bluuebunny/crossref_metadata_2025 huggingface dataset:
Intersemiotic interpretation of demonstrative that in modern TV series
Authors: Zhou Nana
Published: November 2023

The study aims to illustrate that the intersemiotic interpretation of demonstrative that can eliminate the deictic indeterminacy of that in implying the proximity especially when what that identifies is not adequately interpreted in the linguistic expressions. To instantiate this viewpoint, the data are drawn from the modern TV series, annotated by the annotation tool ELAN 6.3, and analyzed by a qualitative method in terms of the complementarity of a visual deictic to demonstrative that, the explicit and implicit demonstrative that, as well as the transformation of that into this. It was found that the visual deictics, such as the arrow, the curve line, the cross, the gaze and other visual images, could eliminate the deictic ambiguity of demonstrative that when that was used to identify an element. The explicit and implicit that sheds light on the deictic divergency of the visual proximity from the linguistic one in multimodal discourse. A visual deictic may force the linguistic deictic that to transform into this by its reappearance. The results do not totally deny the traditional uses of demonstrative that, but expand its deictic function to present the multi-dimensional and dynamic world.
Promoting Alcohol Reduction in Non-Treatment Seeking parents (PAReNTS): a pilot feasibility cluster randomized controlled trial of brief alcohol interventions with parents in contact with child safeguarding services
Authors: McGovern Ruth , Smart Deborah , Alderson Hayley , Fouweather Tony , Kaner Eileen
Published: November 2023

Many parents who come into contact with early help and children’s social care services are risky drinkers. This study aimed to investigate the feasibility and acceptability of conducting a trial of brief alcohol interventions within this setting. We conducted a three-arm pilot feasibility cluster randomised controlled trial in the North-East of England. The additive interventions were: i) screening and a healthy lifestyle leaflet (control); ii) brief advice; iii) extended brief intervention. The trial was later reduced to two-arm due to the extended brief intervention being infeasible. Of the 1769 parents that were approached, 429 consented to be screened (24%), the majority were eligible to participate (n = 415; 97%), 147 of which (35%) scored ≥5 on the AUDIT-C screening tool. There were 108 parents (74%) who consented to participate in the trial (n = 50 control; n = 58 brief advice). Follow-up rates at 6 and 12-months were 61% and 43%. The TLFB30 was found to be a suitable tool to measure the primary outcome of heavy episodic drinking. Qualitative data showed that parents and practitioners largely found trial procedures to be acceptable, however, care should be taken when discussing alcohol risk with parents in this setting. Most of the a-priori success criteria were met in this pilot feasibility trial. The findings suggest that it may be feasible to conduct a two-arm randomised controlled trial of brief alcohol interventions to parents in contact with early help and social care. The TLFB30 was found to be a suitable tool to measure the primary outcome of heavy episodic drinking.
Limited Incision Facelifts: A Contemporary Review of Approaches and Complications
Authors: Amador Ricardo O , Hamaguchi Ryoko , Bartlett Richard A , Sinha Indranil
Published: November 2023

Limited incision facelifts (LIFs) have gained popularity as an alternative to traditional facelift procedures. While surgical techniques vary, these approaches share a common goal: to rejuvenate the face while minimizing scar visibility. Previous studies also suggest that the reduced tissue dissection in LIFs can lead to decreased postoperative swelling, shorter recovery periods, and fewer complications. In this systematic review we delved into the literature on LIFs, shedding light on the various surgical approaches and their respective safety profiles. A systematic review was conducted by independent evaluators who followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A random-effects model was utilized to summarize complications data, and meta-regressions were conducted to analyze associations with operative variables. The analysis encompassed a total of 20 articles, comprising data from 4451 patients. The vast majority (84%) of these patients underwent either local wide-awake surgery or conscious sedation, while the remaining 16% underwent general anesthesia. Our analysis revealed an overall complication frequency of 3.2%, with hematoma being the most common complication (2%), followed by temporary nerve injury (0.2%), and skin necrosis or wounds (0.06%). Notably, hematomas rarely required operating room interventions. Use of drains or tissue sealants was associated with an 86% decrease in complications. Limited incision facelifts can be performed with a low complication rate, utilizing a variety of techniques. Utilization of tissue sealants and drains may limit hematoma formation, which is the most common complication.
SMG: self-supervised masked graph learning for cancer gene identification
Authors: Cui Yan , Wang Zhikang , Wang Xiaoyu , Zhang Yiwen , Zhang Ying , Pan Tong , Zhang Zhe , Li Shanshan , Guo Yuming , Akutsu Tatsuya , Song Jiangning
Published: November 2023

