Pubblicazioni recenti - cardiac mri
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Incidental discovery of unilateral hydronephrosis unveiling psoas major desmoid-type fibromatosis in a 24-year-old male: A case report with a 5-year follow-up.
Medicine (Baltimore)2024 Jul;103(30):e39042. doi: 10.1097/MD.0000000000039042.
Almjersah Abdulrahman, Olaisheh Habib, Salloum Rabab, Alshehabi Zuheir, Almjersah Emad,
Abstract
RATIONALE:
Desmoid-type fibromatosis (DTF), also known as aggressive fibromatosis, is a rare neoplasm originating from the fascial or musculoaponeurotic tissues. While benign and characterized by slow growth, it exhibits local aggressiveness and lacks specific clinical characteristics. However, in a considerable percentage of patients, it could be asymptomatic and discovered by accident during routine clinical examinations. Only a few cases of DTF arising from the psoas major muscle have been reported in the medical literature.
PATIENT CONCERNS:
A 24-year-old male, asymptomatic and without significant personal or family medical history, was diagnosed with grade 2 hydronephrosis by abdominal ultrasonography during a routine physical examination. This diagnosis was made 15 days after undergoing uncomplicated open-heart surgery to repair an atrial septal defect.
DIAGNOSIS:
Intravenous pyelogram revealed hydronephrosis with dilation of the pelvicalyceal system. Ureteroscopy ruled out any intrinsic lesions of the ureter. Contrast-enhanced computed tomography identified a 3.5?×?2?×?5.2?cm mass in the retroperitoneum, closely associated with the psoas muscle and enveloping the ureter adjacent to the iliac artery. Postoperative pathological analysis confirmed a definitive diagnosis of sporadic DTF.
INTERVENTIONS:
The patient underwent exploratory abdominal surgery, during which the tumor was resected without any intraoperative complications.
RESULTS:
After close monitoring over a 5-year follow-up period, which included periodic physical examinations, magnetic resonance imaging, and ultrasonography, no local recurrence was detected.
LESSONS:
Achieving an accurate preoperative diagnosis presents a challenge in cases involving retroperitoneal tumors originating from the psoas major muscle and encasing the ureter. However, the insertion of a double J stent is deemed a crucial step in the surgical process, facilitating the dissection and isolation of the ureter from the tumor while preserving kidney function.
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
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Fine grained automatic left ventricle segmentation via ROI based Tri-Convolutional neural networks.
Technol Health Care2024 Jul;():. doi: 10.3233/THC-240062.
K Gayathri, N Uma Maheswari, R Venkatesh, B Ganesh Prabu,
Abstract
BACKGROUND:
The left ventricle segmentation (LVS) is crucial to the assessment of cardiac function. Globally, cardiovascular disease accounts for the majority of deaths, posing a significant health threat. In recent years, LVS has gained important attention due to its ability to measure vital parameters such as myocardial mass, end-diastolic volume, and ejection fraction. Medical professionals realize that manually segmenting data to evaluate these processes takes a lot of time, effort when diagnosing heart diseases. Yet, manually segmenting these images is labour-intensive and may reduce diagnostic accuracy.
OBJECTIVE/METHODS:
This paper, propose a combination of different deep neural networks for semantic segmentation of the left ventricle based on Tri-Convolutional Networks (Tri-ConvNets) to obtain highly accurate segmentation. CMRI images are initially pre-processed to remove noise artefacts and enhance image quality, then ROI-based extraction is done in three stages to accurately identify the LV. The extracted features are given as input to three different deep learning structures for segmenting the LV in an efficient way. The contour edges are processed in the standard ConvNet, the contour points are processed using Fully ConvNet and finally the noise free images are converted into patches to perform pixel-wise operations in ConvNets.
RESULTS/CONCLUSIONS:
The proposed Tri-ConvNets model achieves the Jaccard indices of 0.9491 ± 0.0188 for the sunny brook dataset and 0.9497 ± 0.0237 for the York dataset, and the dice index of 0.9419 ± 0.0178 for the ACDC dataset and 0.9414 ± 0.0247 for LVSC dataset respectively. The experimental results also reveal that the proposed Tri-ConvNets model is faster and requires minimal resources compared to state-of-the-art models.
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Clinical and Genetic Heterogeneity of Nuclear Envelopathy Related Muscular Dystrophies in an Indian Cohort.
J Neuromuscul Dis2024 Jul;():. doi: 10.3233/JND-230172.
Baskar Dipti, Preethish-Kumar Veeramani, Polavarapu Kiran, Vengalil Seena, Nashi Saraswati, Menon Deepak, Ganaraja Valakunja Harikrishna, Girija Manu Santhappan, Nandeesh Bevinahalli Nanjegowda, Arunachal Gautham, Nalini Atchayaram,
Abstract
INTRODUCTION:
Nuclear envelopathies occur due to structural and/or functional defects in various nuclear envelope proteins such as lamin A/C and lamin related proteins. This study is the first report on the phenotype-genotype patterns of nuclear envelopathy-related muscular dystrophies from India.
