bluuebunny/crossref_metadata_2025_split huggingface dataset:
150 PDC on workplace air exposure assessment using freeware apps Part I: Basic characterisation and measurement processing
Authors: van Balen Peter , Scheffers Theo , Emonds Robert 
Published: June 2024

Abstract
The purpose of these two consecutive IOHA exposure assessment PDC’s is to train assessors in broad accepted strategies and in the assumptions, use and differences of supporting apps and tools.
Part I works with the EN 689 (2018), BOHS-NVvA (2011/22) and AIHA (ed. 4; 2015) strategies and the high-quality apps supportive for a reproducible basic characterisation of exposure profiles, including exposure range finding, need for direct controls or Similar Exposure Group (SEG) formation and sampling.
Tools and instruments like AIHA IHEST and EN689 Annex A support a professional basic characterisation. To distinguish between safe, unsafe and profiles to be monitored, exposure modelling apps exist like AIHA IHMOD and several hybrid models collected in the TREXMO hub (i.e. ECETOC TRA, Stoffenmanager, ART). When sampling is performed the Excel application IH-Aligner helps to convert lab results to TWA (=time-weighted average) exposure levels in accordance with the reference period of the Occupational Exposure Limit Values (OELV). Measurement uncertainty-based confidence intervals are constructed for the individual outcome and to perform individual and small sample screening comparison with the OELV. IH-Aligner automatically prepares worksheets with the TWA exposure values for direct export to several recognized compliance testing apps which will be trained in Part II of the PDC.
Participants need to bring their own laptop with Windows OS, the software installed and the links to the online apps. Participants will receive in advance IH-Aligner, links to download the other apps, instructions and example data sets. If time permits, exposure profiles datasets of participants will be discussed.
229 Exposure and risk assessment for elongate mineral particles
Authors: Korchevskiy Andrey , Darnton Lucy , Case Bruce , Rasmuson James 
Published: June 2024

Abstract
Asbestos and other fibrous minerals remain significant occupational and environmental concerns worldwide. Despite being effectively banned from commercial utilization in the Western world, asbestos is still produced and utilized in many countries. Exposure to so called “legacy” asbestos, still present in buildings and other objects and products, also causes concerns.
This Professional Development Course (PDC) will present a framework for exposure assessment and risk characterization based on the most advanced methods and recently published models. We will show the applications of quantitative risk assessment for different situations that occupational and environmental health professionals worldwide may encounter. Examples will include potential exposure to erionite fibers during forestry activities; exposure to legacy asbestos in buildings with partially disturbed asbestos-containing materials; exposure of populations near current or former mines or other point sources such as former asbestos cement plants and shipyards; exposure during recreational activities at sites containing naturally occurring asbestos (NOA), and others. Participants will review the most recent scientific approaches to the pathogenesis and pathology of asbestos-associated diseases, important for hazard identification and a proper understanding of the health effects of asbestos.
The most innovative approaches to asbestos exposure assessment will be characterized, including real time monitoring instruments, artificial intelligence tools, and exposure reconstruction from the lung burden levels.
The PDC will be presented by the leading scientists in the area of asbestos risk assessment, known for their numerous peer-reviewed publications. As an added value, participants will be provided with copies of some of the most recent papers authored by the presenters, and the asbestos “risk calculator” for practical utilization.
Measures of wave intensity as a non-invasive surrogate for cardiac function predicts mortality in haemodialysis patients
Authors: Mayer Christopher C , Sarafidis Pantelis A , Matschkal Julia , Theodorakopoulou Marieta , Lorenz Georg , Karagiannidis Artemios , Angermann Susanne , Iatridi Fotini , Braunisch Matthias C , Karpetas Antonios , Baumann Marcus , Pella Eva , Heemann Uwe , Wassertheurer Siegfried , Schmaderer Christoph 
Published: June 2024

ABSTRACT

Background
Risk prediction in haemodialysis (HD) patients is challenging due to the impact of the dialysis regime on the patient's volume status and the complex interplay with cardiac function, comorbidities and hypertension. Cardiac function as a key predictor of cardiovascular (CV) mortality in HD patients is challenging to assess in daily routine. Thus the aim of this study was to investigate the association of a novel, non-invasive relative index of systolic function with mortality and to assess its interplay with volume removal.