Cancer genomics is dedicated to elucidating the genes and pathways that contribute to cancer progression and development. Identifying cancer genes (CGs) associated with the initiation and progression of cancer is critical for characterization of molecular-level mechanism in cancer research. In recent years, the growing availability of high-throughput molecular data and advancements in deep learning technologies has enabled the modelling of complex interactions and topological information within genomic data. Nevertheless, because of the limited labelled data, pinpointing CGs from a multitude of potential mutations remains an exceptionally challenging task. To address this, we propose a novel deep learning framework, termed self-supervised masked graph learning (SMG), which comprises SMG reconstruction (pretext task) and task-specific fine-tuning (downstream task). In the pretext task, the nodes of multi-omic featured protein–protein interaction (PPI) networks are randomly substituted with a defined mask token. The PPI networks are then reconstructed using the graph neural network (GNN)-based autoencoder, which explores the node correlations in a self-prediction manner. In the downstream tasks, the pre-trained GNN encoder embeds the input networks into feature graphs, whereas a task-specific layer proceeds with the final prediction. To assess the performance of the proposed SMG method, benchmarking experiments are performed on three node-level tasks (identification of CGs, essential genes and healthy driver genes) and one graph-level task (identification of disease subnetwork) across eight PPI networks. Benchmarking experiments and performance comparison with existing state-of-the-art methods demonstrate the superiority of SMG on multi-omic feature engineering.
Phylogeny, ecology, and evolution of mycophagous Drosophilidae (Diptera)
Authors: Kimura Masahito T , Tuno Nobuko
Published: November 2023

A number of species and taxa of Drosophilidae (Diptera) are used as model clades in various fields of biology, but our knowledge on their ecology and co-evolution (e.g. how their populations are regulated and how they interact with host organisms, enemies, and competitors) is still limited. According to studies on their host use, their primary larval resources are fruits, flowers, plant leaves and stems, tree sap, and fungal fruiting bodies, and most species are specialized to one of these resources. Among these species, those exploiting fungal fruiting bodies (i.e. mycophagous species) have been relatively well studied for their ecology, because their resources are commonly found in the field, hence their interactions with enemies and competitors can be assessed rather easily. So far, a review article has been published on their ecology in 1990. Since then, remarkable advances have been achieved on their taxonomy, phylogeny, diversity, and interactions with parasites, parasitoids, and competitors. This article reviews literature mainly published since 1990 to provide a basis for the future study of their ecology and evolution.
Bistable perception, precision and neuromodulation
Authors: Novicky Filip , Parr Thomas , Friston Karl , Mirza Muammer Berk , Sajid Noor
Published: November 2023

Bistable perception follows from observing a static, ambiguous, (visual) stimulus with two possible interpretations. Here, we present an active (Bayesian) inference account of bistable perception and posit that perceptual transitions between different interpretations (i.e. inferences) of the same stimulus ensue from specific eye movements that shift the focus to a different visual feature. Formally, these inferences are a consequence of precision control that determines how confident beliefs are and change the frequency with which one can perceive—and alternate between—two distinct percepts. We hypothesized that there are multiple, but distinct, ways in which precision modulation can interact to give rise to a similar frequency of bistable perception. We validated this using numerical simulations of the Necker cube paradigm and demonstrate the multiple routes that underwrite the frequency of perceptual alternation. Our results provide an (enactive) computational account of the intricate precision balance underwriting bistable perception. Importantly, these precision parameters can be considered the computational homologs of particular neurotransmitters—i.e. acetylcholine, noradrenaline, dopamine—that have been previously implicated in controlling bistable perception, providing a computational link between the neurochemistry and perception.
Divergent electroencephalogram resting-state functional network alterations in subgroups of autism spectrum disorder: a symptom-based clustering analysis
Authors: Zhu Gang , Li Yuhang , Wan Lin , Sun Chunhua , Liu Xinting , Zhang Jing , Liang Yan , Liu Guoyin , Yan Huimin , Li Rihui , Yang Guang
Published: November 2023

Autism spectrum disorder (ASD) is characterized by etiological and phenotypic heterogeneity. Despite efforts to categorize ASD into subtypes, research on specific functional connectivity changes within ASD subgroups based on clinical presentations is limited. This study proposed a symptom-based clustering approach to identify subgroups of ASD based on multiple clinical rating scales and investigate their distinct Electroencephalogram (EEG) functional connectivity patterns. Eyes-opened resting-state EEG data were collected from 72 children with ASD and 63 typically developing (TD) children. A data-driven clustering approach based on Social Responsiveness Scales-Second Edition and Vinland-3 scores was used to identify subgroups. EEG functional connectivity and topological characteristics in four frequency bands were assessed. Two subgroups were identified: mild ASD (mASD, n = 37) and severe ASD (sASD, n = 35). Compared to TD, mASD showed increased functional connectivity in the beta band, while sASD exhibited decreased connectivity in the alpha band. Significant between-group differences in global and regional topological abnormalities were found in both alpha and beta bands. The proposed symptom-based clustering approach revealed the divergent functional connectivity patterns in the ASD subgroups that was not observed in typical ASD studies. Our study thus provides a new perspective to address the heterogeneity in ASD research.
Feedback-related brain activity in individual decision: evidence from a gambling EEG study
Authors: Jiang Lin , Wang Guangying , Zhang Silai , Ye Jiayu , He Runyang , Chen Baodan , Si Yajing , Yao Dezhong , Yu Jing , Wan Feng , Xu Peng , Yu Liang , Li Fali
Published: November 2023