METHODS:
In this retrospective study, we have described patients with genetically confirmed muscular dystrophy associated with nuclear envelopathy. Data on clinical, laboratory findings and muscle MRI were collected.
RESULTS:
Sixteen patients were included with median age at onset of 3 years (range: 1 month - 17 years). Three genes were involved: LMNA (11, 68.75%), EMD (4, 25%) and SYNE1 (1, 6.25%). The 11 patients with LMNA variants were Congenital muscular dystrophy (MDCL)=4, Limb Girdle Muscular Dystrophy (LGMD1B)=4 and Emery-Dreifuss Muscular Dystrophy (EDMD2)=3. On muscle biopsy, one patient from each laminopathy phenotype (n?=?3) revealed focal perivascular inflammatory infiltrate. Other notable features were ophthalmoparesis in one and facial weakness in one. None had cardiac involvement. Patients with EDMD1 had both upper (UL) and lower limb (LL) proximo-distal weakness. Cardiac rhythm disturbances such as sick sinus syndrome and atrial arrhythmias were noted in two patients with EDMD1. Only one patient with variant c.654_658dup (EMD) lost ambulation in the 3rd decade, 18 years after disease onset. Two had finger contractures with EMD and SYNE1 variants respectively. All patients with LMNA and SYNE1 variants were ambulant at the time of evaluation. Mean duration of illness (years) was 11.6±13 (MDCL), 3.2±1.0 (EDMD2), 10.4±12.8 (LGMD1B), 11.8±8.4 (EDMD1) and 3 (EDMD4). One patient had a novel SYNE1 mutation (c.22472dupA, exon 123) and presented with UL phenotype and prominent finger and wrist contractures.
CONCLUSION:
The salient features included ophthalmoparesis and facial weakness in LMNA, prominent finger contractures in EMD and SYNE1 and upper limb phenotype with the novel pathogenic variant in SYNE1.
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Hyperpolarized Water for Coronary Artery Angiography and Whole-Heart Myocardial Perfusion Quantification.
Tomography2024 Jul;10(7):1113-1122. doi: 10.3390/tomography10070084.
Zhao Yupeng, Lerche Mathilde Hauge, Karlsson Magnus, Olin Rie Beck, Hansen Esben Søvsø Szocska, Aastrup Malene, Redda Mohsen, Laustsen Christoffer, Hanson Lars G, Ardenkjær-Larsen Jan Henrik,
Abstract
Water freely diffuses across cell membranes, making it suitable for measuring absolute tissue perfusion. In this study, we introduce an imaging method for conducting coronary artery angiography and quantifying myocardial perfusion across the entire heart using hyperpolarized water. H was hyperpolarized using dissolution dynamic nuclear polarization (dDNP) with UV-generated radicals. Submillimeter resolution coronary artery images were acquired as 2D projections using a spoiled GRE (SPGRE) sequence gated on diastole. Dynamic perfusion images were obtained with a multi-slice SPGRE with diastole gating, covering the entire heart. Perfusion values were analyzed through histograms, and the most frequent estimated perfusion value (the mode of the distribution), was compared with the average values for O water PET from the literature. A liquid state polarization of 10% at the time of the injection and a 30 s in DO TRIS buffer were measured. Both coronary artery and dynamic perfusion images exhibited good quality. The main and small coronary artery branches were well resolved. The most frequent estimated perfusion value is around 0.6 mL/g/min, which is lower than the average values obtained from the literature for O-water PET (around 1.1 and 1.5 mL/g/min). The study successfully demonstrated the feasibility of achieving high-resolution, motion-free coronary artery angiography and 3D whole-heart quantitative myocardial perfusion using hyperpolarized water.
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Impact of SGLT2 inhibition on markers of reverse cardiac remodelling in heart failure: Systematic review and meta-analysis.
ESC Heart Fail2024 Jul;():. doi: 10.1002/ehf2.14993.
Savage Patrick, Watson Chris, Coburn Jaimie, Cox Brian, Shahmohammadi Michael, Grieve David, Dixon Lana,
Abstract
INTRODUCTION:
Several landmark randomized-controlled trials (RCTs) have demonstrated the efficacy of sodium-glucose co-transport 2 (SGLT2) inhibitors in reducing all-cause mortality, cardiovascular (CV) mortality and heart failure (HF) hospitalizations. Much interest surrounds their mechanism of action and whether they have direct effects on reverse cardiac remodelling. Therefore, we conducted a meta-analysis of placebo controlled RCTs evaluating the impact of SGLT2 inhibition on imaging derived markers of reverse cardiac remodelling in patients with HF.
