Of 1,762 patients who completed the CMR protocol, 1,624 patients (81.7% male, mean age 67.9 ± 10.4 years) completed the follow-up (median [interquartile range], 6.7 [5.6–7.3] years); 251 experienced a MACE (15.5%). Stress CMR was well tolerated. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 2.70 [95%CI, 2.11–3.46], p < 0.001; and HR: 1.52 [95%CI, 1.16–1.99], p = 0.002; respectively). In multivariable Cox regression, inducible ischemia and LGE were independent predictors of a higher incidence of MACE (HR: 2.83 [95%CI, 2.20–3.64]; p < 0.001; and HR: 1.42 [95%CI, 1.06–1.91]; p = 0.012; respectively). CMR-related coronary revascularization was associated with a lower incidence of MACE, even after adjustment.

CONCLUSIONS

Stress CMR and CMR-related revascularization were independently associated with MACE in patients with history of PCI.
Prognostic value of pre-hospitalization stress perfusion CMR to predict death in patients hospitalized for COVID-19
Authors: Pezel T , Garot P , Hovasse T , Unterseeh T , Champagne S , Toupin S , Sanguineti F , Lima J , Garot J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Inducible ischemia is a strong marker of vascular vulnerability that may be a key pathogenetic determinant of COVID-19 severity.

PURPOSE

This study investigated the prognostic value of prior inducible ischemia on stress perfusion CMR to predict death in patients hospitalized for COVID-19.

METHODS

In an observational study, we retrospectively analyzed consecutive patients referred for stress perfusion CMR within last two years prior to hospitalization for COVID-19. The primary outcome was all-cause death, including in-hospital and post-hospitalisation deaths, based on the electronic national death registry.

RESULTS

Among the patients referred for stress perfusion CMR, 481 were hospitalized for COVID-19 (mean age =68.4 ± 9.6 years, 61.3% males) and completed the follow-up (median 73[36-101] days). There were 93 (19.3%) all-cause deaths, of which 13.7% were in-hospital and 5.6% post-hospitalisation deaths.

Using Kaplan-Meier analysis, age, male gender, hypertension, diabetes, known CAD, the presence of prior inducible ischemia, the number of ischemic segments, the presence of LGE, and LVEF were significantly associated with all-cause death. In multivariable stepwise Cox regression analysis, age (HR: 1.04; 95%CI:1.01-1.07, p = 0.023), hypertension (HR: 2.77; 95%CI:1.71-4.51, p < 0.001), diabetes (HR: 1.72; 95%CI:1.08-2.74, p = 0.022), known CAD (HR: 1.78; 95%CI:1.07-2.94, p = 0.025) and the presence of prior inducible ischaemia  (HR: 2.05; 95%CI:1.27-3.33, p = 0.004) were independent predictors of all-cause death.

CONCLUSIONS

In COVID-19 patients, prior inducible myocardial ischemia by stress CMR over the last two years preceding the COVID-19 pandemic was independently associated with all-cause in-hospital and post-hospitalisation deaths, suggesting involvement of vasculature and endothelial dysfunction in the severity of COVID-19.
Usefulness of cardiovascular magnetic resonance in asymptomatic and symptomatic patients with complete left bundle branch block
Authors: Sztajzel J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Complete left bundle branch block (LBBB) is a common indication for referral for cardiovascular magnetic resonance (CMR) imaging. 

Purpose

 The objective of this study was to evaluate asymptomatic and symptomatic patients (pts) with complete LBBB referred to our outpatient institution for a stress CMR examination, in order to identify the cause of this block whether ischemic or non ischemic.

Methods

 We prospectively analysed CMR data of all pts with complete LBBB who were referred for stress CMR (1.5 Tesla) to our Centre de Diagnostic Radiologique de Carouge. All pts had a complete LBBB as defined by standard criteria and all had an echocardiogram. All pts underwent a stress CMR using either adenosine or dobutamine. Standard protocol consisted of: 1) assessment of myocardial function at rest; 2) pharmacological stress induced either by dobutamine or by adenosine; 3) assessment of myocardial scar and/or viability by delayed enhancement (DE) sequences.