In this study, based on scalp electroencephalogram (EEG), we conducted cortical source localization and functional network analyses to investigate the underlying mechanism explaining the decision processes when individuals anticipate maximizing gambling benefits, particularly in situations where the decision outcomes are inconsistent with the profit goals. The findings shed light on the feedback monitoring process, wherein incongruity between outcomes and gambling goals triggers a more pronounced medial frontal negativity and activates the frontal lobe. Moreover, long-range theta connectivity is implicated in processing surprise and uncertainty caused by inconsistent feedback conditions, while middle-range delta coupling reflects a more intricate evaluation of feedback outcomes, which subsequently modifies individual decision-making for optimizing future rewards. Collectively, these findings deepen our comprehension of decision-making under circumstances where the profit goals are compromised by decision outcomes and provide electrophysiological evidence supporting adaptive adjustments in individual decision strategies to achieve maximum benefit.
Emulating a Target Trial of Shorter Compared to Longer Course of Antibiotic Therapy for Gram-Negative Bacteremia
Authors: Tingsgård Sandra , Bastrup Israelsen Simone , Østergaard Christian , Benfield Thomas
Published: November 2023

Background

Despite the availability of antimicrobial therapies, gram-negative bacteremia remains a significant cause of morbidity and mortality on a global level. Recent randomized controlled trials support shorter antibiotic treatment duration for individuals with uncomplicated gram-negative bacteremia. The target trial framework using the cloning approach utilizes real-world data but eliminates the issue of immortal time bias seen in observational studies by emulating the analysis of randomized trials with full adherence.

Method

A hypothetical target trial allocating individuals with gram-negative bacteremia to either short antibiotic treatment duration (5–7 days) or longer antibiotic treatment duration (8–14 days) was specified and emulated using the cloning, censoring, and weighting approach. The primary outcome was 90-day all-cause mortality. Secondary outcome was a composite endpoint of clinical and microbiological relapse. The emulated trial included individuals from four hospitals in Copenhagen from 2018 through 2021.

Results

In sum, 1040 individuals were included. The median age of the cohort was 76 years, the majority were male (54%), had community-acquired gram-negative bacteremia (86%), urinary tract infection as the source of the infection (78%), and Escherichia coli as the pathogen of the infection (73%). The adjusted 90-day risk difference in all-cause mortality was 1.3% (95% confidence interval [CI]: −.7, 3.3), and the risk ratio was 1.12 (95% CI: .89, 1.37). The adjusted 90-day risk difference in relapse was 0.7% (95% CI: −2.3, 3.8), and the risk ratio was 1.07 (95% CI: .71, 1.45).

Conclusions

We found comparative outcomes for shorter treatment duration compared to longer treatment duration in patients with gram-negative bacteremia.
Kidney and urine cell transcriptomics in IgA nephropathy and lupus nephritis: a narrative review
Authors: Schena Francesco P , Chiurlia Samantha , Abbrescia Daniela I , Cox Sharon N
Published: November 2023

This narrative review sheds light on the use of transcriptomics in the analysis of kidney biopsies and urinary cell samples from patients with immunoglobulin A nephropathy or lupus nephritis. The conventional methods of examining kidney biopsy through light microscopy, immunofluorescence and electron microscopy provide valuable clinical information for diagnosis and prognosis but have some limitations that transcriptomics can address. Some recent studies have reported that kidney transcriptomics has uncovered new molecular biomarkers implicated in the inflammatory process induced by the deposition of circulating immune complexes in the investigated kidney diseases. In addition, transcriptomics applied to urinary cells mirrors the inflammatory process that occurs in the kidney. This means that we can study urinary cell transcriptomics in clinical practice to diagnose the stage of the inflammatory process. Furthermore, the transcriptomics of urinary cells can be used to make therapy decisions during patient follow-up to avoid the stress of a second kidney biopsy. The studies analyzed in this review have a significant limitation. Biomarkers have been identified in small cohorts of patients but none of them has been validated in independent external cohorts. Further prospective studies in large cohorts of patients are necessary for accurate and complete validation. Only after that can these biomarkers be widely used in clinical practice.
An incidental finding of a right atrial myxoma with undiagnosed Ebstein anomaly: a case report
Authors: McClenaghan Lisa , Sandhu Manraj , Caputo Massimo , Brennan Paul F
Published: November 2023

Background

Ebstein anomaly (EA) is a rare congenital abnormality of the tricuspid valve which can lead to progressive right heart dilatation and arrhythmias. While often seen in conjunction with other congenital cardiac lesions, such as atrial septal defects, it is not normally associated with atrial myxomas.

Case summary

We present a case report of an incidental finding of a right atrial myxoma in the context of undiagnosed EA, in a 16-year-old male who presented with appendicitis. Subtle cardiomegaly on routine chest X-ray prompted further investigation, which demonstrated characteristic findings of both conditions and culminated in surgical repair using the Cone procedure. At 4-month follow-up, the patient was asymptomatic, and transthoracic echocardiography demonstrated a mean gradient of 4.5 mmHg across the tricuspid valve with mild regurgitation.

Discussion

The combination of EA with right-sided myxoma is exceedingly rare, and, in this case, it may be that the apical displacement of the tricuspid valve was protective against right atrioventricular obstruction. We are reminded that although subtle abnormalities on routine investigations can be of limited significance, they can also indicate more serious underlying pathology and so consideration should be given to an appropriate cascade of further investigations to yield a timely diagnosis and enable prompt treatment.
In-hospital triggers of takotsubo syndrome: a case report on witnessing sudden death in a hospital roommate
Authors: Aweimer Assem , El-Battrawy Ibrahim , Beck Patrick , Mügge Andreas
Published: November 2023

Background

Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, mimicking an acute myocardial infarction, in the absence of obstructed coronary arteries. It is often triggered by physical or emotional stress, with catecholamines playing a central role in its pathophysiology. Recent advances have been made in categorizing TTS patients based on trigger events and comorbidities, as well as proposed classifications differentiating primary and secondary TTS. In-hospital triggers for (secondary) TTS appear to be quite common, and our aim is to bring attention of this prevalent phenomenon.