METHODS:
We performed a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement and Cochrane Collaboration. Data interrogation of each major database including PubMed, EMBASE, MEDLINE and Cochrane Library was performed. RCTs evaluating HF patients >18 years comparing SGLT2 inhibitor versus placebo-control were included. Outcome measures included left ventricular end-diastolic volume and volume index (LVEDV/LVEDVi), left ventricular end-systolic volume and volume index (LVSDV/LVSDVi), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMi), left atrial volume index (LAVi) and left ventricular global longitudinal strain (LV GLS). Studies with an HF with preserved ejection fraction population were excluded from analysis of parameters, which would be significantly affected by baseline LVEF, such as volumes and LVEF. The mean difference and standard error were extracted from each study and a random effects model used pool the mean difference and standard error across studies. A pre-specified sub-group analysis was performed to stratify results according to imaging modality used (cardiac magnetic resonance imaging and echocardiography). This study is registered on PROSPERO: CRD42023482722.
RESULTS:
Seven randomized, placebo-controlled trials in patients with HF comprising a total population of 657 patients were included. Overall LVEF of included studies ranged from 29 ± 8.0% to 55.5 ± 4.2%. In studies included in analysis of HFrEF parameters, baseline LVEF ranged from 29 ± 8% to 45.5 ± 12%. Pooled data demonstrated SGLT2 inhibition, compared with placebo control, resulted in significant improvements in mean difference of LVEDV [-11.62 ml (95% confidence interval, CI -17.90 to -5.25; z = 3.67, P = 0.0004)], LVEDVi [-6.08 ml (95% CI -9.96 to -2.20; z = 3.07; P = 0.002)], LVESV [-12.47 ml (95% CI -19.12 to -5.82; z = 3.68; P = 0.0002)], LVESVi [-6.02 ml (95% CI -10.34 to -1.70; z = 2.73; P = 0.006)], LVM [-9.77 g (95% CI -17.65 to -1.89; z = 2.43; P = 0.02)], LVMi (-3.52 g [95% CI -7.04 to 0.01; z = 1.96; P = 0.05)] and LVEF [+2.54 mL (95% CI 1.10 to 3.98; z = 3.62; P = 0.0005)]. No significant difference in GLS (n = 327) [+0.42% (95%CI -0.19 to 1.02; P = 0.18)] or LAVi [-3.25 ml (95% CI -8.20 to 1.69; z = 1.29; P = 0.20)] was noted.
CONCLUSION:
This meta-analysis provides additional data and insight into the effects of SGLT2 inhibition on reverse cardiac remodelling in patients with HF. Compared with placebo control, we found that treatment with a SGLT2 inhibitor produced significant improvements in several markers of reverse cardiac remodelling.
© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Case report: Side effects of etomidate in propylene glycol in five Göttingen Minipigs.
Front Vet Sci2024 ;11():1376604. doi: 10.3389/fvets.2024.1376604.
Petrucci Mariafrancesca, de Brot Simone, Casoni Daniela,
Abstract
Etomidate, an agonist of the GABA A receptors, is available for clinical use either in combination with 35% propylene glycol or in a lipid emulsion. Its recognized ability to minimally impact the cardiovascular system made etomidate a suitable option for cardiac-compromised patients. Myoclonus and pain at the injection site are recognized side effects of etomidate in propylene glycol, affecting both human and veterinary species. There is no information available concerning potential side effect in minipigs. In the present case series, we report the side effects related to the use of etomidate in 35% propylene glycol in five Ellegaard Göttingen Minipigs that underwent general anesthesia for cardiac magnetic resonance imaging days or weeks after experimentally induced myocardial infarction. Following intravenous injection of etomidate, laryngeal edema and hyperemia were observed in one case. In another case, tachycardia, apnea, and decreased oxygen saturation, accompanied by laryngeal edema and hyperemia, were observed, which resolved spontaneously in a few minutes. In the arterial or venous samples collected shortly after the induction of general anesthesia, hemolysis was macroscopically visible and subsequently confirmed with a hematological exam in all five cases, as well as hemoglobinuria. Necropsies carried out immediately after euthanasia confirmed macroscopic laryngeal edema, marked diffuse lung alveolar and interstitial edema and hyperemia at histology in one animal, and marked acute lung congestion in another animal. These side effects were not observed when etomidate in a lipid emulsion was injected into another 24 animals. The role played by the different formulations (propylene glycol versus lipidic formulation) has not yet been fully elucidated. Based on our observations, we recommend caution in using the formulation of etomidate in 35% propylene glycol in Göttingen Minipigs.
Copyright © 2024 Petrucci, de Brot and Casoni.
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Remote myocardial zone characteristics in type 2 diabetes patients with prior myocardial infarction and comparisons with diabetes patients with no prior infarction.
Ther Adv Endocrinol Metab2024 ;15():20420188241263488. doi: 10.1177/20420188241263488.
Thirunavukarasu Sharmaine, Asad Mehak, Kotha Sindhoora, Procter Henry, Giannoudi Marilena, Xue Hui, Kellman Peter, Greenwood John P, Levelt Eylem,
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Remote myocardial fibrosis predicts adverse outcome in patients with myocardial infarction on clinical cardiac magnetic resonance imaging.
J Cardiovasc Magn Reson2024 Jul;():101064. doi: 10.1016/j.jocmr.2024.101064.
