bluuebunny/crossref_metadata_2025 huggingface dataset:
A smart injectable composite hydrogel with magnetic navigation and controlled glutathione release for promoting in situ chondrocyte array and self-healing in damaged cartilage tissue
Authors: Chiang Min-Yu , Cheng I-Yun , Chou Syun-Hong , Tsai Jen-Hao , Chen Yong-Ji , Lu Huai-En , Yang Shan-Wei , Chang Shwu-Jen , Chen San-Yuan
Published: October 2021

An injectable self-healing HA–pAA hydrogel with LbL-PPMMs encapsulated can induce chondrocytes to form a deep columnar array for repairing the cartilage.
Lipotoxicity: a driver of heart failure with preserved ejection fraction?
Authors: Leggat Jennifer , Bidault Guillaume , Vidal-Puig Antonio
Published: October 2021

Heart failure with preserved ejection fraction (HFpEF) is a growing public health concern, with rising incidence alongside high morbidity and mortality. However, the pathophysiology of HFpEF is not yet fully understood. The association between HFpEF and the metabolic syndrome (MetS) suggests that dysregulated lipid metabolism could drive diastolic dysfunction and subsequent HFpEF. Herein we summarise recent advances regarding the pathogenesis of HFpEF in the context of MetS, with a focus on impaired lipid handling, myocardial lipid accumulation and subsequent lipotoxicity.
Dihydromyricetin ameliorates vascular calcification in chronic kidney disease by targeting AKT signaling
Authors: Feng Liyun , Que Dongdong , Li Zehua , Zhong Xinglong , Yan Jing , Wei Jintao , Zhang Xiuli , Yang Pingzhen , Ou Caiwen , Chen Minsheng
Published: October 2021

Vascular calcification is highly prevalent in chronic kidney disease (CKD), and is characterized by transdifferentiation from contractile vascular smooth muscle cells (VSMCs) into an osteogenic phenotype. However, no effective and therapeutic option to prevent vascular calcification is yet available. Dihydromyricetin (DMY), a bioactive flavonoid isolated from Ampelopsis grossedentata, has been found to inhibit VSMCs proliferation and the injury-induced neointimal formation. However, whether DMY has an effect on osteogenic differentiation of VSMCs and vascular calcification is still unclear. In the present study, we sought to investigate the effect of DMY on vascular calcification in CKD and the underlying mechanism. DMY treatment significantly attenuated calcium/phosphate-induced calcification of rat and human VSMCs in a dose-dependent manner, as shown by Alizarin Red S staining and calcium content assay, associated with down-regulation of osteogenic markers including type I collagen (COL I), Runt-related transcription factor 2 (RUNX2), bone morphogenetic protein 2 (BMP2) and osteocalcin (OCN). These results were further confirmed in aortic rings ex vivo. Moreover, DMY ameliorated vascular calcification in rats with CKD. Additionally, we found that AKT signaling was activated during vascular calcification, whereas significantly inhibited by DMY administration. DMY treatment significantly reversed AKT activator-induced vascular calcification. Furthermore, inhibition of AKT signaling efficiently attenuated calcification, which was similar to that after treatment with DMY alone, and DMY had a better inhibitory effect on calcification as compared with AKT inhibitor. The present study demonstrated that DMY has a potent inhibitory role in vascular calcification partially by inhibiting AKT activation, suggesting that DMY may act as a promising therapeutic candidate for patients suffering from vascular calcification.
Outcomes Following Participation in a Support-Based Summer Camp for Children Who Stutter
Authors: Herring Caryn , Millager Ryan A. , Yaruss J. Scott
Published: October 2021

Purpose:

Self-help and support activities are often recommended for people who stutter, and there is growing interest in understanding whether and how such experiences might be beneficial for children who stutter. The purpose of this study was to explore the potential impact of participation in Camp SAY, an overnight support-based summer camp experience for children who stutter, by measuring changes in scores on the Overall Assessment of the Speaker's Experience of Stuttering (OASES).

Method:

Participants were 107 children who stutter (age range: 8–18 years) who attended Camp SAY during the summers of 2013, 2015, and/or 2016. We examined changes in OASES scores (a) pre- to postcamp, (b) the durability of changes 6 months after the conclusion of the camp, and group differences (c) between school-age campers and teenage campers and (d) between first-time campers and those who had previously attended the camp.

Results:

Comparison of precamp to postcamp scores revealed significant improvements related to reactions to stuttering, quality of life, and overall adverse impact of stuttering. Scores on each subsection of the OASES were maintained (and further improved) 6 months after camp. There were no significant differences between school-age campers and teenage campers. Both first-time and returning campers showed significant improvements related to reactions to stuttering, though first-time campers had a significantly larger improvement in attitudes toward communication related to stuttering than returning campers.

