bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in compound extremes of rainfall and temperature over West Africa using CMIP5 simulations
Authors: Diba Ibrahima , Diedhiou Arona , Famien Adjoua M , Camara Moctar , Fotso-Nguemo Thierry C
Published: October 2022

This study aims to characterize changes in compound extremes of rainfall and temperature over West Africa. For this purpose, data from CHIRPS observations, the ERA5 reanalysis, and twenty-four (24) climate models involved in the CMIP5 Project were analyzed. First, climate models were evaluated in terms of their capacity to simulate summer mean climatology and compound extremes during the historical period (1981–2005), and secondly, changes in compound extremes were examined under RCP8.5 emission scenario between the near future (2031–2055) and the far future (2071–2095) relative to the historical period. Despite the presence of some biases, the ensemble mean of the models well reproduces the compound extremes patterns over West Africa at the seasonal and intraseasonal timescales. The analysis over the historical period with CHIRPS/ERA5 dataset shows a strong occurrence of the dry/warm mode over the northern Sahel during the June-July-August-September period (JJAS; main rainy season) and over the Guinean region during the February-March-April-May season (FMAM; first and main rainy season). These strong occurrences are due to a weak and highly frequent precipitation recorded in these zones. The compound wet/warm mode is frequent in JJAS over the Sahel and the Sudanian zone (transition area between Sahel and Guinean regions), while in FMAM, its occurrence is maximum over the Guinean region. The study also shows that the dry/warm mode will increase in the whole Sahel (western and central) and in the Guinean zone in the near and far futures while the compound wet/warm mode will decrease in the whole region. This study suggests that the West Africa region will be prone to drought intensified by warmer temperatures and calls for climate action and adaptation strategies to mitigate the risks on rain-fed agriculture, energy, and on animals and human health.
Roadmap on chalcogenide photonics
Authors: Gholipour Behrad , Elliott Stephen R , Müller Maximilian J , Wuttig Matthias , Hewak Daniel W , Hayden Brian E , Li Yifei , Jo Seong Soon , Jaramillo Rafael , Simpson Robert E , Tominaga Junji , Cui Yihao , Mandal Avik , Eggleton Benjamin J , Rochette Martin , Rezaei Mohsen , Alamgir Imtiaz , Shamim Hosne Mobarok , Kormokar Robi , Anjum Arslan , Zeweldi Gebrehiwot Tesfay , Karnik Tushar Sanjay , Hu Juejun , Kasap Safa O , Belev George , Reznik Alla
Published: October 2022

Alloys of sulfur, selenium and tellurium, often referred to as chalcogenide semiconductors, offer a highly versatile, compositionally-controllable material platform for a variety of passive and active photonic applications. They are optically nonlinear, photoconductive materials with wide transmission windows that present various high- and low-index dielectric, low-epsilon and plasmonic properties across ultra-violet, visible and infrared frequencies, in addition to an, non-volatile, electrically/optically induced switching capability between phase states with markedly different electromagnetic properties. This roadmap collection presents an in-depth account of the critical role that chalcogenide semiconductors play within various traditional and emerging photonic technology platforms. The potential of this field going forward is demonstrated by presenting context and outlook on selected socio-economically important research streams utilizing chalcogenide semiconductors. To this end, this roadmap encompasses selected topics that range from systematic design of material properties and switching kinetics to device-level nanostructuring and integration within various photonic system architectures.
A comparative study of different machine learning methods for dissipative quantum dynamics
Authors: Rodríguez Luis E Herrera , Ullah Arif , Espinosa Kennet J Rueda , Dral Pavlo O , Kananenka Alexei A
Published: October 2022

It has been recently shown that supervised machine learning (ML) algorithms can accurately and efficiently predict long-time population dynamics of dissipative quantum systems given only short-time population dynamics. In the present article we benchmarked 22 ML models on their ability to predict long-time dynamics of a two-level quantum system linearly coupled to harmonic bath. The models include uni- and bidirectional recurrent, convolutional, and fully-connected feedforward artificial neural networks (ANNs) and kernel ridge regression (KRR) with linear and most commonly used nonlinear kernels. Our results suggest that KRR with nonlinear kernels can serve as inexpensive yet accurate way to simulate long-time dynamics in cases where the constant length of input trajectories is appropriate. Convolutional gated recurrent unit model is found to be the most efficient ANN model.
The evolving just transition: definitions, context, and practical insights for Africa
Authors: Otlhogile Monkgogi , Shirley Rebekah
Published: October 2022

Sub-Saharan Africa is one of the world’s most climate-vulnerable regions, with impacts on food security already being felt while the continent also battles unprecedented levels of unemployment and economic recovery from the Covid-19 pandemic. The inherent connectivity between the twin challenges of climate and economic vulnerability is becoming more and more apparent, and the concept of the Just Transition is gaining traction across development spheres to address these multidimensional problems, albeit with many different interpretations. These varied interpretations of the Just Transition movement can lead to vastly different priorities, policy routes and outcomes—a concerning risk especially where the governing definitions and principles are not produced, advanced, or owned by African stakeholders. This commentary aims to bring more clarity and specificity to the discourse on Just Transitions in Africa. We first provide a short history of the Just Transition movement and its evolution, and then demonstrate how the term has become an umbrella for more specific interest groups and communities, as seen through the expansion of the Just Urban, Rural, Circular Economy, and Energy Transition movements. Through a literature review, drawing from pivotal international examples, and based on the authors’ perspectives, we offer insights into the meaningfulness of these distinctions and posit clearer working definitions. We then explore the direct relevance of these movements to the African context through case studies of successful local and regional initiatives and programs. This commentary aims to provide readers with a simple, succinct, and structured explanation of the Just Transitions movements, and practical insights for their further advancement in Africa. Our exploration does not aim to be definitive or exhaustive, but rather demonstrates that truly just transitions on the continent will require attention first and foremost to consensus-building at the local and national level. This will require shareable research and data about programs and initiatives for each other to learn from, and significantly more climate financing dedicated to African-led initiatives.
The nonlinear effects of air pollution on criminal behavior: evidence from Mexico City and New York
Authors: Sarmiento Luis
Published: October 2022