Methods
A total of 558 (373 male/185 female) HD patients with a median age of 66 years were included in this analysis. They underwent 24-hour ambulatory blood pressure monitoring, including wave intensity analysis [i.e. S:D ratio (SDR)]. All-cause and CV mortality served as endpoints and multivariate proportional hazards models were used for risk prediction. Intradialytic changes were analysed in tertiles according to ultrafiltration volume. During a follow-up of 37.8 months, 193 patients died (92 due to CV reasons).

Results
The SDR was significantly associated with all-cause {univariate hazard ratio [HR] 1.36 [95% confidence interval (CI) 1.20–1.54], P &lt; .001} and CV [univariate HR 1.41 (95% CI 1.20–1.67), P &lt; .001] mortality. The associations remained significant in multivariate analysis accounting for possible confounders. Changes in the SDR from pre-/early- to post-dialytic averages were significantly different for the three ultrafiltration volume groups.

Conclusion
This study provides well-powered evidence for the independent association of a novel index of systolic function with mortality. Furthermore, it revealed a significant association between intradialytic changes of the measure and intradialytic volume removal.
High sensitivity of aortic valve calcium score in predicting high gradients in patients with severe aortic stenosis
Authors: Stergianos E , Benetos G , Ktenopoulos N , Drakopoulou M , Synetos A , Tsalamandris S , Aznaouridis K , Tsioufis C , Toutouzas K 
Published: June 2024

Abstract

Introduction
During the last decade, the use of aortic valve calcium (AVC) score as measured by multidetector computed tomography (MDCT) has gained ground as a reliable, supplemental method of detecting patients with severe aortic stenosis (AS). While its validity has been tested using indirect echocardiographic measures of AS, the relationship between AVC score and peak to peak gradient during left heart catheterization is less well studied.

Purpose
We aimed to evaluate the relationship between AVC score and peak to peak gradient, the sensitivity and specificity of the method using strictly hemodynamic criteria for the severity of AS and to determine the factors associated with poor testing efficacy in diagnosing AS with AVC scoring.

Methods
We retrospectively reviewed the medical records of 126 patients with tricuspid, degenerative, native valve severe AS planned for transcatheter aortic valve implantation (TAVI) in our hospital. All patients included had MDCT and Doppler echocardiography performed prior the operation while peak to peak gradient was measured during TAVI.

Results
Mean AVC was higher in men than women (p=0.02) and in patients with increased interventricular septum thickness at end diastole (p=0.01). AVC score was positively correlated with measured peak to peak gradient (r=+0.43, p=0.001). In our study, measured sensitivity was 89,5% and specificity 27%. Patients were classified into two groups based on whether AVC scoring predicted accurately the severity of AS. Group A (N=106) consisted of patients with concordant severity of AS by AVC and peak to peak gradient while Group B (N=20) had patients with disconcordant severity of AS. We found that there was a statistically significant difference between the two groups regarding the presence of left ventricular hypertrophy (p=0.01).

Conclusion
AVC score is strongly correlated with hemodynamic peak to peak gradient in patients with severe AS undergoing TAVI, showing high sensitivity but moderate specificity.
Epicardial adipose tissue predicts adverse outcomes in asymptomatic aortic stenosis
Authors: Geers J , Manral N , Grodecki K , Newby D E , Slomka P J , Dweck M R , Dey D 
Published: June 2024

Abstract

Background
Epicardial adipose tissue (EAT) represents a metabolically active visceral fat depot within the pericardium, associated with cardiovascular risk factors, but little is known about its role in patients with aortic stenosis (AS).

Purpose
This study sought to investigate the association of EAT volume with disease severity, disease progression, and outcome of asymptomatic patients with AS.

Methods
In a post-hoc analysis of 124 patients with asymptomatic mild to severe AS participating in the prospective SALTIRE2 trial, baseline EAT volume was quantified on computed tomography angiography (CTA) using fully automated deep learning-enabled software (Figure 1A & 1B). AS disease severity was calculated at baseline and 1-year. The primary endpoint was defined as all-cause mortality during follow-up.