Conclusion:

These outcomes suggest that participation in support activities, like Camp SAY, is associated with significant reductions in the overall adverse impact of stuttering and can therefore be beneficial for children who stutter.
Discovery of two isomers of ethynyl cyclopentadiene in TMC-1: Abundances of CCH and CN derivatives of hydrocarbon cycles
Authors: Cernicharo J. , Agúndez M. , Kaiser R. I. , Cabezas C. , Tercero B. , Marcelino N. , Pardo J. R. , de Vicente P.
Published: October 2021

We report the detection of two isomers of ethynyl cyclopentadiene (c-C5H5CCH), namely 1- and 2-ethynyl-1,3-cyclopentadiene, in the direction of TMC-1. We derive column densities of (1.4 ± 0.2) × 1012 cm−2 and (2.0 ± 0.4) × 1012 cm−2, respectively, for these two cyclopentadiene derivatives, which imply that they are about ten times less abundant than cyclopentadiene. We also report the tentative detection of ethynyl benzene (C6H5CCH), for which we estimate a column density of (2.5 ± 0.4) × 1012 cm−2. We derived abundances for the corresponding cyano derivatives of cyclopentadiene and benzene and found values significantly lower than previously reported. The rotational temperature of the ethynyl and cyano derivatives of these cycles is about 9 K, that is, very close to the gas kinetic temperature of the cloud. The abundance ratio of the 1- and 2-isomers of ethynyl cyclopentadiene is 1.4 ± 0.5, while for the two isomers of cyano cyclopentadiene it is 2.4 ± 0.6. The relative abundances of CCH over CN derivatives is 7.7 ± 2.2 for cyclopentadiene, which probably reflects the abundance ratio of the radicals CCH and CN; this ratio is only 2.1 ± 0.5 for benzene, which suggests that additional reactions besides cyano radicals with benzene are involved in the formation of benzonitrile. The formation of these cycles is reasonably well accounted for through a chemical scheme based on neutral-neutral reactions. It is predicted that benzene should be as abundant as cyclopentadiene in TMC-1.
Biosimilars in der Kinderrheumatologie
Authors: Horneff Gerd
Published: October 2021

Mit der Einführung von Biosimilars für Etanercept und Adalimumab können diese zur primären Therapie der juvenilen idiopathischen Arthritis eingesetzt werden oder durch Umstellung/Switch vom Originator auf ein Biosimilar. Bislang liegen nur begrenzte Daten über diesen Einsatz vor. Die Datenbank des nationalen BIKER-Registers wurde genutzt, um Erfahrungen aus der klinischen Praxis mit Etanercept- und Adalimumab-Biosimilars sowohl im head-to-head-Vergleich (n = 118) mit dem Originator als auch nach Switch (n = 117) zu beschreiben. Die Patientencharakteristika und Krankheitsaktivitätsparameter waren bei Therapiestart weitgehend vergleichbar. Kein Unterschied fand sich auch in der Effektivität. Ein Rückgang des JADAS10 zeigt eine vergleichbare Verbesserung in beiden Gruppen an. Auch Unterschiede in der Verträglichkeit ergaben sich nicht. Nach Switchung kann keine Verschlechterung der Krankheitsaktivität erkannt werden. Über besondere Hemmnisse bei der Anwendung von Biosimilars in der Kinderheumatologie kann nur spekuliert werden. Die bisherigen Erfahrungen sowohl bei der Ersteinstellung als auch beim Switching zu Biosimilars zeigen ermutigende Ergebnisse.
Update – Systemische juvenile Arthritis
Authors: Hospach Toni , Horneff Gerd
Published: October 2021

Die systemische juvenile idiopathische Arthritis nimmt unter den Kategorien der JIA eine Sonderstellung ein, klinisch aufgrund der obligat extraartikulären, systemischen Beteiligung, aber auch aufgrund der der vital bedrohlichen Komplikationen, Makrophagenaktivierungssyndrom und Lungenbeteiligung. Untersuchungen legen ein biphasisches Krankheitsgeschehen mit konsekutiven Eigenschaften einer autoinflammatorischen mit denen einer Autoimmunerkrankung nahe. Diese Erkenntnisse führten zu Therapieoptionen wie der IL-1- und IL-6-Blockade mit Biologika und zu Therapiealgorithmen, die zwischen früher Erkrankung und später Erkrankung unterscheiden, letztlich mit dem Ziel, der Nutzung eines „windows of opportunity“ zur Erreichung des Therapieziels der Remission.
Analyzing the mechanisms of ion beam assisted chemical vapor deposition
Authors: Green Leigh Ann
Published: October 2021

Researchers study practical applications of plasma physics through ion beam manipulations.
Regenerative terahertz quantum detectors
Authors: Micheletti Paolo , Faist Jérôme , Olariu Tudor , Senica Urban , Beck Mattias , Scalari Giacomo
Published: October 2021

Because of the ultrafast and photon-driven nature of the transport in their active region, we demonstrate that quantum cascade lasers can be operated as resonantly amplified terahertz detectors with wide RF bandwidth. Tunable responsivities up to 50 V/W and noise equivalent powers down to 100 pW/Hz1/2 are demonstrated at 4.7 THz. Constant peak responsivities with respect to the detector temperature are observed up to 80 K. Thanks to the ≈ps intersub-band lifetime, electrical bandwidths larger than 20 GHz can be obtained, allowing the detection of optical beatnotes from quantum cascade THz frequency combs.
Selenium desorption in tropical soils by sulfate and phosphate, and selenium biofortification of Mombaça grass under increasing rates of phosphate fertilisation
Authors: dos Santos Maria Jéssica Vieira , de Lima Lessa Josimar Henrique , de Assis Mateus Belisário , Raymundo Jéssica Francisco , Ribeiro Bruno Teixeira , Guilherme Luiz Roberto Guimarães , Lopes Guilherme
Published: October 2021