Case summary

We present the clinical course of an 80-year-old man who developed TTS after witnessing the sudden death of his roommate during his hospital stay. Initially hospitalized for bradycardia and complete atrioventricular block, the patient was discharged after a pacemaker implantation. However, he returned to the hospital 3 days later with chest pain and other symptoms indicative of TTS. Diagnostic tests confirmed apical ballooning consistent with TTS, and subsequent echocardiograms showed a substantial improvement in left ventricular function.

Discussion

The case is classified as in-hospital TTS, occurring unexpectedly during medical care, and suggests that secondary TTS could represent a certain ‘basic risk’ for hospitalized patients. We want to emphasize the importance of reducing pain and fear in the hospital setting and encourage further research to understand the association between TTS and medical procedures and therapies. Overall, this case underscores the need for strategies to reduce the frequency of TTS in hospitalized patients.
Incidence, predictors, and prognostic impact of rehospitalization after transcatheter aortic valve implantation
Authors: Bække Pernille Steen , Jørgensen Troels Højsgaard , Thuraiaiyah Jani , Gröning Mathis , De Backer Ole , Sondergaard Lars
Published: November 2023

Aims

Despite rehospitalization being common after transcatheter aortic valve implantation (TAVI), an in-depth analysis on this topic is missing. This study sought to report on the incidence, predictors, and prognostic impact of rehospitalization within 1 year following TAVI.

Methods and results

All consecutive patients treated with TAVI between 2016 and 2020 in East Denmark were included. Medical records of all patients were reviewed to validate rehospitalizations up to 1 year after discharge from the index admission. The study population consisted of 1397 patients, of whom 615 (44%) had an unplanned rehospitalization within the first year post-TAVI. The rehospitalization incidence rate was three-fold higher in the early period (within 30 days) compared with the late period (30 days to 1 year; 2.5 vs. 0.8 per patient-year, respectively; P < 0.001). Predictors of early unplanned rehospitalization were procedure-related complications and prior stroke, whereas late unplanned rehospitalization was associated with preexisting comorbidities. Predictors of heart failure (HF) rehospitalization included ischaemic heart disease, the extent of cardiac damage, atrial fibrillation, and New York Heart Association class at baseline. HF rehospitalization within 30 days and 1 year post-TAVI was associated with a markedly increased 1- and 5-year mortality risk [hazard ratio (HR) of 4.3 and 3.2 for 1-year mortality and HR of 3.2 and 2.9 for 5-year mortality, respectively; P< 0.001].

Conclusions

Rehospitalization after TAVI is frequent in real-world practice. Early rehospitalization is mostly procedure related, whereas late rehospitalization is related to preexisting comorbidities. HF rehospitalization is associated with poor long-term survival and could be validated as a prognostically relevant endpoint for TAVI trials.
Making the voice matter in English Studies Teaching
Authors: Holmes-Henderson Arlene , Wright Tom F
Published: November 2023

This introduction frames the guest edition of the journal on ‘Oracy and English Studies’. The pieces in this special forum explore how a renewed focus on speaking can re-imagine what it means to ‘do English’. We are two university-level teachers, one from Classics, one from English, eager to explore the potential of this idea. We have brought together a series of short provocations from leading UK-based practitioners both within and beyond the subject area: including a speech-writer, university teachers of Shakespeare and contemporary poetry, charity leaders, and political communication specialists. Their pieces reflect on classroom practices including reading aloud and vocalization, impersonation, the analysis of political speeches and argumentation, or getting students to interrogate their attitudes to their own voices. In each case, our contributors have been asked to respond to the concept from educational theory known as ‘oracy’ (simply put, ‘listening and speaking skills’). English studies clearly need to grapple with this suddenly ubiquitous concept. Not just for its political resonances, but because it is rich in implications for teachers of English at all levels, and deserves greater recognition and interrogation beyond the world of education.
An empirical approximation of the effects of trade sanctions with an application to Russia
Authors: Imbs Jean , Pauwels Laurent
Published: November 2023

We propose a data-based approximation of the effects of trade sanctions that can readily be computed on the basis of international input–output data. Approximated effects are very close to the exact responses obtained from a canonical multi-country multi-sector model, without having to make difficult calibration choices. We illustrate the approximation with trade sanctions against Russia and obtain estimates well within the existing range. Russia is much more affected by trade sanctions than the EU, even though the importance of EU markets for Russia has been falling, especially since 2014, with China picking up the slack. Within the EU the consequences are largest in ex-‘satellite’ countries of the Soviet Union: These countries do not typically have access to substitute markets and in fact have historically been highly dependent on Russia. This extreme and persistent dependence is at least partly explained by the existence of specific energy transport infrastructure (pipelines) that appears to constrain tightly the production of electricity. Our proposed approximation is practical and can be implemented in a variety of contexts: We have developed a web-based dashboard, accessible at https://exposure.trade/ that can be used to approximate the costs of trade sanctions for any combinations of sanctioning and sanctioned countries or sectors.
Shelter from the storm: do partnerships buffer the well-being costs of unemployment?
Authors: Prechsl Sebastian , Wolbring Tobias
Published: November 2023