Black Nicholas, Bradley Joshua, Schelbert Erik B, Bonnett Laura J, Lewis Gavin A, Lagan Jakub, Orsborne Christopher, Brown Pamela F, Soltani Fardad, Fröjdh Fredrika, Ugander Martin, Wong Timothy C, Fukui Miho, Cavalcante Joao L, Naish Josephine H, Williams Simon G, McDonagh Theresa, Schmitt Matthias, Miller Christopher A,
Abstract
BACKGROUND:
Heart failure (HF) most commonly occurs in patients who have had a myocardial infarction (MI), but factors other than MI size may be deterministic. Fibrosis of myocardium remote from the MI is associated with adverse remodelling. We aimed to i) Investigate the association between remote myocardial fibrosis, measured using cardiovascular magnetic resonance (CMR) extracellular volume (ECV), and HF and death following MI, ii) Identify predictors of remote myocardial fibrosis in patients with evidence of MI, and determine the relationship with infarct size.
METHODS:
Multicentre prospective cohort study of 1,199 consecutive patients undergoing CMR with evidence of MI on late gadolinium enhancement. Median follow-up 1,133 (895-1,442) days. Cox proportional hazards modelling was used to identify factors predictive of the primary outcome, a composite of first hospitalisation for HF (HHF) or all-cause mortality, post-CMR. Linear regression modelling was used to identify determinants of remote ECV.
RESULTS:
Remote myocardial fibrosis was a strong predictor of primary outcome (?: 15.6, HR: 1.07 per 1% increase in ECV, 95% CI: 1.04-1.11, p
CONCLUSIONS:
Myocardial fibrosis, measured using CMR ECV, is a strong predictor of HHF and death in patients with evidence of MI. The mechanisms underlying remote myocardial fibrosis formation post-MI remain poorly understood, but factors other than infarct size appear to be important.
Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.
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Society for Cardiovascular Magnetic Resonance Guidelines for Reporting Cardiovascular Magnetic Resonance Examinations in Patients with Congenital Heart Disease.
J Cardiovasc Magn Reson2024 Jul;():101062. doi: 10.1016/j.jocmr.2024.101062.
Grosse-Wortmann Lars, Wald Rachel, Valverde Israel, Lsangiacomo-Buechel Emanuela, Ordovas Karen, Raimondi Francesca, Babu-Narayan Sonya, Krishnamurthy Rajesh, Yim Deane, Rathod Rahul H,
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Maternal hemoglobin and iron status in early pregnancy and childhood cardiac outcomes.
Clin Nutr2024 Jul;43(9):1997-2004. doi: 10.1016/j.clnu.2024.07.009.
Quezada-Pinedo Hugo G, Jaddoe Vincent, Gaillard Romy, Duijts Liesbeth, van Rijn Bas, Reiss Irwin K M, Vermeulen Marijn J, Santos Susana,
Abstract
BACKGROUND & AIMS:
Dysregulation of iron homeostasis is associated with cardiac alterations in a sex-dependent manner in adults. It is unknown whether iron status during pregnancy has long-term impact on cardiovascular health, and if this association is influenced by sex. Therefore, this study aimed to evaluate sex-specific association between maternal iron status during early pregnancy and cardiac outcomes in children aged 10 years.
METHODS:
In a population-based cohort study among 1972 mother-child pairs, hemoglobin and ferritin were measured in early pregnancy (150 ?g/L). At 10 years of age, cardiac MRI was performed to measure right and left cardiac outcomes of function (ventricular end-diastolic volume (RVEDV and LVEDV) and ejection fraction (RVEF and LVEF)), and structure (left ventricular mass (LVM), and left ventricular mass-to-volume ratio (LMVR)). Results are presented for boys and girls separately and models were adjusted for confounders and multiple testing.
RESULTS:
In boys, one standard deviation score (SDS) increase in maternal hemoglobin was associated with lower RVEDV and LVEDV (difference (95%CI) -0.10 (-0.17, -0.03) SDS and -0.09 (-0.16, -0.03) SDS, respectively). In boys, maternal anemia, as compared to normal hemoglobin levels, was associated with higher LVEDV (difference 0.34 (0.10, 0.59) SDS). No associations were observed for other cardiac outcomes and for ferritin in boys. No associations were observed in girls.
CONCLUSION:
In boys, dysregulated iron status during early pregnancy might permanently alter cardiovascular RVEDV and LVEDV function. Underlying mechanisms need further study.
Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Additional value of CMR parametric mapping in tissue characterization of common benign pediatric cardiac tumors.
Eur Heart J Cardiovasc Imaging2024 Jul;():. doi: jeae187.
Ciliberti Paolo, Bordonaro Veronica, Curione Davide, Perazzolo Alessio, Ciancarella Paolo, Santangelo Teresa, Napolitano Carmela, Natale Luigi, Galletti Lorenzo, Secinaro Aurelio,
Abstract
BACKGROUND:
Cardiac Magnetic Resonance (CMR) parametric mapping is underexplored in cardiac tumors.