Selenium (Se) is essential for animals and humans, and studies assessing the influence of sulfur (S) and phosphorus (P) on Se availability and biofortification in tropical soils are required. This study evaluated the adsorption of selenate (SeVI) and selenite (SeIV) in two oxidic soils with contrasting soil texture and assessed effects of phosphate and sulfate as competitive anions on Se desorption. The study also examined Se biofortification of Panicum maximum cv. Mombaça grown in Se-treated clayey soil under increasing rates of P fertilisation. In the laboratory, different Se concentrations were added to soils for adsorption studies (0, 1, 2, 4 mg L–1 for SeVI and 0, 4, 8, 16 mg L–1 for SeIV), with Se desorption performed by adding different concentrations of P (0, 2.18, 4.36, 10.90, 21.90 mg L–1) or S (0, 3.75, 7.5, 15, 30 mg L–1). Mombaça grass was grown in pots for 43 days in the clayey soil fertilised with SeVI and increasing P rates. Selenium adsorption varied depending on Se speciation, Se rate and soil texture, with SeIV showing greater adsorption than SeVI. In general, amounts of SeVI desorbed increased with increasing addition of P and (mainly) S. However, only P had a positive effect for releasing SeIV from soils. At all SeVI rates added in the clayey soil, Se contents in the shoot dry matter of Mombaça grass increased with increasing P fertilisation rate, agreeing with the desorption results. Further studies combining desorption with biofortification data are recommended for assessing the influence of P in sandy clay loam tropical soils.
Changes in gaseous concentration of alkylpyrazine analogs affect mouse avoidance behavior
Authors: Osada Kazumi , Miyazono Sadaharu , Ohata Motoko , Noguchi Tomohiro , Kashiwayanagi Makoto
Published: October 2021

We developed a rapid and accurate method for quantifying gaseous phase odorants using headspace solid-phase microextraction (HS-SPME) in conjunction with GC-MS and used our system to quantify alkylpyrazine analogs in the Y-maze. Rapid extraction of volatile compounds in the vapor phase achieved accurate quantitative analysis of gaseous alkylpyrazine analogs at several locations in the Y-maze. We also used a series of three SPME fibers to quantify changes in the concentration over time. We conducted a behavioral test of mice in response to these alkylpyrazines and identified a positive relationship between the rate of increase in gaseous concentration and the avoidance rate induced. Our results demonstrate that the Y-maze is a simple but reliable apparatus for behavioral studies of olfaction. The HS-SPME fast extraction method can quantify how gaseous concentrations of alkylpyrazines change over time, and the time-dependent increase of alkylpyrazine concentration is correlated with induction of aversive behavior in mice.
Proteomic determinants of uterine receptivity for pregnancy in early and mid-postpartum dairy cows
Authors: Aranciaga Nicolas , Morton James D , Maes Evelyne , Gathercole Jessica L , Berg Debra K
Published: October 2021

Dairy cow subfertility is a worldwide issue arising from multiple factors. It manifests in >30% early pregnancy losses in seasonal pasture-grazed herds, especially when cows are inseminated in the early post-partum period. Most losses occur before implantation, when embryo growth depends on factors present in maternal tract fluids. Here we examined the proteomic composition of early and mid-postpartum uterine luminal fluid (ULF) in crossbred lactating dairy cows to identify molecular determinants of fertility. We also explored changes in ULF from first to third estrus cycles postpartum in individual cows, linking those changes with divergent embryo development. For this, we flushed uteri of 87 cows at Day 7 of pregnancy at first and third estrus postpartum, recovering, and grading their embryos. Out of 1563 proteins detected, 472 had not been previously reported in this fluid, and 408 were predicted to be actively secreted by bioinformatic analysis. The abundance of 18 proteins with roles in immune regulation and metabolic function (e.g. cystatin B, pyruvate kinase M2) was associated with contrasting embryo quality. Matched-paired pathway analysis indicated that, from first to third estrus postpartum, upregulation of metabolic (e.g. creatine and carbohydrate) and immune (e.g. complement regulation, antiviral defense) processes were related to poorer quality embryos in the third estrus cycle postpartum. Conversely, upregulated signal transduction and protein trafficking appeared related to improved embryo quality in third estrus. These results advance the characterization of the molecular environment of bovine ULF and may aid understanding fertility issues in other mammals, including humans.
Hierarchical auditory perception for species discrimination and individual recognition in the music frog
Authors: Fan Yanzhu , Fang Ke , Sun Ruolei , Shen Di , Yang Jing , Tang Yezhong , Fang Guangzhan
Published: October 2021

The ability to discriminate species and recognize individuals is crucial for reproductive success and/or survival in most animals. However, the temporal order and neural localization of these decision-making processes has remained unclear. In this study, event-related potentials (ERPs) were measured in the telencephalon, diencephalon, and mesencephalon of the music frog Nidirana daunchina. These ERPs were elicited by calls from 1 group of heterospecifics (recorded from a sympatric anuran species) and 2 groups of conspecifics that differed in their fundamental frequencies. In terms of the polarity and position within the ERP waveform, auditory ERPs generally consist of 4 main components that link to selective attention (N1), stimulus evaluation (P2), identification (N2), and classification (P3). These occur around 100, 200, 250, and 300 ms after stimulus onset, respectively. Our results show that the N1 amplitudes differed significantly between the heterospecific and conspecific calls, but not between the 2 groups of conspecific calls that differed in fundamental frequency. On the other hand, the N2 amplitudes were significantly different between the 2 groups of conspecific calls, suggesting that the music frogs discriminated the species first, followed by individual identification, since N1 and N2 relate to selective attention and stimuli identification, respectively. Moreover, the P2 amplitudes evoked in females were significantly greater than those in males, indicating the existence of sexual dimorphism in auditory discrimination. In addition, both the N1 amplitudes in the left diencephalon and the P2 amplitudes in the left telencephalon were greater than in other brain areas, suggesting left hemispheric dominance in auditory perception. Taken together, our results support the hypothesis that species discrimination and identification of individual characteristics are accomplished sequentially, and that auditory perception exhibits differences between sexes and in spatial dominance.
Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: a case series
Authors: Ciccarelli Gian Paolo , Bruzzese Eugenia , Asile Gaetano , Vassallo Edoardo , Pierri Luca , De Lucia Vittoria , Guarino Alfredo , Lo Vecchio Andrea
Published: October 2021