This article contributes to the existing literature on the effects of unemployment on subjective well-being (SWB) by partnership status. We argue that material and latent deprivation can explain the effects of becoming and remaining unemployed on SWB by partnership status, as both partners and their employment status crucially shape the extent of deprivation. To test our hypothesis about partnership-specific unemployment effects on SWB and the mediating roles of latent deprivation (in terms of status loss) and material deprivation, we use 14 waves of German panel data. To identify time-varying unemployment effects, we rely on time-distributed fixed effects models. Our results suggest a strong negative and rather time-constant impact of unemployment on SWB, buffered over time for those with working or nonworking partners. Furthermore, our results indicate in particular material deprivation but also latent deprivation to be relevant mechanisms for explaining partnership-specific trajectories in the loss of SWB.
Is myocardial fibrosis appropriately assessed by 2D strain derived integrated backscatter?
Authors: Lima M R L , Abecasis J A , Reis Santos R R S , Maltes S M , Guerreiro S G , Campino Padrao C P P , Freitas P F , Ferreira A F , Ribeiras R R , Andrade M J A , Cardim N C , Madeira M M , Ramos S R , Mendes M M
Published: November 2023

Introduction

Calibrated integrated backscatter (cIB) may be obtained from bidimensional (2D) strain echocardiography as a quantification measurement of myocardial ultrasound reflectivity. Increased collagen content of the myocardium modifies tissue reflectivity and cIB is suggested as a marker of left ventricular (LV) fibrosis. However, its diagnostic accuracy is not fully established.

Aim

To assess the correlation between cIB by 2D strain and LV myocardial fibrosis (MF), as evaluated by non-invasive imaging and histopathology.

Methods

Correlation study from a cohort of 157 patients with severe symptomatic aortic stenosis (AS) referred for surgical aortic valve replacement (AVR). Patients with complete preoperative transthoracic echocardiography, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB) obtained from the anterior basal septum at the time of AVR were selected. Two groups of 30 patients were evaluated, with and without late gadolinium enhancement (LGE) at CMR. Integrated Backscatter was obtained at QRS peak in decibels (dB) from both parasternal long axis (PLAX) and apical-three-chamber (A3C) cine clips at Qanalysis. cIB was calculated by subtracting the pericardial intensity from the average of the anteroseptal and basal inferolateral wall values. Correlation analysis was performed for the whole group of patients with global and segmental (anterior basal septum) values of native T1 and extracellular volume (ECV), and EMB collagen volume fraction (CVF) from Masson´s Trichrome staining. IBS values were compared in both group of patients.

Results

60 patients (74 [36-74] years, 45% male) with high gradient (mean gradient: 63±20mmHg), normal flow (45±10mL/m2), preserved ejection fraction (60±9%) AS were included. Basal septal cIB was –9.17±9.45dB and –17.45 (–31.2–10.95) dB from A3C and PLAX views, respectively. These indexes did not correlate with basal septum thickness or global LV mass. Absolute and cIB did not correlate neither with global and regional T1 and ECV values, nor with CVF at EMB. These were not significantly different in both groups of patients and there was no correlation between cIB values and mass of replacement MF in patients with LGE.

Conclusion

In these cohort of patients with classical severe AS, there was no correlation of cIB with imaging markers of both replacement and diffuse MF. cIB also didn´t correlate with CVF at histopathology. These findings suggest that reflectivity indexes are not suitable for myocardial tissue characterization in this setting.
Calcification of aortic valve cusps as independent predictor for permanent pacemaker requirement after transcatheter aortic valve implantation
Authors: Jung S , Ammon F , Smolka S , Moshage M , Marwan M , Achenbach S
Published: November 2023

Background

High-degree atrioventricular (AV) block represents a frequent complication after transcatheter aortic valve implantation (TAVI). Extension of indication for TAVI towards subjects with lower surgical risk requires to reduce the likelihood for the need of permanent pacemaker (PPM) implantation.

Purpose

We examined the role of calcification of the aortic valve cusps and left ventricular outflow tract (LVOT) as potential predictors for PPM implantation after TAVI.

Methods

In a cohort of 1200 consecutive patients without PPM who underwent transfemoral TAVI, clinical and procedural characteristics as well as requirement for PPM implantation after TAVI were assessed systematically. In all patients, cardiac computed tomography (CT) was performed before TAVI including quantitative assessment of calcium volume of the aortic valve cusps and the LVOT in mm3 (see figure).

Results

Median patient age was 81 (IQR 7) years, 50% were male. 9.8% of patients had a pre-existing complete right bundle branch block (RBBB) in ECG. 68% of subjects received a balloon-expandable valve, 32% a self-expandable valve. Postinterventional PPM implantation was necessary in n=155 subjects (13%) due to high-degree AV block. In this group of subjects, calcification of the aortic valve cusps was more pronounced than in the group of subjects without high-degree AV block (see table). Univariate regression analysis revealed pre-existing complete RBBB (p<0.001, OR 8.564), implantation of a self-expandable prosthesis (p=0.013, OR 1.549) as well as calcification of the non-coronary (p=0.016, OR 1.001) and left-coronary cusp (p=0.025, OR 1.001) as significant predictors for PPM implantation. In multivariate regression analysis, these predictors – including calcification of the non-coronary cusp (p=0.037, OR 1.001) remained significant. With every mm3 of calcification, risk for high-degree AV block and PPM implantation increases by 0.1%. With a median calcification of 225 mm3 of the non-coronary cusp, this would make a 22.5% relative risk increase.

