Abnormal Flow Research Articles

Lipid regulation of protocatechualdehyde and hydroxysafflor yellow A via AMPK/SREBP2/PCSK9/LDLR signaling pathway in hyperlipidemic zebrafish

The consumption of a high-cholesterol diet is known to cause hyperlipidemia, which is one of the main risk factors for cardiovascular disease. Protocatechualdehyde (PCA) and hydroxysafflor yellow A (HSYA) are the active components of Salvia miltiorrhiza and safflower, respectively. However, their exact mechanism is still unclear. The aim of this study is to investigate its effects on lipid deposition and liver damage in hyperlipidemic zebrafish and its mechanism of anti-hyperlipidemia. The results showed that the use of PCA and HSYA alone and in combination can improve lipid deposition, slow behavior, abnormal blood flow and liver tissue damage, and the combined use is more effective. Further RT-qPCR results showed that PCA + HSYA can regulate the mRNA levels of PPAR-γ, SREBP2, SREBP1, HMGCR, PCSK9, mTOR, C/EBPα, LDLR, AMPK, HNF-1α and FoxO3a. The PCA + HSYA significantly improves lipid deposition and abnormal liver function in hyperlipidemic zebrafish larvae, which may be related to the AMPK/SREBP2/PCSK9/LDLR signaling pathway.

Artificial intelligence coronary computed tomography, coronary computed tomography angiography using fractional flow reserve, and physician visual interpretation in the per-vessel prediction of abnormal invasive adenosine fractional flow reserve.

A comparison of diagnostic performance comparing AI-QCTISCHEMIA, coronary computed tomography angiography using fractional flow reserve (CT-FFR), and physician visual interpretation on the prediction of invasive adenosine FFR have not been evaluated. Furthermore, the coronary plaque characteristics impacting these tests have not been assessed. In a single centre, 43-month retrospective review of 442 patients referred for coronary computed tomography angiography and CT-FFR, 44 patients with CT-FFR had 54 vessels assessed using intracoronary adenosine FFR within 60 days. A comparison of the diagnostic performance among these three techniques for the prediction of FFR ≤ 0.80 was reported. The mean age of the study population was 65 years, 76.9% were male, and the median coronary artery calcium was 654. When analysing the per-vessel ischaemia prediction, AI-QCTISCHEMIA had greater specificity, positive predictive value (PPV), diagnostic accuracy, and area under the curve (AUC) vs. CT-FFR and physician visual interpretation CAD-RADS. The AUC for AI-QCTISCHEMIA was 0.91 vs. 0.76 for CT-FFR and 0.62 for CAD-RADS ≥ 3. Plaque characteristics that were different in false positive vs. true positive cases for AI-QCTISCHEMIA were max stenosis diameter % (54% vs. 67%, P < 0.01); for CT-FFR were maximum stenosis diameter % (40% vs. 65%, P < 0.001), total non-calcified plaque (9% vs. 13%, P < 0.01); and for physician visual interpretation CAD-RADS ≥ 3 were total non-calcified plaque (8% vs. 12%, P < 0.01), lumen volume (681 vs. 510 mm3, P = 0.02), maximum stenosis diameter % (40% vs. 62%, P < 0.001), total plaque (19% vs. 33%, P = 0.002), and total calcified plaque (11% vs. 22%, P = 0.003). Regarding per-vessel prediction of FFR ≤ 0.8, AI-QCTISCHEMIA revealed greater specificity, PPV, accuracy, and AUC vs. CT-FFR and physician visual interpretation CAD-RADS ≥ 3.

Fetal cardiovascular changes during open and fetoscopic in-utero spina bifida closure.