Background

Multisystem inflammatory syndrome in children (MIS-C) is a rare life-threatening clinical condition that can develop in patients younger than 21 years of age with a history of infection/exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The cardiovascular system is a main target of the inflammatory process that frequently causes myocardial dysfunction, myopericarditis, coronary artery dilation, hypotension, and shock. Multisystem inflammatory syndrome in children-associated myocarditis is usually characterized by fever, tachycardia, non-specific electrocardiogram abnormalities, and left ventricular dysfunction, but serious tachyarrhythmias may also occur. We report two cases of patients with MIS-C-associated myocarditis who developed severe bradycardia.

Case summary

Two female adolescents with recent history of coronavirus disease 2019 (COVID-19) were initially hospitalized for long-lasting high-grade fever and severe gastrointestinal symptoms. Both patients were diagnosed with MIS-C-associated myocarditis for elevation of markers of myocardial injury (mean highly-sensitive cardiac troponin 2663 pg/mL, mean N-terminal-pro-brain natriuretic peptide 5097 pg/mL) and left ventricular dysfunction, which was subsequently confirmed by cardiac magnetic resonance. Both patients developed a severe sinus bradycardia (lowest heart rate 36 and 42, respectively), which appeared refractory to the treatment with intravenous Methylprednisolone and Immunoglobulins, despite a clinical and biochemical improvement. The use of Anakinra (a recombinant interleukin-1 receptor antagonist), was associated with a rapid improvement of cardiac rhythm and excellent clinical outcome at 6 months of follow-up.

Discussion

In patients with MIS-C-associated myocarditis, a continuous cardiac monitoring is mandatory to promptly identify potential conduction abnormalities. Adolescents may present bradycardia as a rhythm complication. We experienced a rapid recovery after treatment with Anakinra, to be considered as add-on therapy in cases refractory to standard anti-inflammatory treatment.
Successful endovascular treatment of simultaneous acute ischaemic stroke and hyperacute ST-elevation myocardial infarction: the first case report of a single-operator cardio-cerebral intervention
Authors: Nardai Sándor , Vorobcsuk András , Nagy Ferenc , Vajda Zsolt
Published: October 2021

Background

The simultaneous management of cardio-cerebral infarctions is an extremely difficult task, as both organs need to receive reperfusion therapy in a limited time to avoid death or permanent disability. The following case is the first published endovascular treatment of synchronous heart and brain infarctions delivered by a single operator with excellent clinical outcome.

Case summary

A 67-year-old female patient was directly transported to the emergency room of a comprehensive stroke centre with acute onset global aphasia and right hemiplegia. The onset to admission time exceeded the 4.5-h time window of systemic thrombolysis. Head computed tomography (CT) excluded extensive early extensive brain damage, CT angiography documented left middle cerebral artery occlusion and mechanical thrombectomy was indicated. Extensive anterior ST elevation was detected on the transport monitor while waiting for in-hospital transfer. The two simultaneously evolving pathologies were handled in a single endovascular procedure that took less than 60 min by a dual-trained interventional cardiologist/neurointerventional surgeon. The patient recovered without any major cardiac or neurologic sequela.

Discussion

Interventional cardiologists, professionally trained through a neurointerventional fellowship programme to perform endovascular stroke interventions according to the latest multi-society position paper, could not only complement stroke teams lacking manpower, but their unique experience could also help the patients suffering from the most devastating forms of cardio-cerebral infarctions.
Machine learning aids clinical decision-making in patients presenting with angina and non-obstructive coronary artery disease
Authors: Ahmad Ali , Shelly-Cohen Michal , Corban Michel T , Murphree Jr Dennis H , Toya Takumi , Sara Jaskanwal D , Ozcan Ilke , Lerman Lilach O , Friedman Paul A , Attia Zachi I , Lerman Amir
Published: October 2021

Aims

The current gold standard comprehensive assessment of coronary microvascular dysfunction (CMD) is through a limited-access invasive catheterization lab procedure. We aimed to develop a point-of-care tool to assist clinical guidance in patients presenting with chest pain and/or an abnormal cardiac functional stress test and with non-obstructive coronary artery disease (NOCAD).

Methods and results

This study included 1893 NOCAD patients (<50% angiographic stenosis) who underwent CMD evaluation as well as an electrocardiogram (ECG) up to 1-year prior. Endothelial-independent CMD was defined by coronary flow reserve (CFR) ≤2.5 in response to intracoronary adenosine. Endothelial-dependent CMD was defined by a maximal percent increase in coronary blood flow (%ΔCBF) ≤50% in response to intracoronary acetylcholine infusion. We trained algorithms to distinguish between the following outcomes: CFR ≤2.5, %ΔCBF ≤50, and the combination of both. Two classes of algorithms were trained, one depending on ECG waveforms as input, and another using tabular clinical data. Mean age was 51 ± 12 years and 66% were females (n = 1257). Area under the curve values ranged from 0.49 to 0.67 for all the outcomes. The best performance in our analysis was for the outcome CFR ≤2.5 with clinical variables. Area under the curve and accuracy were 0.67% and 60%. When decreasing the threshold of positivity, sensitivity and negative predictive value increased to 92% and 90%, respectively, while specificity and positive predictive value decreased to 25% and 29%, respectively.