This article proposes an inverted U-shape relationship between air pollution and criminal behavior. Exposure increases criminality by raising criminals’ taste for risk and violent behavior while also reducing it by changing the number of felons and crime opportunities in the market through exacerbated morbidity and avoidance behavior. I illustrate both mechanisms with an expected utility model of the decision to delict and a simplified search and matching frictions model between criminals and crime opportunities. Linear, quadratic, and nonparametric Poisson pseudo-maximum likelihood estimator panel models confirm this bell-shaped relationship for Mexico City and New York, suggesting that the linear association between pollution and criminality uncovered by late studies may be better estimated with nonlinear models.
Strong Coexpression of Transcription Factors PU.1 and Oct-2 in Rosai-Dorfman Disease
Authors: Kiruthiga Kala Gnanasekaran , Younes Sheren , Natkunam Yasodha
Published: October 2022

Objectives

Rosai-Dorfman disease (RDD) is a rare disorder characterized by the accumulation of large S100 protein-positive histiocytes that typically exhibit emperipolesis. The recently reported expression of Oct-2 in RDD histiocytes led us to explore whether PU.1, a transcription factor that is required for monocyte and B-cell development, could similarly function as a diagnostic marker in RDD.

Methods

We evaluated the expression of PU.1 and Oct-2 using immunohistochemistry in 19 patients diagnosed with RDD involving nodal, extranodal, and cutaneous sites.

Results

Both PU.1 and Oct-2 were positive in all cases studied, with a strong intensity of staining in 84% of cases in which more than 50% of the lesional cells were positive. In three patients, both markers showed weak to moderate intensity of staining. Two patients had concomitant RDD and Langerhans cell histiocytosis in which PU.1 stained both types of histiocytes while Oct-2 stained only the RDD component.

Conclusions

PU.1 emerged as a robust marker with crisp nuclear staining in RDD histiocytes as well as in engulfed inflammatory cells. Strong coexpression of PU.1 and Oct-2 is a useful diagnostic marker in differentiating histiocytic/dendritic cell proliferations.
Integrated genetic analysis of leaf blast resistance in upland rice: QTL mapping, bulked segregant analysis and transcriptome sequencing
Authors: Tan Qingqun , He Haiyong , Chen Wen , Huang Lu , Zhao Dailin , Chen Xiaojun , Li Jiye , Yang Xuehui
Published: October 2022

Elite upland rice cultivars have the advantages of less water requirement along with high yield but are usually susceptible to various diseases. Rice blast caused by Magnaporthe oryzae is the most devastating disease in rice. Identification of new sources of resistance and the introgression of major resistance genes into elite cultivars are required for sustainable rice production. In this study, an upland rice genotype UR0803 was considered an emerging source of blast resistance. An F2 mapping population was developed from a cross between UR0803 and a local susceptible cultivar Lijiang Xintuan Heigu. The individuals from the F2 population were evaluated for leaf blast resistance in three trials 7 days after inoculation. Bulked segregant analysis (BSA) by high-throughput sequencing and SNP-index algorithm was performed to map the candidate region related to disease resistance trait. A major quantitative trait locus (QTL) for leaf blast resistance was identified on chromosome 11 in an interval of 1.61-Mb genomic region. The candidate region was further shortened to a 108.9-kb genomic region by genotyping the 955 individuals with 14 SNP markers. Transcriptome analysis was further performed between the resistant and susceptible parents, yielding a total of 5044 differentially expressed genes (DEGs). There were four DEGs in the candidate QTL region, of which, two (Os11g0700900 and Os11g0704000) were upregulated and the remaining (Os11g0702400 and Os11g0703600) were downregulated in the susceptible parent after inoculation. These novel candidate genes were functionally annotated to catalytic response against disease stimulus in cellular membranes. The results were further validated by a quantitative real-time PCR analysis. The fine-mapping of a novel QTL for blast resistance by integrative BSA mapping and transcriptome sequencing enhanced the genetic understanding of the mechanism of blast resistance in upland rice. The most suitable genotypes with resistance alleles would be useful genetic resources in rice blast resistance breeding.
Climate aridity and habitat drive geographical variation in morphology and thermo-hydroregulation strategies of a widespread lizard species
Authors: Chabaud Chloé , Berroneau Matthieu , Berroneau Maud , Dupoué Andréaz , Guillon Michaël , Viton Robin , Gavira Rodrigo S B , Clobert Jean , Lourdais Olivier , Le Galliard Jean-François
Published: October 2022