Fetoscopic closure of spina bifida using heated and humidified carbon dioxide gas (hhCO2) has been associated with lower maternal morbidity compared with open closure. Fetal cardiovascular changes during these surgical interventions are poorly defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR) < 110 bpm for 10 min) and changes in umbilical artery (UA) Doppler parameters during open vs fetoscopic closure. This was a prospective cohort study of 22 open and 46 fetoscopic consecutive in-utero closures conducted between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and UA Doppler velocimetry were obtained systematically during preoperative assessment, every 5 min during the intraoperative period, and during the postoperative assessment. FHR, UA pulsatility index (PI) and UA end-diastolic flow (EDF) were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocity was measured in the fetoscopic cohort. At each timepoint at which FHR was recorded, maternal heart rate and systolic and diastolic blood pressure were measured. Fetal bradycardia occurred in 4/22 (18.2%) cases of open closure and 21/46 (45.7%) cases of fetoscopic closure (P = 0.03). FHR decreased gradually in both cohorts after administration of general anesthesia and decreased further during surgery. FHR was significantly lower during hour 2 of surgery in the fetoscopic-repair cohort compared with the open-repair cohort. The change in FHR from baseline in the final stage of fetal surgery was significantly more pronounced in the fetoscopic-repair cohort compared with the open-repair cohort (mean, -32.4 (95% CI, -35.7 to -29.1) bpm vs -23.5 (95% CI, -28.1 to -18.8) bpm; P = 0.002). Abnormal UA-EDF (defined as absent or reversed EDF) occurred in 3/22 (13.6%) cases in the open-repair cohort and 23/46 (50.0%) cases in the fetoscopic-repair cohort (P = 0.004). There were no differences in UA-EDF or UA-PI between closure techniques at the individual stages of assessment. We observed a decrease in FHR and abnormalities in UA Doppler parameters during both open and fetoscopic spina bifida closure. Fetal bradycardia was more prominent during fetoscopic closure following hhCO2 insufflation, but FHR recovered after cessation of hhCO2. Changes in FHR and UA Doppler parameters during in-utero spina bifida closure were transient, no cases required emergency delivery and no fetoscopic closure was converted to open closure. These observations should inform algorithms for the perioperative management of fetal bradycardia associated with in-utero spina bifida closure. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

In silico hemodynamical simulations show additional benefits of artery wall softening induced by antihypertensive drugs

Background and objectivesAge-related arterial stiffening increases peripheral resistance and decreases arterial distensibility, thus contributing to hypertension, an important risk factor of atherosclerosis. It causes abnormal blood flow, endothelial dysfunction, higher pulse wave velocity, and consequently elevated pressure wave amplitude. MethodsThis paper presents the influence of these changes via multiscale 3D-0D transient computational fluid dynamics simulations of blood flow in five patient-specific geometries of human carotid bifurcation using archetypal flow waveforms for young and old subjects. ResultsThe proposed model shows a significant decrease in the time-averaged wall shear stress (TAWSS) for the old archetypal flow waveform. This is in good agreement with clinical data on a straight segment of common carotid arteries available for young and old subjects. Moreover, our study showed that the decrease of area-averaged TAWSS related to the old flow waveform is much more pronounced (2.5 ÷ 4.5 times higher) at risk areas (areas showing TAWSS below its threshold value of 0.48 Pa) than in straight segments commonly considered in clinical studies. ConclusionsSince arterial stiffness can be lowered through long-term usage of any of the five basic groups of antihypertensives, possible benefits of such medical therapy could be not only lowering blood pressure and peripheral resistance but also in increasing the TAWSS and thus attenuating an important mechanism of the atherosclerotic process.