Conclusion

An artificial intelligence-enabled algorithm may be able to assist clinical guidance by ruling out CMD in patients presenting with chest pain and/or an abnormal functional stress test. This algorithm needs to be prospectively validated in different cohorts.
Inflammatory bowel disease and cardiovascular diseases: a concise review
Authors: Wu Hao , Hu Tingzi , Hao Hong , Hill Michael A , Xu Canxia , Liu Zhenguo
Published: October 2021

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality despite aggressive treatment of traditional risk factors. Chronic inflammation plays an important role in the initiation and progression of CVDs. Inflammatory bowel disease (IBD) is a systemic state of inflammation exhibiting increased levels of pro-inflammatory cytokines including tumour necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6. Importantly, IBD is associated with increased risk for CVDs especially in women and young adults, including coronary artery disease, stroke, thromboembolic diseases, and arrhythmias. Potential mechanisms underlying the increased risk for CVDs in IBD patients include increased levels of inflammatory cytokines and oxidative stress, altered platelet function, hypercoagulability, decreased numbers of circulating endothelial progenitor cells, endothelial dysfunction, and possible interruption of gut microbiota. Although IBD does not appear to exacerbate the traditional risk factors for CVDs, including hypertension, hyperlipidaemia, diabetes mellitus, and obesity, aggressive risk stratifications are important for primary and secondary prevention of CVDs for IBD patients. Compared to 5-aminosalicylates and corticosteroids, anti-TNF-α therapy in IBD patients was consistently associated with decreasing cardiovascular events. In the absence of contraindications, low-dose aspirin and statins appear to be beneficial for IBD patients. Low-molecular-weight heparin is also recommended for patients who are hospitalized with acute IBD flares without major bleeding risk. A multidisciplinary team approach should be considered for the management of IBD patients.
Pocket-size ultrasound devices may improve the prompt assessment of Covid-19 patients
Authors: Filipiak D , Kasprzak J D , Lipiec P
Published: October 2021

Introduction

Clinical usefulness of pocket-size ultrasound device [PSUD] was previously confirmed in numerous clinical scenarios. During the previous year Covid-19 patients have become a focal point of the cardiology and internal medicine wards. However, there is no data on the use of PSUD in this scenario.

Purpose

To asses if PSUD may be useful in providing additional information in Covid-19 patients.

Methods

In 63 patients (41 men, mean age 63±11) with confirmed Covid-19 the scope of physical examination was expanded with bedside assessment performed with PSUD equipped with dual probe. PSUD examination included: right ventricle measurement, automated LVEF assessment, 4-point compression ultrasound test of lower limbs and lung ultrasound (presence of B-lines, lung consolidations or thickening of pleura). Subsequently, within the next 24 hours all patients underwent chest CT scan, CT pulmonary angiogram and full echocardiographic examination performed on a high-end stationary device.

Results

Lung lesions typical for Covid-19 were confirmed in CT in 53 (84%) patients. The sensitivity and specificity of bedside PSUD examination for diagnosing lung involvement was 92% and 90%, respectively, when presence of any pathology on lung ultrasound was considered as a positive criterion. Increased number of B-lines had a sensitivity of 81%, specificity 83% for the ground glass symptom in CT detection, (AUC 0,82; p<0,0001). Pleural thickening was diagnosed by PSUD with a 95% sensitivity and 88% specificity (AUC 0,91, p<0,0001), whereas lung consolidations with a 71% sensitivity and 86% specificity (AUC 0,79, p<0,0001). In 20 patients (32%) pulmonary embolism was confirmed by angioCT – in 10 among them embolism was limited to subsegmental arteries. RV was found to be dilated in PSUD examination in 27 patients (43%), CUS was positive in 1 patient. Thus, RV enlargement treated as a marker of PE had low sensitivity and specificity (60% i 65% respectively), AUC=0,62, p=0,06. Mean LVEF in standard echocardiography was 46±12%, but during PSUD examination automated LV function analysis software failed to calculate LVEF in 29 (46%) cases due to suboptimal image quality.

Conclusion

In Covid-19 patients PSUD is particularly useful for lung ultrasound and the detection of lung pathologies. RV enlargement observed during PSUD examination has relatively low sensitivity and specificity for the detection of pulmonary embolism in Covid-19. Furthermore, due to low quality of images automated LV function assessment failed to provide any result in almost half of patients.

Funding Acknowledgement

Type of funding sources: None.
Left atrial appendage velocity as an instrument of predicting atrial fibrillation recurrence after successful catheter ablation – a useful tool?
Authors: Grade Santos J , Budzak K , Simoes J , Martinho M , Ferreira B , Briosa A , Pereira A R , Cruz I , Almeida A R , Fazendas P , Joao I , Almeida S , Pereira H
Published: October 2021

Introduction

Catheter ablation for the treatment of Atrial Fibrillation (AF) is a modality of treatment in growing expansion. However the sustained long term response in preventing AF recurrence is poor for most patients, namely in those with a dilated left atrium.

Purpose

Our aim was to assess the utility of an echocardiographic parameter for left atrium function, the left atrial appendage velocity (LAAV), in predicting recurrences after catheter ablation.