Conclusion

In a large cohort of 1200 patients, the volume of aortic cusp calcification, in particular calcification of the non-coronary cusp, was identified as independent predictor for PPM implantation following transcatheter aortic valve implantation. This might be explained by the anatomical proximity of both the AV node and left Tawara branch to the non-coronary cusp, resulting in a higher risk of compression during valve implantation. Our results may contribute to improved risk stratification regarding the need for PPM implantation after TAVI.Assessment of calcium volumeComparison of calcification
Non-invasive assessment of myocardial stiffness by the two-dimensional shear wave elastography ultrasound technique in patients with amyloidosis and Fabry disease
Authors: Cafezeiro C , Alencar Neto A C , Bueno B V K , Rissato J H , Pereira N M , Pereira F L , Ramires F J A , Mathias W , Rochitte C E , Hotta V T , Dabarian A L , Fernandes F
Published: November 2023

Background

Cardiac amyloidosis and Fabry disease are cardiomyopathies that evolve with structural alteration of the ventricular walls, diastolic dysfunction and heart failure. Diastolic dysfunction encompass myocardial stiffness and impaired relaxation. Cardiac elastography has been proposed as a diagnostic modality for the non-invasive assessment of myocardial stiffness.

Purpose

The aim of this study was to investigate if myocardial shear wave elastography could assess myocardial stiffness in Healthy volunteers, Fabry disease and variant transthyretin amyloidosis (ATTRv) patients with cardiac involvement and correlate with other complementary imaging and laboratory tests (electrocardiogram, 2D echocardiogram, troponin and BNP) and with the 6-minute walk test.

Methods

We prospectively included 60 adults: 20 patients with Fabry disease, 20 patients with ATTRv and 20 patients as control group. Echocardiography, electrocardiogram and laboratory evaluations were performed. Elastography assessment of myocardial stiffness was performed using an ultrasound equipment with a multifrequency convex transducer, under specific adjustment of the equipment for performing myocardial elastography.

Results

Myocardial Stiffness was significantly higher in Cardiac Amyloidosis patients than in healthy volunteers in anteroseptal basal segment (ASB) (PLAX 6.95 ± 1.4 kPa vs. 5.45 ± 1.1 kPa, respectively, p=0.02; PSAX 6.85 ± 1.4 kPa vs. 5.4 ± 1.2 kPa, respectively, p=0.02) and right ventricle (RV) (5.9 ± 2.6 kPa vs. 4.0 ± 0.7 kPa, respectively, p=0.003) and no difference in anteroseptal mid and septal apical. Statistically difference between Fabry Disease patients and Cardiac Amyloidosis group was found in right ventricle (5.9 ± 2.6 kPa vs. 4.4 ± 1.0 kPa, respectively, p=0.01).

Conclusion

Myocardial Stiffness was significantly higher in patients with Cardiac Amyloidosis compared with healthy volunteers in anteroseptal basal and right ventricle, but with no difference in anteroseptal mid and septal apical. Cardiac Amyloidosis myocardial stiffness was statistically higher in right ventricle compared with Fabry Disease group.
Left atrial function and the risk of new-onset atrial fibrillation in cardiac amyloidosis
Authors: Adam R D , Neculae G , Badelita S , Stassen J , Jercan A , Rosca M , Calin A , Beladan C , Enache R , Coriu D , Bax J , Baicus C , Ajmone Marsan N , Popescu B A , Jurcut R
Published: November 2023

Background

Cardiac amyloidosis (CA) is an infiltrative disease characterized by the accumulation of misfolded proteins into the extracellular matrix of the myocardium. Ventricular but also atrial myopathy are described in CA, with higher risk of atrial fibrillation (AF) and cardioembolic events even during sinus rhythm.

Purpose

We aimed to investigate which parameters of left atrial (LA) structure and function could predict new-onset AF (NOAF) in patients with CA, aiding in improved follow-up.

Methods

We prospectively included patients diagnosed with CA, both light chain (AL) and variant transthyretin (ATTRv) with no history of AF, from 2 tertiary European centers. Cardiac involvement was assessed according to current European recommendations. Comprehensive echocardiographic studies were performed at baseline with measurement of both classical structure and function parameters parameters derived from speckle tracking echocardiography measured with a vendor-dependent analysis software and the primary outcome was NOAF.