Thermo-hydroregulation strategies involve concurrent changes in functional traits related to energy, water balance and thermoregulation and play a key role in determining life-history traits and population demography of terrestrial ectotherms. Local thermal and hydric conditions should be important drivers of the geographical variation of thermo-hydroregulation strategies, but we lack studies that examine these changes across climatic gradients in different habitat types. Here, we investigated intraspecific variation of morphology and thermo-hydroregulation traits in the widespread European common lizard (Zootoca vivipara louislantzi) across a multidimensional environmental gradient involving independent variation in air temperature and rainfall and differences in habitat features (access to free-standing water and forest cover). We sampled adult males for morphology, resting metabolic rate, total and cutaneous evaporative water loss and thermal preferences in 15 populations from the rear to the leading edge of the distribution across an elevational gradient ranging from sea level to 1750 m. Besides a decrease in adult body size with increasing environmental temperatures, we found little effect of thermal conditions on thermo-hydroregulation strategies. In particular, relict lowland populations from the warm rear edge showed no specific ecophysiological adaptations. Instead, body mass, body condition and resting metabolic rate were positively associated with a rainfall gradient, while forest cover and water access in the habitat throughout the season also influenced cutaneous evaporative water loss. Our study emphasizes the importance of rainfall and habitat features rather than thermal conditions for geographical variation in lizard morphology and physiology.
Management and outcome of patients with non-ST elevation myocardial infarction and intercurrent non-coronary precipitating events
Authors: Sharon Amir , Fishman Boris , Massalha Eias , Itelman Edward , Mouallem Meir , Fefer Paul , Barbash Israel M , Segev Amit , Matetzky Shlomi , Guetta Victor , Grossman Ehud , Maor Elad
Published: October 2022

Aims

To evaluate the effect of an intercurrent non-coronary illness on the management and outcome of patients with non-ST-segment elevation myocardial infarction (NSTEMI).

Methods and results

Consecutive hospitalized patients with a primary diagnosis of NSTEMI between August 2008 and December 2019 at Sheba Medical Center. All patients’ records were reviewed for the presence of a non-coronary precipitating event (NCPE): a major intercurrent acute non-coronary illness or condition, either cardiac or non-cardiac. The primary outcome was all-cause mortality. Cox regression with interaction analysis was applied. Final study population comprised 6491 patients, of whom 2621 (40%) had NCPEs. Patients with NCPEs were older (77 vs. 69 years) and more likely to have comorbidities. The most prevalent event was infection (35%, n = 922). During a median follow-up of 30 months, 2529 patients died. Patients with NCPEs were 43% more likely to die during follow-up in a multivariable model (95% CI: 1.31–1.55). Invasive strategy was associated with a 55% lower mortality among patients without NCPE and only 44% among patients with NCPE (P for interaction < 0.001). Dual antiplatelet therapy (DAPT) was associated with a 20% lower mortality in patients without NCEP and a non-significant mortality difference among patients with NCPE (P for interaction = 0.014). Sub-analysis by the specific NCPE showed the highest mortality risk among patients with infectious precipitant. The lower mortality associated with invasive strategy was not observed in this subgroup.

Conclusion

Among NSTEMI patients, the presence of an NCPE is associated with poor survival and modifies the effect of management strategies.
An artificial intelligence-based platform for automatically estimating time-averaged wall shear stress in the ascending aorta
Authors: Lv Lei , Li Haotian , Wu Zonglv , Zeng Weike , Hua Ping , Yang Songran
Published: October 2022

Aims

Aortopathies are a series of disorders requiring multiple indicators to assess risk. Time-averaged wall shear stress (TAWSS) is currently considered as the primary indicator of aortopathies progression, which can only be calculated by Computational Fluid Dynamics (CFD). However, CFD's complexity and high computational cost, greatly limit its application. The study aimed to construct a deep learning platform which could accurately estimate TAWSS in ascending aorta.

Methods and results

A total of 154 patients who had thoracic computed tomography angiography were included and randomly divided into two parts: training set (90%, n = 139) and testing set (10%, n = 15). TAWSS were calculated via CFD. The artificial intelligence (AI)-based model was trained and assessed using the dice coefficient (DC), normalized mean absolute error (NMAE), and root mean square error (RMSE). Our AI platform brought into correspondence with the manual segmentation (DC = 0.86) and the CFD findings (NMAE, 7.8773% ± 4.7144%; RMSE, 0.0098 ± 0.0097), while saving 12000-fold computational cost.

Conclusion

The high-efficiency and robust AI platform can automatically estimate value and distribution of TAWSS in ascending aorta, which may be suitable for clinical applications and provide potential ideas for CFD-based problem solving.
Use of artificial intelligence for point-of-care echocardiographic assessment of left ventricular ejection fraction among COVID-19 patients
Authors: Dadon Z , Levi N , Orlev A , Belman D , Butnaru A , Glikson M , Gottlieb S , Alpert E A
Published: October 2022

Background

The association between COVID-19 infection and the cardiovascular system has been well described. Isolation precautions limit the use of formal echocardiography in this setting. Artificial intelligence (AI) utilization using a hand-held device in these patients can be a reliable tool for left ventricular ejection fraction (LVEF) assessment.

Aims

To prospectively investigate the accuracy of AI-base tool for LVEF assessment using a hand-held echocardiogram in patients with COVID-19.

Methods

From April-28 through July-26, 2020, consecutive patients with COVID-19 underwent a real-time LVEF assessment within 48-h of admission using a hand-held echocardiogram evaluation (Vscan Extend) equipped with LVivoEF, an AI-based tool that automatically evaluates LVEF. The examinations were further analyzed off-line by a blinded fellowship-trained echocardiographer for LVEF as a gold standard.