Methods

We performed a 9 year retrospective analysis of all patients who underwent a successful catheter ablation for the treatment of atrial fibrillation and had a valid pre-procedural transesophagic echocardiogram in a single expert centre. Medical records were analysed for demographic, procedural data and outcomes.

Results

Seventy-three (73) patients fulfilled all inclusion criteria and were analysed. The mean age was 62±11 with a male preponderance (58,7%). The majority of patients (82,7%) had preserved left ventricle ejection fraction. Only 46% of patient had a volumetric assessment of the left atrium dimensions prior to ablation, with slight, moderate and severe dilation of the left atrium in 20%; 8,6% and 28,6% of patients. Of the patients subjected to an AF ablation the average LAAV was 50,6±19 cm/s, with 78% of patients with normal atrial appendage velocities.

Patients with low LAAV (<40cm/s) had a higher proportion of AF recurrences at 3 and 6 months (58,3 vs 12,8% and 89% vs 21,7%; p<0,05 for all) with a linear correlation between the presence of recurrences and LAAV (LAAV of 39,1 vs 57,5 cm/s; p<0,05 OR 0,91 (CI 95% = 0,85–0,97); r2=0,34 at 3 months and LAAV of 43,5 vs 59 cm/s; p=0,01; OR 0,94 (CI 95% = 0,89–0,99); r2=0,24 at 6 months respectively). There was a trend towards association with recurrences at 1 year although it did not reach statistical significance. There was no significant difference in the use of antiarritmic drugs, either prior or post ablation, in both groups. It was not possible to assess the additive predictive value to the left atrium dimensions due to the low percentage of volumetric assessment of left atrium prior to AF ablation.

Conclusions

Patients with low left atrial appendage velocities had a lower long term success rate of catheter ablation, with higher rates of recurrence at 3 and 6 months and a trend towards higher recurrences at 1 year, with linear correlation which hypothesises the use of the left atrial appendage velocity as novel predictive parameter for an integrative model.

Funding Acknowledgement

Type of funding sources: None.
Left atrial appendage function by strain predicts subclinical atrial fibrillation in patients with cryptogenic stroke/TIA
Authors: Saberniak J , Skrebelyte-Strom L , Orstad E.B , Solberg M.G , Hilde J.M , Ronning O.M , Kjekshus H , Steine K
Published: October 2021

Background

Left atrial (LA) function by strain has shown to be promising to predict clinical atrial fibrillation (AF) in patients with cryptogenic stroke/TIA. However, there is little knowledge, if this novel method may prospectively predict subclinical AF (SCAF) and moreover, if left atrial appendage (LAA) function by strain and mechanical dispersion may be more sensitive to improve prediction of SCAF.

Purpose

The aim of the present study was to investigate if LA and LAA function by strain could improve the prediction of SCAF in patients at risk.

Methods

In this prospective study (mean follow-up 859±226 days), 185 patients with cryptogenic stroke/TIA, mean age 68±13 years, 33% female and no history of clinical AF or SCAF, were included. All participants underwent 2D and 3D transesophageal and transthoracic echocardiography in sinus rhythm after index cryptogenic stroke/TIA (mean 5±3days). LAA and LA functions by phasic strain, including reservoir strain (Sr), conduit strain (Scd) and contraction strain (Sct) and mechanical dispersion of Sr were assessed. SCAF episodes were detected by cardiac monitoring during follow up (mean 257±273 days).

Results

LAA function by strain was decreased in those with SCAF (60/32% of all patients) compared to those without: Sr: 19.2±4.5% vs. 25.6±6.5% (p<0.001), Scd: −11.0±3.1% vs. −14.4±4.5% (p<0.001), Sct: −7.9±4.0% vs. −11.2±4% (p<0.001), respectively, while mechanical dispersion by Sr strain was increased, 34±24ms vs. 26±20ms (p=0.02). However, LA function by strain and mechanical dispersion did not differ in patients with SCAF compared to patients without. By ROC analyses, LAA strain and mechanical dispersion were highly significant in prediction of SCAF. LAA reservoir strain showed the best AUC of 0.80 (95% CI 0.73–0.87) with a cut-off value of 22.2%, sensitivity of 80%, and specificity of 73%, p<0.001. (Figure)

Conclusions

For the first time, we showed, that left atrial appendage function by strain and mechanical dispersion predicts SCAF, as opposed to left atrial function. Left atrial appendage function by strain may be useful in risk prediction in patients at considerable AF risk.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Akershus University Hospital, Oslo/Lørenskog, Norway
A comprehensive model to estimate underlying atrial fibrillation in cryptogenic stroke: the decrypting score
Authors: Cecconi A , Vera A , Ximenez-Carrillo A , Ramos C , Martinez-Vives P , Lopez Melgar C , Roquero Gimenez P , Martinez-Avial Silva M , Sanz-Garcia A , Ortega G , Aguirre C , Vivancos J , Alfonso F , Jimenez-Borreguero L.J
Published: October 2021

Introduction

Cryptogenic stroke (CS) represents up to 30% of ischemic strokes. Since atrial fibrillation (AF) can be detected in up to one-third of CS, there is a clinical need for estimating the probability of underlying AF in CS to guide the optimal secondary prevention strategy.

Surrogate markers of left atrial dysfunction such as left atrial size, left atrial strain (LAS) and NTproBNP has been described as predictors of AF in patients with CS. However the evidence about AF markers in comprehensive and prospective studies in CS is still limited.