Results

 A total of 138 pts, 75 women and 63 men, mean age 67.8 ± 15.4 years, with complete LBBB were referred for stress CMR. Of the 138 pts, 59 (43%) were asymptomatic (group 1) and 69 (50%) were symptomatic (group 2). Mean ventricular ejection fraction (LVEF) was 58 ± 17% in group 1, and 52 ± 17% in group 2 (p < 0.05). In group 1, 15 pts (25%) had abnormal LVEF values between 35-48% (mean value 41 ± 16%), and in group 2, 28 pts (41%) had LVEF values between 16-48% (mean value 35 ± 11%; p < 0.03 when comparing group 1 to group 2 values). Septal dyskinesia was present in 17 group 1 pts (29%) and in 27 group 2 pts (39%; p < 0.05 when comparing group 1 to group 2 values)). Stress CMR data revealed ischemia in 3 group 1 (5%) and in 9 group 2 pts (13%; p < 0.04 when comparing group 1 to group 2 values). Finally, DE sequences showed myocardial infarction in 8 pts of both groups (13% vs 12%), intramyocardial DEwas seen in 1 group 1 (2%) patient and in 2 group 2 pts (3%). 

Conclusions

Our study showed that symptomatic pts with complete LBBB had a significantly lower mean LVEF and a higher number of wall motion abnormalities, mainly LV septal dyskinesia. Of note, CMR detected a rather low percentage of ischemic or non ischemic causes as well in asymptomatic as in symptomatic pts with complete LBBB.
Prevalence of pericardial late gadolinium enhancement in patients after cardiac surgery: clinical and histological correlation
Authors: Martinez R , Pavon A-G , Arangalage D , Colombier S , Rotman S , Monney P , Kirsch M , Schwitter J , Rutz T
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Opening of the pericardial sack during cardiac surgery induce usually, a mild inflammatory reaction. Late gadolinium enhancement of the pericardium (pLGE) still has been observed on cardiovascular magnetic resonance (CMR) in patients even long-time after cardiac surgery suggesting ongoing pericardial inflammation. Clinical relevance and histological correlation are unknown. We present a study evaluating the prevalence of pLGE and correlating it to clinical and histological findings.

Materials and Methods

185 patients after cardiac surgery underwent CMR on a 1.5 or 3.0 T system. Presence (LGE+) or absence (LGE-) of pLGE was rated by 2 independent operators blinded to clinical characteristics. In case of discordance a third observer served as referee. Information on clinical symptoms were obtained at the time of CMR or from medical records. A pericardial biopsy was performed in 4 patients who underwent a second cardiac surgical intervention after CMR.

Results

Mean time between CMR and cardiac surgery was 158 ± 110 months. Pericardial LGE was observed in 83 patients (38%), two independent observers agreed in 73 (89%). The presence of LGE was not significant correlated to the type (p = 0.812) or duration of surgery (p = 0.734), nor the use of intrapericardial foreign material (p = 0.534). Two biopsies in LGE + patients showed mild inflammation and calcification, one biopsy in a LGE + patient showed the presence of fibrosis without inflammation while one biopsy in a LGE – patient was negative for inflammation. None of patients presented clinical signs for an active pericarditis.

Discussion

Presence of pericardial LGE is frequent in patient after cardiac surgery, however without clinical features of pericarditis. The CMR findings appear to be histologically correlated to the presence of fibrosis or mild chronic inflammation which remains to be confirmed in a larger patient population.

Figure 1: Basal ventricular short axis view in LGE sequences showing the presence of LGE of the pericardium (Panel A, yellow arrows) compatible with mild inflammation present in histological findings, shown by the presence of T lymphocytes CD3+ (Panel B) and the presence of fibrin (Panel C) : (hematoxylin and eosin) and (Panel D) : (FAOG). Mid-ventricular short axis view in LGE sequences showing the presence of LGE of the pericardium (Panel E, yellow arrows), which is compatible with histological findings, showing the presence of granulomatous inflammation in a fibrinous pericardium (Panel F,H) : (hematoxylin and eosin) and (Panel G) : (fils polarized). Visible granuloma (Panel F).
Limitations of a non-invasive model of the estimation of pulmonary vascular resistance by magnetic resonance imaging in patients with heart failure
Authors: Vidal Urrutia V , Cubillos-Arango A , Garcia-Gonzalez P , Gradoli-Palmero J , Nunez-Villota J , Facila-Rubio L , Fernandez-Diaz C , Abdala-Lizarraga J , Vilar Herrero JV , Berenguer-Jofresa A , Paya Serrano R , Rumiz-Gonzalez E
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. Pulmonary vascular resistance (PVR) is a hemodynamic parameter with important diagnostic and prognostic implications in patients with heart failure. Currently the gold standard technique for its quantification is right heart catheterization (RHC). However, cardiovascular magnetic resonance imaging (CMR) has been postulated as a non-invasive alternative for its estimation. The aim of this study is to assess the accuracy of a non-invasive model of PVR estimated by CMR in a specific subgroup of patients with acute heart failure (AHF).