Results

Among 42 patients, 21 (50%) were male (aged 53.3±17.8 years, mean BMI 27.6±5.1 kg/m2). Seven (16.7%) patients couldn't turn on their left side and three (7.1%) couldn't maintain effective communication. The mean length of each echocardiogram study was 6.8±2.2 minutes, battery usage was 13.4±4.9%, and mean operator-to-patient proximity was 64.5±9.3 cm.

A fair to good correlation was demonstrated between the AI and the echocardiographer LVEF assessment (Pearson's correlation of 0.691, p<0.001). An almost perfect agreement was demonstrated between the AI and the echocardiographer for LVEF using a threshold of 45% (kappa=0.806, p<0.001).

The sensitivity of focused echocardiogram for 45% LVEF threshold is 85.7%, specificity is 97.1% with a PPV of 85.7% and NPV of 97.1%.

Conclusions

An AI-based algorithm incorporated into an existing hand-held echocardiogram device can be reliably utilized as a decision support tool for automatic real-time LVEF assessment among COVID-19 patients.

Funding Acknowledgement

Type of funding sources: None.
Right ventricular free wall longitudinal strain (RVFWSL) a new outcome predictor in patients candiate for TAVI
Authors: Dellino C , Pergola V , Torresan F , Cecchetto A , Aruta P , Tarantini G , Fraccaro C , Mele D , Iliceto S
Published: October 2022

Background

Right ventricular (RV) systolic dysfunction is considered an outcome predictor in various cardiovascular diseases. RV dysfunction, assessed by RV free wall longitudinal strain (RVFWSL) in patients candidate for trans-catheter aortic valve implantation (TAVI), has not been extensively explored as an outcome predictor.

Purpose

Evaluate the prognostic value of pre intervention RVFWSL in patients undergoing TAVI.

Methods

Retrospective analysis of 100 patients who underwent transfemoral TAVI in our hospital from 2015 to 2019, with at least a pre and post-TAVI echocardiography. Clinical and echocardiographic data before and after TAVI and follow-up data were collected. We considered the value of [23.3]% the cut-off of normality for RVFWSL. The primary end-point was a composite of death from any cause and hospitalization for heart failure.

Results

The median age of the patients was 81 years (79–83) with a functional status NYHA II–III (81%) before the intervention. EF was preserved in most of the patients (median 56%, 55–58), while Right ventricle dysfunction assessed with RVFWLS was reduced in half of the patients at baseline. At a median follow-up of 1023 days (630–1387), the univariate analysis demonstrated a predictive value for a reduced RVFWSL (<[23.3]%, P=0.015) and EF<50% (P=0.014) before TAVI. Cox regression analysis found that pre-TAVI reduced RVFWSL (HR 2.875, 95% CI: 1.113–7.425; P=0.03) and EF <50% (HR 2.511, 95% CI: 1.07–5.892; P=0.03) were independently associated with composite end-point of the study. Moreover, a reduced EF associated with RVFWSL <[23.3]% showed an incremental value in predicting the outcome (P=0.021).

Conclusions

Among patients with severe aortic stenosis undergoing TAVI, a reduced pre-implant RVFWSL is able to predict long-term outcome.

Funding Acknowledgement

Type of funding sources: None.
Myocardial strain indices and coronary flow reserve are only mildly affected in healthy hypertensive patients
Authors: Evangelou D , Bechlioulis A , Tzeltzes G , Lakkas L , Theodorou I , Kalaitzidis R , Dounousi E , Michalis L K , Naka K K
Published: October 2022

Hypertension is a major risk factor for cardiovascular disease and is associated with functional and structural changes in the heart and the vessels.

Left ventricular deformation imaging with 2D Strain Echocardiography (2DSTE) and stress echocardiography with a vasodilator,such as dipyridamole (DIPSE), are useful tools for the detection of early myocardial abnormalities in hypertensive patients

The aim of the current study was to investigate whether early (relatively healthy) hypertensive patients with normal left ventricular (LV) ejection fraction may differ in 2D Strain indices at baseline and in response to a stress test such as dipyridamole, compared to healthy controls. In the current study, the associations of 2DSTE indices and their changes following DIPSE with other studied parameters were also assessed.

Forty-seven male hypertensive patients (aged 57±9 years) with normal ejection fraction and without left ventricular hypertrophy and 20 healthy male subjects were studied with conventional and 2D Strain echocardiography at rest and post DIPSE. Coronary flow reserve (CFR) in the left anterior descending artery following DIPSE was also evaluated.

Global longitudinal strain (GLS) and TWIST were higher while UNTWIST rate was lower in hypertensives versus controls (p<0.05 for all). TWIST remained higher in hypertensives (p=0.021) after adjustment for differences in age and body mass index (BMI) between the groups. CFR was higher in controls compared to hypertensives even after adjustment for confounders (4.14 vs. 2.53, p=0.001).

DIPSE-induced changes did not differ between the groups after adjustment for age and BMI (p>0.05 for all).

DIPSE-induced improvement in GLS was associated with higher CFR only in hypertensive patients (r −0.372, p=0.010).

The current study showed that well controlled hypertensive patients have mild echocardiographic differences compared to controls. Some of these differences appear to depend on age and Body mass index. A “hyper-rotation” phenomenon (higher TWIST) early in hypertension may be a compensatory mechanism to preserve global systolic LV function. Coronary microcirculatory function was impaired in hypertensive patients, albeit within normal range, and was associated with DIPSE-induced changes in myocardial long-axis systolic function.