Results

Of the 179 patients diagnosed with CA, 86 were excluded due to history of AF, unacceptable image quality and non-AL or non-ATTRv diagnoses. Finally, 93 patients with CA were included (mean age 54.3±9.8, 58% males), and 44 patients developed NOAF during a median follow up of 11 (32.5) months. Patients with NOAF had heavier hearts (LVMi 155.5±39.6 vs. 136.6±44.3 g/m2, p= 0.03), worse global LV function (LVEF 46.7±10.9 vs. 53.8±11.2 %, p= 0.003), more LV longitudinal impairment (GLS -10.0±4.7 vs. -13.4±3.7 %, p= 0.0002), larger atria (LAVi 44.6±14.3 vs. 35.4±13.6 mL/m2, p= 0.002) and worse LA function (LA emptying fraction 28.5±15.5 vs. 44.9±14.6 %, p< 0.001; LA peak longitudinal strain (PALS) 13.6±11.3 vs. 20.5±10.4 %, p= 0.003). In the multivariate analysis adjusting for confounding factors, including LA diameter, LAVi and other LA function parameters, lower PALS was independently associated with higher risk for NOAF (HR: 0.874, 95% CI: 0.784-0.974, p= 0.014). Using the receiver operating characteristics curve analysis, we identified the optimal cut-off of PALS for predicting NOAF as 14.3% (Sn 71%, Sp 73%, AUC 0.75). Furthermore, PALS ≤14.3% was an independent predictor for NOAF (HR: 5.259, 95% CI: 2.653–10.423, P< 0.001). The Kaplan–Meier curves showed that patients with PALS ≤14.3% had a higher risk for NOAF than those with PALS >14.3% (P<0.001 by log-rank test, Figure 1).

Conclusions

PALS is an independent predictor for NOAF in patients with CA.Figure 1.Kaplan-Meier curves for NOAF
Echocardiographic nomograms for left ventricular parameters in 13,454 infants
Authors: Voegg R O B , Sillesen A S , Wohlfahrt J , Pihl C A , Norsk J B , Axelsson Raja A A , Vejlstrup N , Elia E , Sleeper L , Colan S , Iversen K K , Boyd H A , Bundgaard H
Published: November 2023

Background

Cardiac dimensions and function are key parameters in the management of children with cardiopulmonary abnormalities and are important predictors of clinical outcome. In particular, left ventricular (LV) dimensions and function are important predictors of clinical outcome and prognosis. In pediatric echocardiography, nomograms are essential in the separation of normal variation from pathological conditions and ascertaining normal growth. However, data from cohorts of newborns are limited, and current nomograms remain an insufficient approximation of the range of values that should be considered normal.

Purpose

We developed nomograms and Z scores for two-dimensional echocardiographic measurements of LV structure and function in a large group of healthy newborns.

Methods

Our study population included newborns from a large population study of newborns (n >25,000) who were born at term to healthy mothers, had a systematic transthoracic echocardiogram (TTE) performed within 30 days of birth, and with no signs of any major congenital heart diseases. We developed nomograms for 10 LV parameters by modelling these parameters as a function of body surface area (BSA) through joint modelling of the mean, standard deviation, skewness, and kurtosis. We then evaluated the impact of infant sex and age at time of echocardiography on the model fit.

Results

The 13,454 infants in the study population (48.5% females), had a median age of 12 days at TTE for both boys and girls (interquartile range IQR 8–15 and 8–12 days, respectively), and a median BSA of 0.23 m2 (IQR 0.22 m2 - 0.24 m2). All nomograms had acceptable goodness-of-fit within strata of sex. In contrast, model fit was worse for infants examined <7 days of age, compared with those examined from 7 to 30 days of age, necessitating the creation of separate nomograms for the two age groups. Examples of the plotted Z scores of one of the 10 LV parameters is shown in the figure.

Conclusions

We provide a large normative dataset and Z scores for echocardiographic measures of LV structure and function in neonates. Normative data is crucial in the management of patients with heart disease and these results provide a needed tool for evaluation of LV size and function in the newborn population.Plotted Z scores of the IVSd
Identification of abnormal ventricular asymmetry in 2nd trimester fetal ultrasound using artificial intelligence
Authors: Levy M , Stos B , Thorey V , Askinazi E , Gardella C
Published: November 2023

Introduction

Prenatal ultrasound screening for congenital heart disease (CHD) suffers from poor detection yield (10%-56%)[1, 2], with a strong impact on neonatal morbidity and mortality. The need for expertise in fetal cardiology and the high volume of screening cases limit the current detection rates. Computer-assisted prenatal screening could support clinicians in improving diagnostic yield, including for abnormal ventricular asymmetry, which is often hard to discriminate from physiological asymmetry. Here we aim at evaluating a deep neural network (DNN) for detection of abnormal ventricular asymmetry, which can be linked to multiple types of CHD, including coarctation of the aorta, pulmonary or aortic valve stenosis, ventricular hypoplasia or univentricular heart.

Purpose

To determine if a novel DNN can identify cases of abnormal ventricular asymmetry in 2nd trimester fetal ultrasound videos.

Methods

We used as an endpoint the presence of any abnormality causing a significantly abnormal asymmetry of the ventricles as seen in the fetal ultrasound.

Consecutive patients who had an echocardiography performed at one center were included retrospectively starting from 2022, January 1st. Inclusion criteria were single pregnancy between 18 and 25 weeks of gestation. To have a high number of positive patients, patients were included separately if they were expected to be positive (n=35) or negative (n=75) to the endpoint, based on their medical record. Each case was reviewed by one of two physicians expert in fetal echocardiography interpretation to confirm the presence or absence of the endpoint. For each patient, a single video showing an interpretable four chamber view was selected. Patients with no such video were excluded.

The DNN takes as input fetal ultrasound videos, and predicts the absence or presence of the endpoint for each video. If its confidence is low, the DNN predicts an "inconclusive" output instead. The DNN has a ResNet-50 architecture[3] adapted to videos and was trained on data from patients not included in the evaluation. The detection performance of the DNN and the proportion of conclusive outputs were assessed.