Methods. Between January 2014 and December 2018, 108 patients with AHF who underwent RHC and CMR on the same day were prospectively included. PVR was assessed by CMR using the model: 19.38 - [4.62 x Ln mean pulmonary artery velocity - 0.08 x right ventricular ejection fraction (RVEF)]. During RHC, PVR were calculated using the ratio between transpulmonary gradient and cardiac output. We evaluated their correlation using the Spearman correlation coefficient, receiver operating characteristic [ROC] curves, and Bland-Altman analysis.

Results. The mean age of our cohort was 65 ± 11 years and 64.8% were male. The median PVR (Wood Units, WU) assessed by CMR and RHC were 5.1 WU (3.4 - 6.8) and 3 WU (1.5 - 3.9); p < 0.001, respectively. A weak correlation was observed between the PVR obtained by RHC and those obtained by CMR in our population (r = 0.21; p = 0.02). On Bland-Altman analysis, the mean bias was -1.7, and the 95% limits of agreement ranged from -10.02 to 6.6 WU. The area under the ROC curve for PVR assessed by CMR to detect PVR ³3 WU was 0.57, 95% confidence interval (CI): 0.47-0.68.

Conclusions. In patients with AHF, the non-invasive estimation of PVR using CMR shows poor accuracy, as well as a limited capacity to discriminate increased PVR values.
Comparative study of cardiac magnetic resonance imaging and transesophageal echocardiography in detection of left atrial and left atrial appendage thrombi
Authors: Shahawy H , Al Agha A , Helmy M
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial (LA) thrombi are the most common intracardiac masses. Left atrial

appendage (LAA) is the most common site for thrombus formation in patients with atrial

fibrillation (AF), and in patients with valvular lesions. Transesophageal echocardiography (TEE)

has been the conventional investigation for thrombus detection. However, because TEE is a

semi-invasive technique; a completely non-invasive technique would be of great concern. 

Purpose

 The aim of this study is to evaluate the feasibility and diagnostic performance of cardiac magnetic resonance imaging (CMR), for the assessment of thrombi in the left atrium and left atrial appendage (LA/ LAA). Also whether CMR is comparable to TEE in identification and measurement of thrombus size.

Methods

We studied 43 patients who were diagnosed to have LA/LAA thrombus, or highly

suspected thrombus by TEE. They underwent multisequence CMR for assessment of thrombus

detection; within 7 days of TEE performance. Data collected from CMR study were statistically

analyzed to evaluate for sensitivity, specificity, negative predictive value (NPV), positive

predictive value (PPV) and overall accuracy of detection of LA/LAA thrombus using TEE as the

gold standard. Also agreement between both imaging techniques was assessed using kappa

agreement coefficient. We conducted a questionnaire where 10 questions were asked to every

patient in the study. It aimed to obtain an idea about patients’ opinion of both tests.

Results

During the study period of 13 months, 43 patients were assessed. Twenty one patients

had AF and 22 patients were in sinus rhythm. The median CHA2DS2VASc score of AF patients

was 2.52 ± 1.12, and 76.7% of patients were undergoing anticoagulation therapy. In all subjects,

the LAA was readily visualized with CMR. When evaluating the diagnostic performance of

CMR results revealed overall sensitivity, specificity, PPV, NPV and accuracy of 97.44%, 75%,

97.44%, 75% and 95.35% respectively. Results of questionnaire was statistically significant p

value yielding good overall opinion for the sake of CMR. There was an additional role for CMR regarding tissue characterization; where CMR detected 3 cases, diagnosed by TEE as thrombus, 1 case revealed Libman-Sacks Endocarditis and 2 cases revealed fibroelastoma. This made a paradigm shift in patient management.

Conclusion

CMR is a noninvasive, feasible and comparable modality for thrombus detection in

the LA and LAA and could be a reasonable, more comfortable alternative to TEE.
Overcoming claustrophobia in cardiovascular magnetic resonance with medical hypnosis
Authors: Pavon A , Chautems C , Odin Y , Arangalage D , Rutz T , Hugelshofer S , Monney P , Schwitter J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

the role of Cardiovascular Magnetic Resonance has gained the more and more importance in the field of cardiovascular disease. Claustrophobia remains a frequent cause of failure to complete a CMR. It is estimated that 2 million scans worldwide cannot be performed annually either due to premature termination or refusal of the patient to be scanned due to claustrophobia. In this setting, medical hypnosis may prove useful to overcome this main limitation.