Funding Acknowledgement

Type of funding sources: None.
Speckle tracking echocardiography in patients with systemic sclerosis: a meta-analysis
Authors: Velagapudi S , Sharma B , Hussain K , Sana M K , Kannayiram S , Murthi M , Khanal S , Gomez J
Published: October 2022

Background

Myocardial dysfunction is well established in systemic sclerosis (SSc). The utility of standard echocardiography is limited to detect the onset of myocardial dysfunction. Speckle tracking echocardiography (STE) and strain imaging has emerged as a useful technique to quantify left ventricle hemodynamics and myocardial function in early stages of myocardial dysfunction. We aimed to systematically analyze the existing literature on the application of STE and strain analysis in identifying SSc associated myocardial dysfunction

Methods

PubMed, Cochrane, and Google Scholar were queried for studies from the inception of the databases to 2022. Case control studies that used 2D STE for assessment of strain in SSc patients and controls, were included for the analysis. PRISMA guidelines were followed for selections of studies. Two independent reviewers extracted data. Analysis was done using Cochrane Review Manager 5.0.

Results

Total of 19 studies were included in the analysis that compared strain analysis in SSc patient's vs healthy controls. Of the 16 studies that reported left ventricular (LV) global longitudinal strain, we found significantly lower LV global longitudinal strain in SSc patients (mean difference 1.92; 95% CI 0.98–2.87). Six studies reported LV circumferential strain which was noted to be lower in SSc patients compared to healthy controls (mean difference 3.55; 95% CI 1.60–5.51). Five studies reported LV global radial strain with a similar decrease in radial strain among SSc patients compared to controls (mean difference 4.39; 95% CI −6.95 to −1.83). 10 studies reported right ventricular longitudinal strain with a decrease in longitudinal strain in SSc patient's vs controls (mean difference 2.57; 95% CI 2.03–3.12).

Conclusions

SSc patients have lower strain values compared to controls, which is suggestive of an impaired myocardial function in left and right ventricle. Strain analysis by STE could help with early detection of myocardial dysfunction.

Funding Acknowledgement

Type of funding sources: None.
The link between left atrial mechanics and the pulmonary circulatory-right ventricular uncouplings in acute decompensated heart failure
Authors: Barki M , Losito M , Caracciolo M M , Rovida M , Alfonzetti E , Guazzi M
Published: October 2022

Background

The worsening of right ventricular (RV) function and its uncoupling to pulmonary circulation (Pc) represents a turning point in terms of clinical outcome in heart failure (HF) patients. Relate to this In this context, the deterioration of Left Atrial (LA) function, which physiologically act as a watershed between the LV and the right heart cavities, favors the development of pulmonary venous congestion and vascular remodeling, triggering congestion. This is most apparent in the setting of Acute Decompensated Heart Failure (ADHF), where LA dysfunction unmask pulmonary capillary hypertension. The link between the acute changes in LA dynamics and the adaptive/maladaptive hemodynamic RV-to-Pc coupling is not defined in the acute decompensated (AD) HF.

Purpose

To investigate, in a cohort of ADHF patients, the association between the degree of RV-to-Pc uncoupling, assessed by the ratio between tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), and LA mechanics, evaluated with Speckle Tracking Echocardiography (STE).

Methods

Eighty-five ADHF patients (mean age 75.6±10.4 years, 59% males) were prospectively enrolled within 24 hours from admission to the Emergency Department. In the acute phase all patients underwent cardiac echocardiography and laboratory blood testing. Patients were then stratified in tertiles according to TAPSE/PASP ratio (group I: <0.4 mm/mmHg; group II: 0.4 to 0.6 mm/mmHg and group III: >0.6 mm/mmHg) correlating the degree of RV-to-Pc with LA mechanics. LA function was evaluated analyzing LA strain at peak relaxation and STE analysis was performed offline.

Results

At baseline, patients exhibited a high prevalence of RV dysfunction, increased PASP and an impairment in terms of RV coupling to PC (average TAPSE/PASP at admission: 0.44±0.18 mm/mmHg). When stratified in tertiles according to TAPSE/PASP ratio (group I: <0.4 mm/mmHg; group II: 0.4 to 0.6 mm/mmHg and group III: >0.6 mm/mmHg), exhibited an exponential direct relationship between LA-Strain values at admission, with levels increasing progressively with the increment of the ratio (Figure 1). A linear correlation between the degree of RV-to-Pc uncoupling and a more severely depressed LA functioning was noticed (r=0.4, CI 95% 0.21–0.57; p<0.001) (Figure 2).

Conclusions

In ADHF, there is a strong association between RV to Pc uncoupling and echo-derived measures of LA mechanics. These data underscore the importance to detect and treating the LA mechanical properties to blunt the negative repercussions on the right heart ultimately impacting on the clinical evolution.

Funding Acknowledgement

Type of funding sources: None.
High resting coronary flow velocity predicts worse survival in chronic coronary syndromes
Authors: Ciampi Q , Cortigiani L , Zagatina A , Gaibazzi N , Rigo F , Picano E
Published: October 2022

Background

Coronary flow velocity (CFV) in the mid-distal left anterior descending coronary artery (LAD) can be easily assessed with transthoracic echocardiography (TTE). Although high resting CFV is associated with a reduced coronary flow velocity reserve which is a predictor of poor outcome, the prognostic significance of resting CFV remains unknown.