OBJECTIVES:
To evaluate the contribution of mapping sequences on the characterization of pediatric tumors.
METHODS:
All pediatric patients referred for cardiac tumors at Bambino Gesù Children's Hospital from June 2017 to November 2023, who underwent CMR with mapping sequences, were included. The diagnosis of tumor type was performed according to signal characteristics on different sequences. Mass parametric mapping for each subtype and interobserver variability was assessed.
RESULTS:
Sixteen patients were enrolled. The mean age at CMR was 7 ± 5 years. "Traditional" mass-type assessment diagnosed hemangioma (Group A) in 3 patients (19%), fibroma (Group B) in 4 patients (25%), rhabdomyoma (Group C) in 6 patients (37%), and lipoma (Group D) in 3 patients (19%). The ANOVA analysis revealed significant differences in mass native T1 and mass extracellular volume (ECV) values among the four subgroups (p
CONCLUSIONS:
Mass mapping analysis is feasible and reproducible in children. ECV values provide the most accurate differentiation. Mass ECV consistently resembles normal myocardium in rhabdomyoma, is extremely high (approaching 100%) in fibroma, equals to zero in lipoma, and matches blood pool ECV (1-Hct) in hemangioma.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Reliability of left ventricular hemodynamic forces derived from feature-tracking cardiac magnetic resonance.
PLoS One2024 ;19(7):e0306481. doi: 10.1371/journal.pone.0306481.
Ismailov Temirlan, Khamitova Zaukiya, Jumadilova Dinara, Khissamutdinov Nail, Toktarbay Bauyrzhan, Zholshybek Nurmakhan, Rakhmanov Yeltay, Salustri Alessandro,
Abstract
BACKGROUND:
Hemodynamic forces (HDF) analysis has been proposed as a method to quantify intraventricular pressure gradients, however data on its reliability are still scanty. Thus, the aim of this study is to assess the reliability of HDF parameters derived from cardiac magnetic resonance (CMR).
METHODS:
CMR studies of 25 athletes were analysed by two independent observers and then re-analysed by the same observer one week apart. Intraclass Correlation Coefficient (ICC [95% CI]) and Bland-Altman plots were used to assess association, agreement, and bias of the longitudinal (A-B) HDF, transverse (L-S) HDF, and Impulse Angle. The sample size required to detect a relative change in the HDF parameters was also calculated.
RESULTS:
In terms of inter-observer variability, there was a good correlation for the A-B and L-S (ICC 0.85 [0.67-0.93] and 0.86 [0.69-0.94]; p
CONCLUSIONS:
The results of this study showed a low inter- and intra-observer variability of HDF parameters derived from feature-tracking CMR. This provides the fundamental basis for their use both in research and clinical practice, which could eventually lead to the detection of significant changes at follow-up studies.
Copyright: © 2024 Ismailov et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Noncontrast MR Lymphangiography to Identify Progression of Lymphatic Abnormalities over the Course of Fontan Completion.
Radiol Cardiothorac Imaging2024 Aug;6(4):e240201. doi: 10.1148/ryct.240201.
Collins Jeremy D, Thompson Scott M,
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A new method for scaling inlet flow waveform in hemodynamic analysis of aortic dissection.
Int J Numer Method Biomed Eng2024 Jul;():e3855. doi: 10.1002/cnm.3855.
Wang Kaihong, Armour Chlöe H, Guo Baolei, Dong Zhihui, Xu Xiao Yun,
Abstract
Computational fluid dynamics (CFD) simulations have shown great potentials in cardiovascular disease diagnosis and postoperative assessment. Patient-specific and well-tuned boundary conditions are key to obtaining accurate and reliable hemodynamic results. However, CFD simulations are usually performed under non-patient-specific flow conditions due to the absence of in vivo flow and pressure measurements. This study proposes a new method to overcome this challenge by tuning inlet boundary conditions using data extracted from electrocardiogram (ECG). Five patient-specific geometric models of type B aortic dissection were reconstructed from computed tomography (CT) images. Other available data included stoke volume (SV), ECG, and 4D-flow magnetic resonance imaging (MRI). ECG waveforms were processed to extract patient-specific systole to diastole ratio (SDR). Inlet boundary conditions were defined based on a generic aortic flow waveform tuned using (1) SV only, and (2) with ECG and SV (ECG?+?SV). 4D-flow MRI derived inlet boundary conditions were also used in patient-specific simulations to provide the gold standard for comparison and validation. Simulations using inlet flow waveform tuned with ECG?+?SV not only successfully reproduced flow distributions in the descending aorta but also provided accurate prediction of time-averaged wall shear stress (TAWSS) in the primary entry tear (PET) and abdominal regions, as well as maximum pressure difference, ?P, from the aortic root to the distal false lumen. Compared with simulations with inlet waveform tuned with SV alone, using ECG?+?SV in the tuning method significantly reduced the error in false lumen ejection fraction at the PET (from 149.1% to 6.2%), reduced errors in TAWSS at the PET (from 54.1% to 5.7%) and in the abdominal region (from 61.3% to 11.1%), and improved ?P prediction (from 283.1% to 18.8%) However, neither of these inlet waveforms could be used for accurate prediction of TAWSS in the ascending aorta. This study demonstrates the importance of SDR in tailoring inlet flow waveforms for patient-specific hemodynamic simulations. A well-tuned flow waveform is essential for ensuring that the simulation results are patient-specific, thereby enhancing the confidence and fidelity of computational tools in future clinical applications.