Results

Overall, 37 positive and 66 negative ultrasound videos were included. The DNN achieved an AUC of 75.5%, a sensitivity of 71.4% (54.9-83.7, 95%CI) and a specificity of 64.4% (51.7-75.4, 95%CI) in identifying cases of abnormal ventricular asymmetry, after excluding inconclusive diagnosis. The DNN predicted a conclusive diagnosis in 91.3% of cases.

Conclusion

A DNN could accurately identify cases of abnormal ventricular asymmetry in fetal heart ultrasound videos. Importantly, this evaluation was performed in a population of patients who had an echocardiogram, and which therefore contains more abnormal cases compared to patients undergoing standard screening. This work lays the ground for diagnostic support to enable a more efficient, accurate, and scalable analysis of fetal heart ultrasounds.
Clinical characteristics and outcomes of left ventricular thrombus patients with mildly reduced and preserved left ventricular ejection fraction
Authors: Goh F , Teo Y N , Teo Y H , Leow A S T , Chan M Y Y , Yeo L L L , Kong W K F , Poh K K , Ho J S Y , Yeo T C , Tan B Y Q , Sia C H
Published: November 2023

Background

Abnormal left ventricular ejection fraction (LVEF) is associated with the development of left ventricular thrombus (LVT) following acute myocardial infarction and also in non-ischaemic cardiomyopathies. LVT formation in normal LVEF is less common.

Purpose

We aimed to describe the clinical characteristics and outcomes of patients with LVT and LVEF>40%, and compare them against patients with LVT associated with LVEF≤40%.

Methods

We retrospectively studied 551 consecutive patients with LVT from our tertiary centre’s echocardiography database between March 2011 and January 2021. We compared baseline co-morbidities and echocardiographic parameters between patients with LVT and LVEF>40% versus LVEF≤40%. The Kaplan Meier method with log-rank test was used to compare rates of thrombus resolution, stroke and all-cause mortality between the 2 groups. Multivariable Cox regression models were constructed to correct for potential confounders.

Results

Mean age of the study population was 59.8 ± 12.9 years old and 86/551 (15.6%) were female. LVT in patients with LVEF>40% made up 100/551 cases (18.1%), of which 91.0% were associated with ischaemic heart disease. Patients with LVEF>40% were younger and had fewer cardiovascular co-morbidities than their counterparts with LVEF≤40%, including a lower prevalence of hypertension, hyperlipidaemia, diabetes mellitus, ischaemic heart disease and heart failure (Figure 1). Patients with LVEF>40% more often had a smaller thrombus (mean diameter 14.1 ± 5.9 mm) compared to those with LVEF≤40% (mean diameter 17.2 ± 8.2 mm). LVT with LVEF>40% was independently associated with thrombus resolution (HR 1.42, 95% CI 1.08–1.87, p=0.013) corrected for anticoagulant use, as well as lower mortality (HR 0.49, 95% CI 0.26–0.94, p=0.031) corrected for baseline co-morbidities (Figure 2). LVEF did not influence stroke rates.

Conclusions

In patients with LVEF>40%, LVT was less common. These patients had fewer cardiovascular co-morbidities, developed smaller thrombi, were more likely to have thrombus resolution and had a lower mortality rate. However, overall stroke risk was similar to patients with a reduced LVEF.Figure 1:Baseline characteristicsFigure 2:Outcomes
Left atrial strain as an independent predictor of sinus rhythm maintenance after catheter ablation for paroxysmal atrial fibrillation in HFpEF patients
Authors: Katbeh A , De Potter T , Geelen P , Vanderheyden M , Bartunek J , Van Camp G , Penicka M
Published: November 2023

Background

The early AF treatment by radio-frequency catheter ablation (CA) is very important for improving clinical outcome in patients with history of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Left atrial (LA) strain showed to be a useful index to monitor atrial function in AF and HFpEF states. However, the accuracy of LA strain to predict the long-term maintenance of sinus rhythm (SR) in HFpEF patients with paroxysmal AF undergoing CA is still under debate.

Aims

To define the best echocardiography derived parameters to predict the long-term maintenance of SR in paroxysmal AF patients with high probability of HFpEF undergoing CA.

Methods

We prospectively enrolled 200 consecutive patients (62 ± 10 years, 58% males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%). All patients had a H2FPEF score suggesting high probability of HFpEF. During sinus rhythm, all patients underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional speckle tracking in apical views.

Results

After 42+/-8 months follow-up, a total of 34 (17%) patients had a documented recurrence of AF. Patients with AF recurrence had lower LASr (22.2% vs. 28.3%, p < 0.001) and LASct (10.9% vs. 13.2%, p < 0.01) compared to patients who keep on SR. Among speckle tracking derived LA phasic strain indices, LASr showed the largest area under the curve (AUC = 0.8, p < 0.001) and the strongest independent predictive value (LASr > 22%) of long-term maintenance of SR with sensitivity of 80% and specificity of 66% (Figure 1). Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve. Using multivariable logistic regression, only LASr (OR 0.89, 95% CI 0.81-0.97, p=0.013) was independently associated with long-term SR maintenance while other LA size and function indices were not.

Conclusion

In HFpEF patients with paroxysmal AF undergoing CA, LASr is more accurate predictor of SR maintenance than other standard echocardiographic parameters in long-term follow-up.