Purpose

The present study was designed to develop the first score to predict underlying AF in CS patients that includes markers of atrial dysfunction. To reach our aim we developed a comprehensive analysis including clinical, laboratory, electrocardiografic and advanced echocardiographic variables in patients with CS.

Methods

Sixty-three consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Clinical, laboratory, electrocardiografic and echocardiographic variables were collected. All patients underwent 15 days wearable Holter monitoring. Main objective was the Decryptoring score creation to predict AF in CS. Score variables were initially selected by a univariate logistic regression and, thereafter, the score points were derived according to a multivariant analysis.

Results

AF was detected in 15 patients (24%). Patients in the AF group were older (81.4±6.9 vs 76.5±7.8 years; p=0.035. There was no difference in sex between groups. Regarding cardiovascular risk factors patients who developed AF had more often hypertension (87% vs 52%; p=0.018) without differences in diabetes, dyslipidemia and tobacco consumption. T troponin and NTproBNP were higher in the AF group (47±55.9 vs 16.8±12.4 ng/L; p=0.018 and 1379±1650 vs 317±496 ng/ml; p=0.001 respectively). There were no differences in ECG parameters such as p wave voltage, interatrial block, PR interval or QRS.

LAS reservoir, LAS conduct and LAS contraction were lower in patients with AF (18.6±4.6 vs 32.1±10.9%; 8±4.3 vs 15.6±8%; 10.5±3.4 vs 16.6±7 respectively, all p<0.001).

Age >75 (9 points), hypertension (1 point), Troponin T >40 ng/L (8.5 points), NTproBNP >200 pg/ml (0.5 points), LAS reservoir <25.3% (24.5 points) and LAS conduct <10.4% (0.5 points) were included in the score. The rate of AF detection was 0% among patients with a score of <10 and 80% among patients with a score >35.

Conclusion

The proposed score offers an accurate AF prediction in patients with CS providing a new clinical tool to orient the optimal treatment in these patients.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Spanish Society of Cardiology
Myocardial work still reflect function while strain simply measure deformation when afterload increases
Authors: Sletten O J , Aalen J M , Remme E W , Khan F H , Wajdan A , Villegas M , Hisdal J , Smiseth O A , Skulstad H
Published: October 2021

Introduction

Global longitudinal strain is recommended by the European Society of Cardiology to detect subclinical left ventricular (LV) dysfunction, but is markedly load-dependent. Myocardial work was recently introduced as a clinical tool to study LV function by pressure-strain analysis. Since myocardial work incorporates afterload, it is assumed to be less afterload-dependent than strain, but the relationship with afterload is incompletely understood.

Hypothesis

Myocardial work is a better tool than strain, to measure myocardial function during elevated afterload.

Methods

In eleven anesthetized dogs, LV volume and longitudinal strain were measured by sonomicrometry, and pressure by micromanometry. Myocardial work was calculated by pressure-strain analysis. Additionally, stroke work was calculated as the area of the pressure-volume loop. Afterload was instantly increased by aortic constriction using a pneumatic cuff around the ascending aorta. Measurements were performed at baseline, during moderate- and marked afterload elevations.

Results

Table 1 summarizes the results. LV pressure (LVP) successively increased with moderate and marked afterload elevation, while longitudinal strain was successively reduced. Myocardial work and stroke work, on the other hand, increased with moderate afterload elevation, but was then reduced at marked afterload increase (Figure 1 and Table 1). Stroke volume and ejection fraction corresponded to strain and were reduced with afterload elevation.

Conclusions

Longitudinal strain and myocardial work have qualitatively different responses to increased afterload. While moderate changes in afterload cause reductions in strain that can be falsely interpreted as reductions in contractility, myocardial work increases as it incorporates the increased workload at moderately elevated afterload.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association
Implication of Current ASE/EACVI Left Ventricular Diastolic Function Classification in Predicting 2-Year MACE in Asymptomatic Patients with Diabetes and Hypertension
Authors: Foo D , Lam K H , Igo M , Sulaiman M N A , Ku M Y , King T L , Yeo L S , Chunggat J , Ahip S S , Sahiran M F , Mustapha M , Michael J , Abdullah A , Fong A Y Y
Published: October 2021

Background

Left ventricular diastolic dysfunction (LVDD) has been shown to be more prevalent in patients with diabetes, and once progress to overt heart failure, carry worse clinical outcomes. Substantial number of patients were classified as indeterminate DF based on the current ASE/EACVI guidelines. The implication of current DF classification in predicting MACE among diabetic patients is not well established.

Purpose

To assess prognostic impact of current guidelines-based DF classification, and determine predictors of 2-year MACE based on individual LVDD parameters.

Methods

A total of 111 patients with diabetes and hypertension who attended diabetic clinic follow-up at the primary healthcare settings were enrolled. All patients had no prior cardiovascular events, had preserved left ventricular (LV) ejection fraction on echocardiography and sinus rhythm on ECG at screening. Echocardiography was performed to obtain parameters of LV dimensions, LV volumes and LVDD. The 2016 ASE/EACVI guidelines were applied to classify DF. All patients were followed up until 2 years to assess MACE.