© 2024 The Author(s). International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd.
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Identifying the Mechanisms of a Peripherally Limited Exercise Phenotype in Patients With Heart Failure With Preserved Ejection Fraction.
Circ Heart Fail2024 Jul;():e011693. doi: 10.1161/CIRCHEARTFAILURE.123.011693.
Skow Rachel J, Sarma Satyam, MacNamara James P, Bartlett Miles F, Wakeham Denis J, Martin Zachary T, Samels Mitchel, Nandadeva Damsara, Brazile Tiffany L, Ren Jimin, Fu Qi, Babb Tony G, Balmain Bryce N, Nelson Michael D, Hynan Linda S, Levine Benjamin D, Fadel Paul J, Haykowsky Mark J, Hearon Christopher M,
Abstract
BACKGROUND:
We identified peripherally limited patients using cardiopulmonary exercise testing and measured skeletal muscle oxygen transport and utilization during invasive single leg exercise testing to identify the mechanisms of the peripheral limitation.
METHODS:
Forty-five patients with heart failure with preserved ejection fraction (70±7 years, 27 females) completed seated upright cardiopulmonary exercise testing and were defined as having a (1) peripheral limitation to exercise if cardiac output/oxygen consumption (VO) was elevated (?6) or 5 to 6 with a stroke volume reserve >50% (n=31) or (2) a central limitation to exercise if cardiac output/VO slope was ?5 or 5 to 6 with stroke volume reserve
RESULTS:
Peak VO during cardiopulmonary exercise testing was not different between groups (central: 13.9±5.7 versus peripheral: 12.0±3.1 mL/min per kg; =0.135); however, the peripheral group had a lower peak arterial-to-venous oxygen content difference (central: 13.5±2.0 versus peripheral: 11.1±1.6 mLO/dL blood;
CONCLUSIONS:
Peripherally limited patients with heart failure with preserved ejection fraction identified by cardiopulmonary exercise testing have impairments in oxygen transport and utilization at the level of the skeletal muscle quantified by invasive knee extension exercise testing, which includes an increased blood flow/V?O ratio and poor muscle diffusive capacity.
REGISTRATION:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04068844.
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Impact of physical activity on surrogate markers of cardiovascular disease in the haemodialysis population.
Clin Kidney J2024 Jul;17(7):sfae198. doi: sfae198.
Hull Katherine L, Abell Lucy, Adenwalla Sherna F, Billany Roseanne E, Burns Stephanie, Burton James O, Churchward Darren, Graham-Brown Matthew P M, Gray Laura J, Highton Patrick, Lightfoot Courtney J, Said Rahma, Smith Alice C, Young Hannah M L, March Daniel S,
Abstract
BACKGROUND:
The haemodialysis (HD) population is sedentary, with substantial cardiovascular disease risk. In the general population, small increases in daily step count associate with significant reductions in cardiovascular mortality. This study explores the relationship between daily step count and surrogate markers of cardiovascular disease, including left ventricular ejection fraction (LVEF) and native T1 (a marker of diffuse myocardial fibrosis), within the HD population.
METHODS:
This was a post hoc analysis of the association between daily step count and metabolic equivalent of task (MET) and prognostically important cardiac magnetic resonance imaging parameters from the CYCLE-HD study (ISRCTN11299707). Unadjusted linear regression and multiple linear regression adjusted for age, body mass index, dialysis vintage, haemoglobin, hypertension and ultrafiltration volume were performed. Significant relationships were explored with natural cubic spline models with four degrees of freedom (five knots).
RESULTS:
A total of 107 participants were included [age 56.3 ± 14.1 years, 79 (73.8%) males]. The median daily step count was 2558 (interquartile range 1054-4352). There were significant associations between steps and LVEF (? = 0.292; = .009) and steps and native T1 (? = -0.245; = .035). Further modelling demonstrated most of the increase in LVEF occurred at up to 2000 steps/day and there was an inverse dose-response relationship between steps and native T1, with the most pronounced reduction in native T1 between ?2500 and 6000 steps/day.
CONCLUSIONS:
The results suggest an association between daily step count and parameters of cardiovascular health in the HD population. These findings support the recommendations for encouraging physical activity but are not the justification. Further research should evaluate whether a simple physical activity intervention improves cardiovascular outcomes in individuals receiving maintenance HD.
© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.
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Novel mutation in Carney complex: a case report and literature review.
Front Endocrinol (Lausanne)2024 ;15():1384956. doi: 1384956.