Results
Median EAT volume was 100 [74-139]mL, and was higher in men compared to women (109 [78-148]mL vs 79 [62-106]mL; p=0.004). There was a significant correlation between EAT volume and baseline troponin level (r=0.23, p=0.009), left ventricular (LV) mass (r=0.46, p&lt;0.001), and LV ejection fraction (LVEF, r=-0.28, p=0.002). EAT volume did not correlate with AS severity as assessed by echocardiography (aortic valve peak velocity (Vmax): r=0.02, p=0.83) or CT calcium score (r=0.04, p=0.66). Equally, no correlation was observed between baseline EAT volume and subsequent disease progression (1-year change in Vmax: r=0.02, p=0.86). During the median follow-up of 48 [26-73] months, a total of 23 (18%) patients reached the primary endpoint. Both EAT volume (hazard ratio (HR) 1.57, 95% confidence interval (CI) 1.05-2.35; p=0.029) and troponin level (HR 1.43, 95%CI 1.13-1.82; p=0.003) were significant predictors of all-cause mortality in multivariable cox regression. Patients with EAT volume &gt;90mL had worse survival compared to patients with EAT volume ≤90mL (p = 0.026, Figure 1C).

Conclusions
In a prospective trial of patients with asymptomatic AS, EAT volume showed marked prognostic importance and predicted all-cause mortality during follow-up. Higher EAT volume was associated with increased troponin value, increased LV mass, and reduced LVEF, and could therefore be a marker of impaired myocardial health, but further studies are warranted to elucidate the exact underlying mechanisms.
Evaluating cardiac dynamic CZT-SPECT for the measurement of the coronary flow reserve and the determination of the normal values in patients with suspected cardiac micro vascular disease
Authors: Goldstein M , Declerck P , Denizli Y , Venet C , Rezai Monfared M , Elst J , Soens J , Foading Deffo B , Malanca M 
Published: June 2024

Abstract
Reduced coronary flow reserve (CFR) is a strong indicator of major adverse cardiovascular events. It is observed in INOCA and MINOCA. Measuring the CFR is now more recommended in clinical practice, particularly in patients with multiple cardiovascular risk factors.
Different modalities for CFR measurement exist, each with their pros and cons. PET is the most validated modality for measuring CFR, followed by cardiac MR. Both modalities are expensive and not widely available. Cardiac dynamic CZT-SPECT (CD-SPECT) will become more available and less expensive in the future.
The current challenges are how to perform reproducible measurements of the CFR and determining the limit values for normal and decreased CFR. There is a heterogeneity of methods to acquire, to process and to calculate the CFR and not so many studies are done. A well founded and standardized study protocol is needed. An in-house study has been designed including, at the time of writing, 82 patients with multiple cardiac risk factors, all genders and ages. Among those patients 27 had no significant coronary stenosis. The goal is to determine the correct way of performing the CFR measurement and to determine the normal values of CFR.
The CFR cut-off value for CD-SPECT seems to be around 1.5 lower than PET where normal is &gt; 2.0. All patients underwent a one day CD-SPECT rest study followed by a stress study for CFR measurement. Done with Technetium 99m Tc-tetrofosmin through a pump injection (LT Opticvantage®, 30ml/sec, 15 sec). The stress phase was induced with Regadenoson (400mcg) protocol using MyoSpect® GE-Healthcare and calculated with the AlgotMCS6=530C Ottawa Heart Inst. program.
26 patients had no significant coronary stenosis on coronary CT-scan by a Siemens Somaton® force 2x192 following the Cury RC Card Comp Tomography 2016 protocol). A patient had a normal invasive coronarography. In the subgroup with normal coronary arteries, all had a normal myocardial perfusion scintigraphy. 41% had a CFR &gt; 1.5 and 59% a CFR &gt; 1.5. In the group of diabetic patients 19% had a CFR &gt; 1.5. Among those with lowered CFR, 54% were female, age did not demonstrate a significant impact. The preliminary results from this pilot study encourage us to extend our observation to a broader sample.
Myocardial ischemia: beyond the normal perfusion images
Authors: Gobbo M , Meretta A H , Carvelli M V , Rosa D , Corneli M , Perez Balino N A , Masoli O H 
Published: June 2024