Results

There were 65 (58.6%) female patients. Mean age was 59.86 (7.45); mean duration of DM was 10.5 (5.41). 80 (72.1%) patients were classified as having normal DF (nDF); 24 (21.6%) patients were classified as indeterminate DF (iDF); 7 patients (6.3%) were classified as LVDD. Patients with LVDD had significantly higher LV mass index (LVMI) (mean 121.72±23.28g/m2 vs 116.62±24.66g/m2 in iDF vs 102.50±22.89g/m2 in nDF); higher left atrial volume index (LAVI) (mean 41.24±10.28ml/m2 vs 30.55±10.07ml/m2 in iDF vs 25.75±6.30ml/m2 in nDF); lower lateral e' velocity (mean 6.35±2.05cm/s vs 7.37±1.73cm/s in iDF vs 8.59±2.13cm/s in nDF); higher septal E/e' ratio (mean 14.89±3.29 vs 12.16±3.99 in iDF vs 9.99±2.35 in nDF); higher average septal-lateral E/e' ratio (mean 14.22±3.77 vs 11.34±3.74 in iDF vs 9.04±2.10 in nDF).

Among these 111 patients, 10 patients (9%) reported MACE at 2 years. The risk of 2-year MACE is elevated in both iDF [odds ratio (OR) 3.80, 95% CI 0.87–16.54, p=0.075] and LVDD [OR 7.60, 95% CI 1.11–52.02, p=0.039]. LVMI (OR 1.027, 95% CI 1.004– 1.051, p=0.023), LAVI (OR 1.092, 95% CI 1.017–1.172), and average septal-lateral E/e' ratio (OR 1.276, 95% CI 1.047–1.557, p=0.016) significantly correlated with 2-year MACE.

Conclusions

LVDD is correlated with increased MACE at 2 years. LVMI, LAVI and average septal-lateral E/e' ratio were predictors of increased risk of MACE at 2 years. Further investigation with larger sample size is warranted.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health Malaysia
Left bundle branch block causes left atrial dyssynchrony: a result of atrio-ventricular mechanical interaction
Authors: Hammersboen L E R , Stugaard M , Remme E W , Donal E , Duchenne J , Voigt J U , Galli E , Sletten O J , Aalen J , Smiseth O A
Published: October 2021

Introduction

Left bundle brach block (LBBB) leads to left ventricular (LV) mechanical dyssynchrony with septal flash and delayed lateral wall contractions. Since atrium and ventricle are anatomically connected, dyssynchronous LV contractions may be transmitted to the left atrium, thereby disturbing left (LA) function.

Purpose

To test the hypothesis that patients with LBBB have LA dyssynchrony induced by tethering to the dyssynchronous left ventricle.

Methods

Myocardial strain was measured by speckle-tracking echocardiography in 20 non-ischaemic heart failure patients with LBBB, before and 6 months after cardiac resynchronization therapy (CRT), and in 20 healthy controls. For the LA, dyssynchrony was measured as time delay between onset of the interatrial septum and the lateral wall, and for the LV, between onset septal flash and onset lateral wall contraction. White arrows in Figure indicate onset LA stretch.

Results

As shown in the Figure, patients with LBBB and HF had marked LA reservoir phase dyssynchrony. Before CRT time delay from onset LA septal stretch to onset lateral wall stretch was 125±71 ms (mean±SD), and decreased to 23±70 (p<0.0001) with CRT. In controls there was a small delay of 34±56 ms. The LA dyssynchrony correlated with LV dyssynchrony (r=0.50, p=0.033), supporting the hypothesis that LA dyssynchrony in LBBB represents mechanical interaction due to tethering between the respective walls.

Conclusions

Patients with LBBB had marked LA reservoir phase dyssynchrony, which was abolished with CRT. The LA dyssynchrony was attributed to direct LV-LA mechanical interaction. The observed LA resynchronization by CRT represent an additional benefit of CRT in patients with heart failure.

Funding Acknowledgement

Type of funding sources: None. Left atrial and ventricular dyssynchrony
Left atrial deformation parameters among beta-thalassemia major patients
Authors: Patsourakos D , Aggeli C , Gatzoulis K , Delicou S , Dimitroglou Y , Androulakis A , Tsioufis K
Published: October 2021

Introduction

Atrial cardiomyopathy is present in a significant proportion of beta thalassemia major (β-TM) patients, complicating their clinical condition. The diagnosis of atrial cardiomyopathy is challenging using conventional echocardiographic techniques.

Purpose

In our study we aimed to identify the presence of atrial cardiomyopathy by applying novel echocardiographic techniques in these patients.

Methods

56 β-TM patients (mean age 39.3±9 years, 50% male sex) and 30, age and sex matched, healthy controls were examined by transthoracic echocardiography. Conventional echocardiographic parameters were estimated alongside with deformation indices (left atrial strain at reservoir (LASr), conduit (LAScd) and contraction (LASct) phase respectively as well as left ventricular global longitudinal strain (GLS)). T2* was calculated by cardiac magnetic resonance imaging in β-TM patients.

Results

LAVI, E/e' ratio, GLS and left atrial deformation parameters differed between patients and controls. In patient group, left atrial deformation indices were correlated with LAVI, E/e' ratio, GLS and T2* (Table 1). GLS was also correlated with LAVI, but not with T2* or E/e' ratio. T2* was correlated only with left atrial deformation indices. Patient with prior episodes of atrial fibrillation were older, had increased E/e' and LAVI and impaired left atrial deformation indices but did not differ in terms of GLS or T2* (Figure 1). Patients with iron overload differed only in terms of left atrial deformation parameters.

Conclusions

Atrial deformation indices could be of clinical use in the early detection of atrial cardiomyopathy. Impaired left atrial strain may be associated with silent atrial fibrillation and be indicative of myocardial iron overload.

Funding Acknowledgement

Type of funding sources: None. Correlation tableScatter plot of T2* and LASr