Zheng Huaqiang, Kang Hong, Qiu Yizhen, Xie Liangxiao, Wu Jinzhi, Lai Pengbin, Kang Jiapeng,
Abstract
OBJECTIVE:
Carney complex is a rare autosomal dominant syndrome that has been shown to be associated with inactivation due to mutations. We revealed a novel gene mutation in Chinese patient with Carney complex and review the literature to enhance understanding of Carney complex.
CASE PRESENTATION:
A 23-year-old Chinese male patient with a family history cardiac myxoma was admitted to our Department of Endocrinology because of central obesity and hyperpigmentation. Physical examination revealed a maximum blood pressure of 150/93mmHg, a waist circumference of 102cm, a weight of 70kg, a height of 170cm, and a BMI of 24.22kg/m2. Additionally, there was spotty skin pigmentation on the lip mucosa, purple striae on the abdomen, thin skin on both legs, and visible veins. Blood examination revealed hypercortisolemia, decreased adrenocorticotropic hormone (ACTH) levels and failure to suppress cortisol with low and high-dose dexamethasone suppression tests. Magnetic resonance imaging (MRI) scan revealed multiple small adrenal nodules and Retroperitoneal neurogenic tumor. Genetic testing showed a novel heterozygous mutation in exon 5 of (c.500_502 + 8delAAGGTAAGGGC). The patient underwent resection of the right adrenal gland and retroperitoneal neoplasms in 2020. Postoperative pathology following the right adrenal gland resection showed nodular hyperplasia of the adrenal cortex. The pathology from the retroperitoneal tumor resection revealed spindle cell tumors rich in pigment and cells. The patient was diagnosed as Carney complex according to Stratakis CA in 2001 guidelines. After long-term follow-up, the patient's condition was stable, with weight loss, waist circumference reduction, significantly lower cortisol levels, and normal blood lipids.
CONCLUSION:
This case reported a Carney complex in a Chinese patient, characterized clinically by non-ACTH-dependent Cushing's syndrome, familial recurrent cardiac myxomas, psammomatous melanotic schwannoma (PMS) and skin and mucosal pigmentation. A novel subtype of mutation was discovered, which may affect the characteristics of the protein and contribute to the development of Carney complex.
Copyright © 2024 Zheng, Kang, Qiu, Xie, Wu, Lai and Kang.
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Development of a prediction model of conversion to Alzheimer's disease in people with mild cognitive impairment: the statistical analysis plan of the INTERCEPTOR project.
Diagn Progn Res2024 Jul;8(1):11. doi: 10.1186/s41512-024-00172-6.
Lombardo Flavia L, Lorenzini Patrizia, Mayer Flavia, Massari Marco, Piscopo Paola, Bacigalupo Ilaria, Ancidoni Antonio, Sciancalepore Francesco, Locuratolo Nicoletta, Remoli Giulia, Salemme Simone, Cappa Stefano, Perani Daniela, Spadin Patrizia, Tagliavini Fabrizio, Redolfi Alberto, Cotelli Maria, Marra Camillo, Caraglia Naike, Vecchio Fabrizio, Miraglia Francesca, Rossini Paolo Maria, Vanacore Nicola, ,
Abstract
BACKGROUND:
In recent years, significant efforts have been directed towards the research and development of disease-modifying therapies for dementia. These drugs focus on prodromal (mild cognitive impairment, MCI) and/or early stages of Alzheimer's disease (AD). Literature evidence indicates that a considerable proportion of individuals with MCI do not progress to dementia. Identifying individuals at higher risk of developing dementia is essential for appropriate management, including the prescription of new disease-modifying therapies expected to become available in clinical practice in the near future.
METHODS:
The ongoing INTERCEPTOR study is a multicenter, longitudinal, interventional, non-therapeutic cohort study designed to enroll 500 individuals with MCI aged 50-85 years. The primary aim is to identify a biomarker or a set of biomarkers able to accurately predict the conversion from MCI to AD dementia within 3 years of follow-up. The biomarkers investigated in this study are neuropsychological tests (mini-mental state examination (MMSE) and delayed free recall), brain glucose metabolism ([F]FDG-PET), MRI volumetry of the hippocampus, EEG brain connectivity, cerebrospinal fluid (CSF) markers (p-tau, t-tau, A?1-42, A?1-42/1-40 ratio, A?1-42/p-Tau ratio) and APOE genotype. The baseline visit includes a full cognitive and neuropsychological evaluation, as well as the collection of clinical and socio-demographic information. Prognostic models will be developed using Cox regression, incorporating individual characteristics and biomarkers through stepwise selection. Model performance will be evaluated in terms of discrimination and calibration and subjected to internal validation using the bootstrapping procedure. The final model will be visually represented as a nomogram.
DISCUSSION:
This paper contains a detailed description of the statistical analysis plan to ensure the reproducibility and transparency of the analysis. The prognostic model developed in this study aims to identify the population with MCI at higher risk of developing AD dementia, potentially eligible for drug prescriptions. The nomogram could provide a valuable tool for clinicians for risk stratification and early treatment decisions.