Aim

To assess the relationship between resting CFV and outcome.

Methods

Out of 11,410 initially screened, we prospectively enrolled 10,023 patients (age 64±12 years, 5,902 men, left ventricular ejection fraction [LVEF] 58±10%) with chronic coronary syndromes referred for resting TTE and with interpretable CFV. Recruitment (years 2004–2020) involved 5 accredited laboratories, with inter-observer variability <10% for CFV at study entry. Baseline peak diastolic CFV was obtained by pulsed-wave Doppler in mid-distal LAD. All-cause death was the only end-point.

Results

The feasibility of CFV was 95%. The mean CFV of LAD was 32±14 cm/s. By multivariable logistic regression analysis diabetes mellitus, prior myocardial infarction, lower LVEF and higher age, heart rate, and systolic blood pressure were associated with the highest quintile of CFV. During a mean follow-up of 4.6±3.7 years, 1,066 died. Mortality at 10-years was lowest (15%) in patients in the lowest quintile (≤24 cm/s) and highest (34%) in patients in the highest (≥38 cm/s) quintile of CFV. Age (HR 1.057, 95% CI 1.053–1.062; p<0.0001), diabetes mellitus (HR 1.845, 95% CI 1.573–2.164; p<0.0001), prior coronary surgery (HR 1.350, 95% CI 1.064–1.712; p=0.01), LVEF (HR 0.973, 95% CI 0.963–0.982; p<0.0001), the 4th quintile (HR 1.267, 95% CI 1.010–1.589; p=0.04), and the 5th quintile of CFV of LAD (HR 1.311, 95% CI 1.040–1.652; p=0.02) independently predicted mortality. At incremental analysis, CFV of LAD added prognostic information to clinical findings and LVEF.

Conclusion

CFV imaging in mid-distal LAD is highly feasible with TTE. High resting CFV predicts worse survival in the long-term.

Funding Acknowledgement

Type of funding sources: None.
Combined cardiopulmonary test and exercise Doppler echocardiography in systemic sclerosis
Authors: Quevedo N M , Simbine R E B , Bellagamba C C A , Torres M
Published: October 2022

Background

Cardiopulmonary exercise test (CPET) and exercise Doppler echocardiography (EDE) may be useful for the early detection of pulmonary hypertension in systemic sclerosis (SSc)

Aim

To assess the feasibility of CPET and EDE in detecting early changes in gas exchange and/or pulmonary hemodynamics in SSc

Methods

From 2016 to 2021, we evaluated 19 SSc patients (Group 1, age = 52.58±11.27, women 17 (89.5%)), and age 32.10±6.67, men 17 (89.4%) matched healthy controls (Group 2). Simultaneous CPET and EDE were performed. With CPET, we assessed peak oxygen uptake (VO2), peak respiratory quotient (RQ), respiratory equivalent ratio for carbonic gas (VE/VCO2), and maximal respiratory equivalent divided by maximal ventilatory ventilation (V̇E Max/VVM). With EDE, we assessed tricuspid regurgitant velocity (TRV) jet and pulmonary flow acceleration time (ACT) to derive systolic pulmonary arterial pressure (SPAP).

Results

Exercise duration was similar in the 2 groups (Group 1 = 9.2±2.93 vs Group 2 = 10.14±1.78 minutes). Among CPET parameters, SSc patients showed lower peak VO2 (Group 1 = 1.23±0.55 vs Group 2 = 2.45±0.7, p<0.001), similar RQ (1.10±0.10 vs 1.17±0.09;. p=0.036), VE/VCO2 (Group 1 = 31.90±3.65 vs Group 2 = 23.79±2.64, p<0.001) and V̇E Max/VVM (Group 1 = 1.93±0.60 vs Group 2 = 1.76±0.36, p=NS). With EDE, feasibility at peak stress was low for TRV (Group 1 = 42% vs Group 2 = 58%, p=NS), moderate for ACT (Group 1 = 53% vs Group 2 = 78%, p=NS) and high when at least one was technically adequate (Group 1 = 73% vs Group 2 = 100%, p<0.001). Rest TRV (Group 1 = 2.48±0.14 vs Group 2 = 2.08±0.12 m/s, p=0.033) and ACT (Group 1 = 100.14±10.63 vs Group 2 = 108.86±6.38 ms, p=0.482) showed similar values in the 2 groups (será que ficou similar?). During stress, TRV increased more markedly in SSc (Group 1 = 3.33±0.32 vs Group 2 = 2.34±0.09 m/s, p=0.004) and ACT decreased (Group 1 = 81.9±6.54 vs 73.39±5.18 ms, p=0.304), with estimated peak SPAP higher in SSc (Group 1 = 53.34±7.88 vs Group 2 = 43.33±5.49, p<0.001): see figure.

Conclusion

CPET and EDE offer complementary information on gas exchange and pulmonary hemodynamics in SSc and can detect early alterations missed by resting assessment. The success rate of EDE increases significantly with the combination of TRV and ACT.