Bi-channel hybrid GAN attention based anomaly detection system for multi-domain SDN environment

Software-Defined Networking (SDN) is a strategy that leads the network via software by separating its control plane from the underlying forwarding plane. In support of a global digital network, multi-domain SDN architecture emerges as a viable solution. However, the complex and ever-evolving nature of network threats in a multi-domain environment presents a significant security challenge for controllers in detecting abnormalities. Moreover, multi-domain anomaly detection poses a daunting problem due to the need to process vast amounts of data from diverse domains. Deep learning models have gained popularity for extracting high-level feature representations from massive datasets. In this work, a novel deep neural network architecture, supervised learning based LD-BiHGA (Low Dimensional Bi-channel Hybrid GAN Attention) system is designed to learn class-specific features for accurate anomaly detection. Two asymmetric GANs are employed for learning the normal and abnormal network flows separately. Then, to extract more relevant features, a bi-channel attention mechanism is added. This is the first study to introduce an innovative hybrid architecture that merges bi-channel hybrid GANs with attention models for the purpose of anomaly detection in a multi-domain SDN environment that effectively handles real-time unbalanced data. The suggested architecture demonstrates its effectiveness on three benchmark datasets, achieving an average accuracy improvement of 7.225% on balanced datasets and 3.335% on imbalanced datasets compared to previous intrusion detection system (IDS) architectures in the literature.

Diagnostic efficiency of ultrasound diagnosis of venous catheters and venous catheter blood flow spectrum

BackgroundVenous catheter abnormalities are related to chromosomal abnormalities, in order to detect whether the fetus has congenital diseases as soon as possible. ObjectiveTo explore the image characteristics and diagnostic efficiency of ultrasound diagnosis of venous catheter abnormalities and venous catheter blood flow spectrum abnormalities. Method60 pregnant women were divided into a venous catheter abnormality group (n = 12) and a normal group (n = 48). Both groups underwent ultrasound examination. Collect abnormal fetal umbilical vein catheter and venous catheter blood flow spectrum parameters from the abnormal venous catheter group. Calculate the diagnostic efficiency and prognosis of two groups of patients. ResultIn this experiment, there were differences in peak atrial systolic velocity among participants, and the peak atrial systolic velocity in the group with abnormal venous catheters was lower than that in the normal group (P < 0.05). The positive detection rate of the normal group was 4.17%, and the negative detection rate was 95.83%. The positive detection rate of venous catheter abnormalities group was 66.67%, and the negative detection rate was 33.33%. The prognostic differences among participants in this experiment showed SSI (P<0.05). The proportion of abnormal prognosis of venous catheter abnormalities is higher than that of the normal group. ConclusionUltrasound diagnosis of fetal venous catheter abnormalities has high clinical value, which is beneficial for determining whether the fetus has congenital diseases through abnormal venous catheter blood flow spectrum.

Impulse Oscillometry as an Alternative Lung Function Test for Hospitalized Adults.

Impulse oscillometry (IOS) is a noninvasive technique that measures lung physiology independently of patient effort. In the present study, we aimed to investigate the utility of IOS parameters in comparison with pulmonary function testing (PFT) among hospitalized subjects, with emphasis on obstructive and small airway diseases. Sixty-one subjects hospitalized either with unexplained dyspnea or for pre-surgery evaluation were included in the study. All subjects underwent PFTs and IOS test. The correlation between IOS results and PFTs was examined in different subgroups. The ability of IOS parameters to predict abnormal PFTs was evaluated using the area under the receiver operating characteristic (ROC) curve, and optimal cutoff values were calculated. IOS results were found to correlate with PFT values. Subgroup analysis revealed that these correlations were higher in younger (age < 70) and non-obese (body mass index < 25kg/m2) subjects. The resonant frequency was an independent predictor and had the best predictive ability for abnormal FEV1/FVC (area under the ROC curve 0.732 [95% CI 0.57-0.90], optimal cutoff 17 Hz, 87% sensitivity, 62% specificity) and abnormal forced expiratory flow during the middle half of the FVC maneuver (area under the ROC curve 0.667 [95% CI 0.53-0.81], optimal cutoff 15 Hz, 77% sensitivity, 54% specificity). Area of reactance and the difference in respiratory resistance at 5 Hz and 20 Hz also showed a good predictive ability for abnormal FEV1/FVC (area under the ROC curve 0.716 and 0.730, respectively). We found that the IOS performed well in diagnosing small airway and obstructive diseases among hospitalized subjects. IOS might serve as an alternative to standard PFTs in non-cooperative or dyspneic hospitalized patients.