TRIAL REGISTRATION:
ClinicalTrials.gov NCT03834402. Registered on February 8, 2019.
© 2024. The Author(s).
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MetSCORE: a molecular metric to evaluate the risk of metabolic syndrome based on serum NMR metabolomics.
Cardiovasc Diabetol2024 Jul;23(1):272. doi: 10.1186/s12933-024-02363-3.
Gil-Redondo Rubén, Conde Ricardo, Bruzzone Chiara, Seco Maria Luisa, Bizkarguenaga Maider, González-Valle Beatriz, de Diego Angela, Laín Ana, Habisch Hansjörg, Haudum Christoph, Verheyen Nicolas, Obermayer-Pietsch Barbara, Margarita Sara, Pelusi Serena, Verde Ignacio, Oliveira Nádia, Sousa Adriana, Zabala-Letona Amaia, Santos-Martin Aida, Loizaga-Iriarte Ana, Unda-Urzaiz Miguel, Kazenwadel Jasmin, Berezhnoy Georgy, Geisler Tobias, Gawaz Meinrad, Cannet Claire, Schäfer Hartmut, Diercks Tammo, Trautwein Christoph, Carracedo Arkaitz, Madl Tobias, Valenti Luca, Spraul Manfred, Lu Shelly C, Embade Nieves, Mato José M, Millet Oscar,
Abstract
BACKGROUND:
Metabolic syndrome (MetS) is a cluster of medical conditions and risk factors correlating with insulin resistance that increase the risk of developing cardiometabolic health problems. The specific criteria for diagnosing MetS vary among different medical organizations but are typically based on the evaluation of abdominal obesity, high blood pressure, hyperglycemia, and dyslipidemia. A unique, quantitative and independent estimation of the risk of MetS based only on quantitative biomarkers is highly desirable for the comparison between patients and to study the individual progression of the disease in a quantitative manner.
METHODS:
We used NMR-based metabolomics on a large cohort of donors (n?=?21,323; 37.5% female) to investigate the diagnostic value of serum or serum combined with urine to estimate the MetS risk. Specifically, we have determined 41 circulating metabolites and 112 lipoprotein classes and subclasses in serum samples and this information has been integrated with metabolic profiles extracted from urine samples.
RESULTS:
We have developed MetSCORE, a metabolic model of MetS that combines serum lipoprotein and metabolite information. MetSCORE discriminate patients with MetS (independently identified using the WHO criterium) from general population, with an AUROC of 0.94 (95% CI 0.920-0.952, p?0.001). MetSCORE is also able to discriminate the intermediate phenotypes, identifying the early risk of MetS in a quantitative way and ranking individuals according to their risk of undergoing MetS (for general population) or according to the severity of the syndrome (for MetS patients).
CONCLUSIONS:
We believe that MetSCORE may be an insightful tool for early intervention and lifestyle modifications, potentially preventing the aggravation of metabolic syndrome.
© 2024. The Author(s).
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Expenditure mapping of pediatric imaging costs using a resource utilization band analysis of claims data.
Curr Probl Diagn Radiol2024 Jul;():. doi: S0363-0188(24)00129-4.
Baskar Danika, Jarmul Jamie A, Donnelly Lane F,
Abstract
OBJECTIVE:
To segregate imaging expenditures from claims data by resource utilization bands (RUBs) and underlying conditions to create an "expenditure map" of pediatric imaging costs.
METHODS:
A Claims data for children enrolled in a commercial value-based plan were categorized by RUB 0 non-user, 1 healthy user, 2 low morbidity, 3 moderate morbidity, 4 high morbidity, & 5 very high morbidity. The per member per year (PMPY) expense, total imaging spend, and imaging modality with the highest spend were assessed for each RUB. Diagnosis categories associated with high imaging costs were also evaluated.
RESULTS:
There were 40,022 pediatric plan members. 14% had imaging-related claims accounting for approximately $2.8 million in expenditures. Member distribution and mean PMPY expenditure RUB was respectively: RUB 0 (3,037, $0), RUB 1 (6,604, $7), RUB 2 - 13,698, $27), RUB 3 - 13,341, $87), RUB 4 (2,810, $268), RUB 5 (532, $841). RUB 3 had the largest total imaging costs at $1,159,523. The imaging modality with the greatest mean PMPY expense varied by RUB with radiography highest in lower RUBs and MRI highest in higher RUBs. The top 3 diagnoses associated with the highest total imaging costs were developmental disorders ($443,980), asthma ($388,797), and congenital heart disease ($294,977) and greatest mean PMPY imaging expenditures malignancy/leukemia ($3,100), transplant ($2,639), and tracheostomy ($1,661).
DISCUSSION:
Expense mapping using claims data allows for a better understanding of the distribution of imaging costs across a covered pediatric population. This tool may assist organizations in planning effective cost-reduction initiatives and learning how imaging utilization varies by patient complexity in their system.
Copyright © 2024. Published by Elsevier Inc.
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