Funding Acknowledgement

Type of funding sources: None.
Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation
Authors: Motoc A , Scheirlynck E , Roosens B , Luchian M L , Chameleva H , Galloo X , Von Kemp B , De Asmundis C , Magne J , Droogmans S , Cosyns B
Published: October 2022

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia and it is associated with a high risk of cardiovascular complications [1]. Cryoballoon ablation (CBA) has emerged as a safe and efficient therapeutic option for AF [2]. However, AF recurrence occurs in more than 25% of the patients, which leads to repeated ablations and increased rates of complications and hospitalizations [3]. Previous reports on the role of left atrial (LA) diameter and LA volume assessed by two-dimensional echocardiography (2DE) as predictors of AF recurrence after ablation have shown controversial results [4,5]. This might be explained by the fact that these methods imply geometrical assumptions of the LA remodeling, which is a three-dimensional process [6].

Purpose

The purpose of this study was to evaluate the additional value of LA remodeling assessed by three-dimensional echocardiography (3DE) to predict AF recurrence after CBA.

Methods

Consecutive patients with paroxysmal/persistent AF undergoing CBA were prospectively included. Echocardiography was performed before CBA, according to standard recommendations. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period.

Results

One hundred seventy two patients (62.2±12.2 years, 61% male) were included in the analysis. During the follow-up period of 11.7±1.6 months, fifty (29%) patients had AF recurrence after the blanking period. 3DE LA maximum volume index (LAVI) had the highest incremental predictive value for AF recurrence (HR 5.50, 95% CI 1.34–22.45, p<0.001) (Figure 1). Twenty-two percent of the AF recurrences occurred in patients with non-dilated LA diameter index and LAVI by 2DE (68 (39.5% patients)). In this category of patients, LAVI by 3DE was able to discriminate AF recurrence with a sensitivity of 90% and a specificity of 66%, for an optimal cut-off value of 30.4 ml/m2.

Conclusion

This study showed that LAVI assessed using 3DE had an additional predictive value for AF recurrence after CBA. Moreover, LAVI by 3DE was able to discriminate AF recurrence even in patients with non-dilated LA by M-Mode and 2DE. These findings suggest that 3DE might reflect better and earlier the asymmetric and variable nature of LA remodeling and could be a potential tool in clinical practice for an improved risk stratification and pre-ablation selection of AF patients.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Universitair Ziekenhuis Brussel: Wetenschappelijk Fonds Willy Gepts of the UZ Brussel
Reduced 3D-left atrium ejection fraction predicts development of atrial fibrillation in patients with hypertrophic cardiomyopathy
Authors: Amador A , Martins Da Costa C , Calvao J , Pinto R , Proenca T , Carvalho J M , Cabrita A , Marques C , Pinho A , Santos L , Oliveira C , Moreira H , Palma P , Sousa C , Macedo F
Published: October 2022

Introduction

Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), occurring in approximately 25% of patients, related to left atrial (LA) dilatation and remodeling. HCM patients who develop AF have increased risk of HCM-related death, functional impairment, and stroke. Accurate risk stratification for AF in this population is crucial as contemporary treatments are highly successful.

Purpose

To assess if new echocardiographic parameters can predict the development of AF in HCM patients.

Methods

HCM patients who underwent comprehensive echocardiographic examination during 2011 were followed and checked for “de novo” AF until November 2021. We searched for associations between AF development and novel echocardiographic parameters such as LA Volume index, Left Atrioventricular Coupling Index (LACI, as LAVI/a'), 3D LA volumes and 3D LA ejection fraction (3D-LAEF).

Results

A total of 43 patients were included, with 62.8% male and mean age 56,1±6,2 years old. 55.8% had the septal asymmetric HCM type and mean LV mass was 326±127g. Mean LA diameter and biplane 2D volume was 46±7 mm and 78±37 mL, respectively. 11.6% of patients already had AF. During a median follow-up of 9.4 years, the incidence of “de novo” AF was 31,6%. Within the total 17 patients with AF, 35,2% took warfarin and the remaining direct oral anti-coagulation. No stroke was documented. There were 3 deaths (mortality rate of 7,0%), none from cardiac causes.

No association was found between AF development and LAVI, LACI or 3D LA volumes. We only found a statistically significant difference regarding 3D-LAEF, which was lower in patients who developed AF compared with those without AF (26±12% VS 39±19%, p=0.04).

Binary logistic regression analysis found that reduced 3D-LAEF predicts the development of AF (p=0.019, odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0 to 1.1). The area under a receiver operating characteristic curve using 3D-LAEF as a predictive marker for AF development in HCM patients was 0.743 (p=0.004). When the cut-off value of 3D-LAEF was set at 34,5%, the sensitivity and specificity for AF diagnosis were 66% and 86%, respectively.

Conclusion

In our study, 3D LAEF predicted the development of AF in HCM patients – this may be a useful tool to identify patients at high risk of future AF who may benefit from more intensive rhythm monitoring and a lower threshold for oral anticoagulation.

Funding Acknowledgement

Type of funding sources: None.
Gender mismatch and outcomes following heart transplantation in the United States
Authors: Briasoulis A , Kourek C , Kampaktsis P , Doulamis I
Published: October 2022

Background

Available literature indicates the possible detrimental effect of gender mismatching on mortality in patients undergoing heart transplantion. Our objective was to examine the role of gender mismatching on mortality and graft rejection in patients undergoing heart transplantation in the US.

Methods

Data on adult patients January who underwent heart transplantation between January 2015 and October 2021, was queried from the United Network of Organ Sharing (UNOS) registry. The main outcomes were all-cause mortality, 1-year all-cause mortality and treated acute rejection.