Giant Left Atrial Aneurysm In A Three Year Old

Background: The PA to the LA fistula is a rare cause of central cyanosis. Embryologically, incomplete degeneration of septum between the arterial and venous plexus of the pulmonary vascular bed or defective capillary loop leads to formation of thin-walled sacs resulting in formation of pulmonary arteriovenous fistula. The more restrictive the fistula is, the more subtle is the extent of cyanosis and the less evident is the clinical presentation Case Description We describe the case of three years-old patient, who presented with unresolving pneumonia, that necessitated CT imaging. CT imaging revealed a mass in the posterior mediastinum that was communicating with the left atrium. Originally it was thought that this is an aneurysmal dilation of one of the pulmonary veins, that could have resulted from mitral regurge. Echocardiography showed an aneurysmal dilation of the left atrium, with an abnormal retrograde flow across the roof of the left atrium, pulmonary hypertension and mitral regurge were excluded. 3D CT angiographic reconstruction revealed the presence of a fistulous communication between the RPA and left atrium, this explains the low normal oxygen saturations of this patient due to mixing (90-92%) and the high hemoglobin concentration (160) due to chronic subclinical hypoxia. Conclusion and learning points Aneurysmal dilation of left atrium is commonly encountered with severe mitral regurge, rare causes such as PA to LA fistulae should be thought of especially if clinical or subclinical hypoxia or polycythemia is present.

Kiosk 2R-TC-04 - Assessment of Abnormal Transvalvular Flow and Wall Shear Stress for Pediatric/young Adults with Bicuspid Aortic Valve: A Cross-sectional 4D Flow Study

Kiosk 2R-TC-04 - Assessment of Abnormal Transvalvular Flow and Wall Shear Stress for Pediatric/young Adults with Bicuspid Aortic Valve: A Cross-sectional 4D Flow Study

Effect of IFRS Convergence on Real Earnings Management in Nigerian Manufacturing Firms.

This research endeavors to present empirical insights into the influence of IFRS convergence on real earnings management (REM) within Nigerian Manufacturing Firms. The study utilizes data sourced from the Nigerian Exchange Group (NGx), with a sample size consisting of 5 manufacturing firms. Secondary data is employed for analysis. Financial statements spanning from 2014 to 2023 were utilized to conduct descriptive statistical analyses pertaining to the pre-convergence stage of IFRS. The study employed ex-post facto research design. The methodology incorporates descriptive, correlation, and regression analyses. This impact is observed through the abnormal operation cash flow proxy, both before and after the convergence of IFRS, with firm size serving as a control variable. The findings of this investigation suggest a positive impact of IFRS convergence on REM and firm size within the selected manufacturing firms in Nigeria. The study thus concluded that IFRS convergence on has a huge significant impact on real earnings management (REM) of Nigerian Manufacturing Firms. The study recommended amongst other that there is a pressing need for enhanced monitoring and enforcement mechanisms to ensure compliance with IFRS standards and prevent any potential resurgence of earnings management practices

Quantitative assessment of dysphagia in myasthenia gravis.