Abstract

Background
Historically, a positive exercise stress test (EST) with a normal myocardial perfusion imaging (MPI) in patients without obstructive coronary artery disease (CAD) was considered a false positive of the EST and associated with a good prognosis.
However, it is crucial to acknowledge that myocardial ischemia may present itself due to coronary microvascular dysfunction (MVD) even in the absence of obstructive CAD.
The assessment of MVD can be conducted both invasively and non-invasively, with the latter involving the determination of myocardial flow reserve (MFR). Various stimuli can be employed to assess MFR, each potentially characterizing distinct pathophysiological mechanisms.
The cold pressor test (CPT) is recognized as an endothelium-dependent stimulus, while dipyridamole (DIP) and exercise are considered non-endothelium-dependent stimuli. The utilization of CZT gamma cameras facilitates the comprehensive evaluation of these diverse tests.

Objectives
The aim of this study was to non-invasively evaluate MFR during exercise (EXE), vasodilation with DIP, and CPT in patients with positive EST, normal MPI, and without CAD.

Methods
We studied 10 patients with a history of positive EST in previous studies, without CAD. MPI and dynamic imaging with CZT-SPECT using Tc 99m-MIBI were performed on three consecutive days at rest, during EXE, after DIP administration, and during CPT.
On the first day, rest was followed by EST using a modified Astrand protocol. It was considered positive when changes in the ST segment were equal to or greater than 0.1 mV measured at 80 msec from the J point, descending or horizontal morphology during exertion or immediate recovery.
On the second day, 0.56 mg/kg of DIP was administered intravenously over 4 minutes, and on the third day, CPT was performed was performed immersing their left hand in the ice water bath (4°C) for 2 minutes.
Normal MPI was defined as homogeneous tracer uptake with a summed scale equal to zero.
Myocardial blood flow was determined at rest and after each stress. MFR was defined as the ratio of hyperemic flow during each stress to resting flow. Normal values were set as EXE and DIP ³2; CPT ³1.5. MVD was defined as the presence of one or more abnormal MFR values.

Results
All patients had positive EST with normal MPI at rest and after different stresses. Of the total patients, only 4 (40%) showed abnormal MFR with DIP, while 7 (70%) had altered MFR during EXE, and 8 (80%) had abnormal MFR with CPT (Table 1) (Figure 1).

Conclusions
MVD was present in almost all patients with positive EST, normal MPI without CAD. The presence of positive EST could be a predictor of myocardial ischemia caused by MVD.
The use of different stressors allowed the evaluation of various pathophysiological mechanisms of MVD, which could be underdiagnosed if only assessed with DIP.
Assessing myocardial flow reserve using CZT SPECT perfusion imaging: a step towards clinical application
Authors: Mesquita C , Palazzo I , Pacheco J , Ker W , Sabra M M M , Chambi A , Correa N L 
Published: June 2024

Abstract

Background
Maximal hyperemia capacity and myocardial flow reserve (MFR) have emerged as critical indicators of cardiovascular prognosis, with reduced vascular functionality associated with adverse outcomes (1). PET-CT serves as the gold standard for MFR assessment in clinical practice. In recent years, SPECT equipment with high-performance CZT detectors has been utilized for quantitative assessment of coronary flow at rest and under maximal hyperemia. The potential of MFR in guiding clinical decision-making for coronary artery disease (CAD) management is increasingly recognized. However, the clinical feasibility and utility of CZT-derived MFR data remains under active investigation.

Objective
This study aims to describe the feasibility of quantitatively measuring myocardial flow reserve obtained using SPECT equipment with CZT detectors in patients undergoing scintigraphy to assess coronary disease.