Results

A total of 19,805 adult patients underwent heart transplant during the study period. Approximately, one out of ten patients in the M-F group had a PHM mismatch<25%, while only four out of ten patients had such a mismatch in the F-M group. In both M-M and F-F groups, seven out of ten patients had a PHM mismatch<25% (p=0.122). Proportion of PHM mismatch was similar throughout the study period. Unadjusted analysis showed that M-F was associated with increased risk for all-cause mortality (HR: 1.13; 95% CI: 1.02, 1.27; p=0.026) and 1-year mortality (HR: 1.26; 95% CI: 1.09, 1.45; p=0.002) compared to M-M. Graft failure incidence was higher in the M-F group compared to M-M (HR: 1.12; 95% CI: 1.01, 1.25; p=0.041).

Conclusions

Gender mismatching is associated with post-transplant mortality with transplantation of female donor grafts to male recipients demonstrating worse outcomes. Further research is required to elucidate pathways involved and possible changes in clinical practice.

Funding Acknowledgement

Type of funding sources: None.
The effect of cryothermic and radiofrequency Cox maze IV ablation on atrial size and function assessed by 3D echocardiography, a randomized trial. To freeze or to burn
Authors: Boano G , Farkas V , Astrom Aneq M
Published: October 2022

Background

The Cox maze procedures have been shown to be safe methods for restoring sinus rhythm (SR) in patient with atrial fibrillation and often performed concomitant to mitral valve (MV) surgery. Cryothermy (Cryo) and Radiofrequency (RF) are available techniques to achieve atrial linear scars. The differences between the effect of these energy sources on late left atrial (LA) reverse remodeling are not fully described.

Purpose

This study aims to compare the impact of Cryo and RF procedures on left atrial (LA) size and function one year after Cox-maze IV concomitant to MV surgery using 3-dimensional echocardiography (3DE).

Methods

Seventy-two patients with MV disease and atrial fibrillation were randomized to either Cryo (35) or RF (37) ablation. Another 33 patients were enrolled according to the protocol without concomitant ablation (NoMaze group). All patients had an echocardiogram before and one year after surgery.

Results

The 42 ablated patients who recovered sinus rhythm (SR) one year after surgery had comparable left and right systolic ventricular function and a mean reduction of LA size by 23% (LA volume index decreased from 66±24 to 54±13ml/m2, p=0.004). The 3DE extracted reservoir and booster function showed higher values after RF ablation compared to Cryo (37±10% vs 26±6%; p<0.001 resp. 18±9 vs 7±4%, p<0.001), while passive conduit function was comparable (24±11 vs 20±8%; p=0.17). Patients with restored SR without ablation had more preserved systolic atrial function but similar LA size reduction as those who underwent maze surgery.

Conclusions

SR restoration after MV surgery and maze results in LA size reduction irrespective of the energy source used. By 3DE we could show that, compared to RF maze, the extension of ablation area produced by Cryo implies a major LA structural remodeling affecting LA systolic function. The reverse size remodeling seems to be the least, the longer AF history.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ALF funding for clinical research-Sweden
A multidisciplinary program based on early follow-up in a day hospital after heart failure hospitalizations. Reduction of 30-day readmissions in a population analysis over a 6-year period
Authors: Vaqueriza Cubillo D , Beltran Herrera C , Dominguez Munoa M , Suberviola Sanchez-Caballero V , Gomez Mariscal E , Briongos Figuero S , Estevez Paniagua A , Sanchez Hernandez A , Cortina Camarero C , Sarrion Catala M , Jimenez Loeches S , Mora Yague L , Giganto Arroyo M L , Cano Moracho J M , Munoz Aguilera R
Published: October 2022

Introduction and objectives

Readmission rates at 30 days after heart failure (HF) hospitalizations are high. Disease management programs have shown to reduce them; however, the results of clinical trials are difficult to extrapolate to the entire population with HF. Our hospital has a multidisciplinary program for HF management (MHFP) led by the Cardiology Department, based on early post-discharge follow-up in a day hospital, for clinical-analytical assessment, optimization and titration of pharmacological treatment, structured education, promotion of self-care and intravenous treatment if appropriate. The objective of this study is to assess the impact of the MHFP on our patients all cause 30-day readmission rate (MHFP group), compared with the rest of our region (control group).

Methods

All discharges with HF as main diagnosis in our region were analysed through anonymized consultation of the Minimum Basic Data Set (an administrative public data base) in the period 2009–2015. The first admission of each patient in the period was identified as index admission. Patients who died in the index admission were excluded. Epidemiological characteristics, comorbidities and hospital stay were compared in the two groups. The outcome variable was the time to first readmission in the first 30 days after discharge. Quantitative variables were compared using Student's t and categorical variables with χ2. Cox method was used for multivariate analysis.

Results

We included 62,162 patients, 1,447 in the MHFP group and 60,715 in the control group. Epidemiological characteristics and main comorbidities were compared, and the results are shown in the table. Readmission rate was significantly lower in the MHFP group (13.5 vs 16%, HR 0.85, 95% CI 0.74–0.98 in multivariate analysis). The variables independently associated with an increase in readmissions at 30 days were age adjusted Charlson index, hospital length of stay in index admission and several comorbidities (obstructive pulmonary disease, myocardial infarction, and renal failure)

Conclusions

Over a period of 6 years, a MHFP significantly reduced 30-day readmissions after admission for HF, in its reference area. The generalization of these programs could have a relevant impact on costs reduction.

Funding Acknowledgement

Type of funding sources: None.