Methods

we propose an observational study of consecutive patients referred to CMR and known for severe claustrophobia. Patients were proposed to undergo CMR examination with the help of medical hypnosis according to Milton H. Erickson’s method or with administration of mild sedation (lorazepam 2.5 mg).

Results

20 severe claustrophobic patients were considered in the study. 1 patient was excluded due to psychiatric condition, 1 patient undergo to general anesthesia, 5 patients refused the examination. Among the 13 patients, 10 underwent medical hypnosis while 3 patients accepted to undergo to CMR examination with the administration of lorazepam 2.5 mg. All patients treated with medical hypnosis were able to complete the examination with a great tolerance and no sign of stress or anxiety were reported. CMR protocol was performed according to clinical request and was not different form non-claustrophobic patients. None of the patients treated with lorazepam 2.5mg was able to complete the exam.

Conclusion

we prove medical hypnosis to be safe and effective in controlling patients’ anxiety, allowing optimal diagnostic imaging quality without the need to adapt the examination. Further studies in larger populations are needed to confirm our results.
Sequential cardiovascular magnetic resonance assessment of left ventricular ejection fraction for prediction of subsequent events in a large multicenter STEMI registry
Authors: Gavara J , Marcos-Garces V , Rios-Navarro C , Lopez-Lereu MP , Monmeneu JV , Bonanad Lozano C , Moratal D , Chorro FJ , Valente F , Lorenzatti D , Rodriguez-Palomares JF , Ortiz-Perez JT , Bodi V
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER”

Background. Cardiovascular magnetic resonance (CMR) is the best tool for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of sequential LVEF assessment for major adverse cardiac event (MACE) prediction after ST-segment elevation myocardial infarction (STEMI) is uncertain.

Purpose. We explored the prognostic impact of sequential assessment of CMR-derived LVEF after STEMI to predict subsequent MACE.

Methods. We recruited 1036 STEMI patients in a large multicenter registry. LVEF (reduced [r]: <40%; mid-range [mr]: 40-49%; preserved [p]: ≥50%) was sequentially quantified by CMR at 1 week and after >3 months of follow-up. MACE was regarded as cardiovascular death or re-admission for acute heart failure after follow-up CMR.

Results. During a 5.7-year mean follow-up, 82 MACE (8%) were registered. The MACE rate was higher only in patients with LVEF < 40% at follow-up CMR (r-LVEF 22%, mr-LVEF 7%, p-LVEF 6%; p-value < 0.001). Based on LVEF dynamics from 1-week to follow-up CMR, incidence of MACE was 5% for sustained LVEF³40% (n = 783), 13% for improved LVEF (from <40 to ³40%, n = 96), 21% for worsened LVEF (from ³40% to <40%, n = 34) and 22% for sustained LVEF <40% (n = 100), p-value < 0.001. Using a Markov approach that considered all studies performed, transitions towards improved LVEF predominated and only r-LVEF (at any time assessed) was significantly related to higher incidence of subsequent MACE.

Conclusions. LVEF constitutes a pivotal CMR index for simple and dynamic post-STEMI risk stratification. Detection of reduced LVEF (<40%) by CMR at any time during follow-up identifies a small subset of patients at high risk of subsequent events.
Late gadolinium enhancement predicts adverse clinical outcome in patients with mitral valve prolapse/mitral annulus disjunction
Authors: Figliozzi S , Georgiopoulos G , Aquaro GD , Bauer K , Monti L , Filomena D , Pica S , Censi S , Lopez P , Quattrocchi G , Servato ML , Schwitter J , Andreini D , Bogaert J , Masci PG
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Mitral vAlve prolapse and disjunction by cardiac maGnetIC resonance (MA-GIC) registry

Backgroung

Mitral valve prolapse (MVP) is 2-3% prevalent in the general population with good prognosis. However, some patients develop complex ventricular arrhythmias (CVAs), sudden cardiac death (SCD), or severe mitral regurgitation (MR). Previous studies suggested that bi-leaflet involvement, mitral annulus disjunction (MAD), and myocardial fibrosis (MF) are associated with adverse outcome. Notwithstanding, these findings were limited to autopsic series or single-centre studies involving highly selected patients. Moreover, MF has been scantly investigated as predictor of clinical outcome.

Purpose

To investigate the prognostic significance of MF in an international multicentre study of MVP patients studied by cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). 