Methodology
One hundred patients with suspected or known CAD underwent pharmacological stress myocardial perfusion scintigraphy (adenosine) and rest imaging using a D-SPECT device (Spectrum Dynamics) between October 7th, 2021, and December 30th, 2022. Dynamic tomographic images were acquired with the administration of 99mTc-sestamibi via an injection pump (Bracco) at a flow rate of 1 ml/second. Cedars Sinai's QPS kinetic software was used to calculate MFR, with values &lt; 2 considered abnormal. Statistical analysis was performed using a significance level of 5% and the Student's T-type comparison test.

Results
Twenty patients (71 men), with a mean age of 69.4 years, were evaluated. Thirteen exams presented global MFR &lt; 2, with an additional 11 patients showing global MFR &gt; 2 and regional MFR in any of the three coronary territories below 2. Notably, six patients with MFR &lt; 2 did not demonstrate abnormal myocardial perfusion imaging in SPECT. Patients with MFR values &lt; 2 had a lower mean left ventricular ejection fraction compared to those with MFR &gt; 2 (52% vs. 62%; p = 0.02). All exams were of good quality and interpretable. Motion correction was required in most exams (&gt;90%). In two patients, the radiotracer and adenosine were administered through external jugular venous access due to unavailability of venous access in the cubital fossa.

Conclusion
Myocardial flow reserve (MFR) assessment can be effectively conducted using SPECT equipment equipped with CZT detectors, enabling the identification of patients with diminished MFR both globally and within specific coronary territories. These findings provide valuable insights into the management of patients with suspected or confirmed coronary artery disease (CAD). However, further investigation is warranted to elucidate the precise clinical implications of MFR assessment with CZT SPECT in guiding management strategies for patients with CAD.
Low sensitivity of 99mTc-DPD bone scan in early onset Val50Met cardiac amyloidosis
Authors: Jimenez-Heffernan A , Manovel-Sanchez A , Fernandez-Romero P , Brero-Sanchez L , Sanchez-Mora E , Rebollo-Aguirre A , Gonzalez-Macia A , Moreno-Ballesteros A , Gragera-Martinez A , Salgado-Garcia C , Borrachero-Garro C 
Published: June 2024

Abstract

Introduction
Low sensitivity of 99mTc-DPD has been reported in early-onset Val50Met amyloidosis by Azevedo and by Rodrigues.

Purpose
We aim to assess the frequency of negative 99mTc-DPD scans in our patient cohort of hereditary ATTR in an endemic area.

Methods
Since 2012 all patients under evaluation by our hospital’s Multidisciplinary Amyloidosis Team for cardiac amyloidosis have undergone 99mTc-DPD scintigraphy. Up to January 2024 55 patients with biopsy-proven and genetic testing for ATTR Val50Met mutation have been studied.
Cardiac evaluation is noninvasive including: clinical functional capacity, ECG, Holter, echocardiography and cardiac biomarkers. The subsets of early onset (age &lt;50 y) and late onset (age ≥50 y) comprised 22 and 33 patients respectively. Mean age was 41.7±6.1 y and 65.3±9.2 y for the early-onset and late-onset subsets respectively. Wholebody planar images were acquired 3h post-injection and visually assessed for cardiac uptake. Patients with Perugini grade uptake &gt;0 underwent SPECT/CT.

Results
Cardiac involvement was considered to be present in 12 of 22 (54.5%) patients with early onset and in 16 of 33 (48.5%) patients with late onset of disease. Cardiac scans were negative (Perugini =0 or 1) in 11 of the 12 (91%) early-onset patients and in 2 of the 16 (12.5%) late-onset patients. Of note the only positive patient (Perugini 3) in the early-onset group was 49 years old and the two patients with negative scans (Perugini 0) in the late-onset group were both 56 years old. These ages are quite near the 50 y age cut-off value for classification of disease onset as early or late, suggesting the idea that probably the real limit is a range around 50 y and not a sharp line. The poor diagnostic performance of 99mTc-DPD in early-onset Val50Met ATTR is a worrisome situation and is related to the full-length TTR fiber composition (type B) in contrast to the mixture of full-length and truncated TTR (type A) present in Val50Met late-onset disease.

Conclusion
A negative 99mTc-DPD scan should not exclude the diagnosis of Val50Met ATTR cardiomyopathy in patients with early onset of disease or in patients classified as late onset but in the younger range of the age spectrum.