Methods

From October 2007 to June 2020 patients undergoing LGE-CMR were screened in 14 European centres. Inclusion criteria were: i) age > 18 years; ii) full clinical history and cardiac rhythm monitoring at baseline; iii) MVP (leaflet displacement ≥ 2 mm beyond the annulus). Exclusion criteria were: i) ischemic heart disease; ii) primary cardiomyopathy; iii) inflammatory heart disease; iv) congenital heart diseases; v) moderate-to-severe valvular heart disease. CVAs at the study outset was defined as one of the following: i) ventricular ectopic beats >10000/24h; ii) ≥ 1 episode of non-sustained ventricular tachycardia (VT); iii) sustained VT; iv) aborted SCD. Primary end-point was a composite of SCD, unexplained syncope, and mitral valve repair/replacement. Secondary end-point was a composite of SCD and unexplained syncope. 

Results

Four-hundred-fifty-eight MVP patients were eventually included (46 ± 16 years old, 51% males) of whom 68% had MAD. LGE was detected in 103 (22%) of subjects with mid-wall pattern (46%) in left ventricular (LV) lateral wall (66%) as the most prevalent feature. At baseline, 37% of LGE-positive patients vs. 18% of LGE-negative individuals had CVAs (P < 0.001). SVT and/or aborted SCD were more prevalent in LGE-positive than in LGE-negative patients (9% vs 2%, P < 0.001). By multivariable Cox-regression analysis, LGE presence or extent were strong independent predictors of the primary (HR = 4.02, P = 0.003 and HR = 4.76 per 10% increase, P = 0.032, respectively) and secondary (HR = 5.39, P = 0.008 and HR = 8.78 per 10% increase, P = 0.012, respectively) endpoints after correction for major confounders including LV volumes, left atrial size and MAD presence.

Conlusion

Myocardial fibrosis by LGE is the strongest independent predictor of clinical outcome in MVP. In contrast, MAD per se does not harbinger worse prognosis.
Differential diagnosis of left ventricular hypertrophy with cardiac magnetic resonance imaging texture feature analysis
Authors: Pineiro-Vidal TPV , Vidal-Sospedra IVS , Higueras-Ortega LHO , Santabarbara JSG , Ruiz-Espana SRE , Moratal DMP , Maceira-Gonzalez AMG
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Hypertrophic cardiomyopathy (HCM), hypertensive cardiomyopathy (HTCM), and cardiac amyloidosis (CA) are characterized by left ventricular (LV) hypertrophy. CMR with late gadolinium enhancement is used in the differential diagnosis. Radiomics aims to extract features from medical images and quantify their patterns to produce quantitative biomarkers.  Our aim was to develop radiomics-derived biomarkers capable of differentiating between HCM, HTCM, CA and healthy controls using CMR cine images.

Methods

We included 103 patients (42 HCM, 51 HTCM, 10 CA; 31 females, age 65.0 ± 12.8 years) and 50 healthy subjects (29 females, age 52.5 ± 18.0 years). The study was done on a 1.5 T CMR scanner (Sonata; Siemens, Erlangen, Germany) and all the subjects underwent a conventional protocol including cine sequences acquired in the 2-, 4- and 3-chamber views as well as in a short axis stack. The most basal slice of the short axis stack immediately distal to the LV outflow tract was used for texture feature analysis and regions of interest (ROI) were defined by segmenting the LV myocardium and dividing it into 6 segments. For image analysis a radiomic approach was used. Five different quantizations were obtained in order to find the optimal one and 43 texture features were extracted by quantization and segment. Feature selection (FS) methods were studied to see the optimal number of textures, and 4 predictive models were evaluated including k-Nearest Neighbour (KNN) and Support Vector Machine with a linear kernel (SVML) models. Performance of each model was evaluated with the area under the ROC curve (AUC).

Results

The AUCs of each of the models for the different texture features were analysed, from 1 to 43, according to the ranking obtained and for 5 different number of grey levels. The maximum average AUC, 1.0, was obtained with KNN model trained to classify CA and control subjects. More interestingly, 0.89 average AUC was achieved with SVML model and 1 single feature for HCM vs HTCM vs CA study.

Table 1 shows the best average AUCs (mean ± SD) obtained for each study, number of subjects (N), number of grey levels used in each case, number of optimal features and the classification model.

Conclusions

Texture analysis allows for the correct differential diagnosis of LVH. Best results (AUC of 89%), were achieved using the SVML model in septal segments. Texture feature analysis applied to CMR cine sequences is a promising advance that might allow for the use of contrast-free protocols for the differential diagnosis of LVH.
Localization of ST-elevation on ECG is associated with regional myocardial fibrosis in acute myocarditis
Authors: Karolyi M , Kolossvary M , Weber L , Matziris I , Sokolska J , Alkadhi H , Manka R
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Both ST elevation (STE) on ECG and late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) are related to poor outcome in myocarditis.

Purpose

We evaluated if there is an association between regional STE and LGE pattern in patients with suspected myocarditis.

Methods

51 patients (42 male, 32 ± 13 years old) underwent 12-lead ECG and CMR with LGE due to suspected myocarditis. >1mm STE was assessed in the antero-septal (V1-V4, aVR), inferior (II, III, aVF) and lateral (I, aVL, V5-V6) localizations. LGE was quantified as visual presence score (VPS) (1-17) and visual transmurality score (VTS) (1-68) on CMR, according to the 17-segment AHA model. STE and LGE were correlated using linear regression analysis. 

Results

31% of the patients had STE on admission ECG and a median VPS of 3 (IQR: 1-5) and VTS of 6 (IQR: 3-11) on CMR. STE showed an association with VPS and VTS in univariate and multivariate analysis (p < 0.001 all). STE was most frequent in the lateral and inferior leads (48% and 31%) which correlated with regional VPS and VTS in univariate model (p < 0.05 all), and remained significant in multivariate analysis for VPS (p < 0.05 both). STE was less frequent in the antero-septal region (21%, where no association between LGE and STE could be revealed (p > 0.05 all).

Conclusions

 Inferior and lateral STE in myocarditis is associated with regional LGE on CMR, which is an indicator of myocardial fibrosis and possible poor outcome. Our results need not be validated on larger cohorts with follow-up.
Feasibility of non-gated dynamic fetal cardiac MRI for identification of fetal cardiovascular anatomy
Authors: Geiger J , Tuura R , Callaghan FM , Burkhardt BUE , Payette K , Jakab A , Kellenberger CJ , Valsangiacomo ER
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose

We sought to retrospectively evaluate the feasibility of identifying the fetal cardiac and thoracic vascular structures with non-gated dynamic balanced steady-state free precession MRI sequences.

Methods

We retrospectively assessed the visibility of cardiovascular anatomy in 66 fetuses without suspicion of congenital heart defect (mean gestational age 27+/- 4, range 21-38 weeks). Non-gated dynamic balanced steady-state free precession (SSFP) sequences were acquired in three planes (axial, coronal and sagittal) of the fetal thorax (slice thickness 4-5mm, FOV 400, FA 60°, matrix 256x256). The images were analysed following a segmental approach in consensus reading by an experienced paediatric cardiologist and radiologist. An imaging score was defined by giving one point to each visualized structure. Basic diagnostic structures included the atria, ventricles, systemic veins, right and left ventricular outflow tracts (RVOT/LVOT), aortic arch, descending aorta (DAO), ductus arteriosus and thymus (12 points); advanced diagnostic features included the atrioventricular (AV) valves, pulmonary arteries and veins, supraaortic arteries and trachea, yielding a maximum score of 21 points. Image quality was rated from 0 (poor) to 2 (good). The influence of gestational age (GA), field strength, placenta position, and maternal panniculus on image quality and imaging score were tested.

Results

34 scans were performed at 1.5 T, 32 at 3 T. Heart position, atria and ventricles could be seen in all 66 fetuses. Basic diagnosis (>12 points) was achieved in 60 (90%) cases, with visualization of the IVC and SVC in 65 (98%) and 63 (95%), RVOT in 62 (94%), LVOT in 61 (92%), aortic arch in 60 (91%), DAO in 64 (97%), ductus arteriosus in 59 (89%) and thymus in 50 (76%) fetuses. The AV valves were recognised in 55 (83%), the pulmonary arteries in 35 (53%), at least one pulmonary vein in 46 (70%), the supraaortic arteries in 42 (64%), and the trachea in 59 (89%) fetuses. The mean imaging score was 16.8 +/- 3.7. Maternal panniculus (r -0.3; p 0.01) and gestational age (r 0.6; p < 0.001) correlated with imaging score. Field strength influenced image quality, with 1.5 T being better than 3T images (p 0.04), but not the total imaging score. Imaging score or quality were independent from placenta position.

Conclusions

Fetal heart MRI with a non-gated SSFP sequence in multiple planes enables recognition of basic cardiovascular anatomy. Advanced diagnostics may be limited by thick maternal panniculus, lower GA and higher field strength.