Objective Dysphagia is a common and disabling symptom in patients with myasthenia gravis (MG). Moreover, it is caused by muscle weakness or fatigability in the pharynx, swallowing, and respiration discoordination. The current study aimed to establish a novel method for evaluating swallowing difficulty in patients with MG. Methods The ventilation patterns and submental surface electromyography (sEMG) activity of the swallowing reflex were simultaneously recorded for 10 min during the continuous infusion of distilled water (150 mL/h) into the pharynx in 10 patients with MG and 22 healthy controls. Moreover, we assessed excessive expiratory flows, clusters of excessive expiratory flows, high-inspiratory flows, and prolonged EMG patterns. Results Patients with MG who presented with dysphagia had abnormal excessive expiratory flows, clusters of excessive expiratory flows, high inspiratory flows, and prolonged EMG patterns compared to healthy controls (all p <0.05). Among these parameters, the incidence of an excessive expiratory flow, cluster of excessive expiratory flows, and prolonged EMG pattern significantly improved after treatment (p <0.05). Conclusion Based on this study, the respiratory patterns and submental sEMG are likely to reflect the severity of pharyngeal muscle weakness/fatigability and thus can be used as a quantitative parameter for dysphagia in patients with MG.

Kiosk 4R-TA-05 - Anatomy of Neo-aorta in Hypoplastic Left Heart Syndrom Can Cause Abnormal Flow Patterns

Kiosk 4R-TA-05 - Anatomy of Neo-aorta in Hypoplastic Left Heart Syndrom Can Cause Abnormal Flow Patterns

Longitudinal trajectories of cognitive decline and cerebral blood flow abnormalities in octogenarian men with normal global cognition

AimsCognitive and perfusion changes have been previously observed in older men with Mini Mental State Examination scores>24 points. We aimed to investigate time change in cognitive domains in a cohort of non-demented men between age 68 and 82, and how they are expressed in regional defects estimated by Cerebral Blood Flow (rCBF). Methods103 men at age 81 with MMSE scores >24 (mean 28.4 ± 1.7), no dementia or stroke, were examined with the same cognitive test battery at age 68 and age 81: Synonyms (SRB-1), Block design (SRB-3), Paired Associates, Digit Symbol Substitution and Benton Visual Retention test. rCBF was estimated using 99mTc-HMPAO SPECT at age 82. ResultsBetween ages 68 and 82 we observed a relative decline (Δ%) of cognitive test scores: SRB-3 and Benton tests, -33.7 % (SD 16,8) and -25.8 % (SD 23.9) respectively, followed by Digit Symbol test: -22,6 % (SD 15,6). The cluster of men (46 %) could be detected, grouped on the largest test score decline and highest overall test predictors’ importance in decreasing order: Δ% SRB-3, Δ% Paired Associates, Δ% Digit Symbol, Δ% Benton VR and Δ% SRB-1. Compared to the cluster with stable cognitive functions, it expressed lower rCBF in frontal and parietal lobes, and in subcortical areas. ConclusionNearly half of the studied, community-dwelling cohort of non-demented, octogenarian men with MMSE > 24, had a combination of decreasing visuospatial ability and episodic memory during preceding years, expressed by widespread rCBF changes in fronto-subcortical areas.

Factors affecting TIMI (Thrombolysis In Myocardial Infarction) flow grade in patients undergoing primary PCI (Percutaneous Coronary Intervention).

Objective: To determine the causes of normal blood flow in coronary arteries in patients presenting with STEMI and receiving pPCI. Study Design: Observational study conducted retrospectively. Setting: National Institute of Cardiovascular Disease (NICVD) Karachi, Cath Lab. Period: August 17 2020 to November 2020. Material &amp; Methods: Data was obtained from patients presented to the emergency department with STEMI and experienced primary PCI in last two years from January 2016 to Decemebr 2018.Social Sciences (SPSS) version 19 was used analyze these data.Th in those patients who had suboptimal coronary blood flow. Young patients &lt;40 years of age had more (14%) normal coronary blood flow as compared to elders i.e &gt;40 years. Diabetes mellitus, Hypertension, and smoking had no significant impact on coronary blood flow in these patients. Conclusion: In this study, it was found that most of the coronary arteries had abnormal blood flow during primary PCI. Multiple factors are affecting the blood flow in coronaries. The onset of symptoms and the time presented in the hospital was the main factors. Further studies are required to find more reasons for having normal blood flow in coronaries in STEMI.

The Effect of Accrual Earnings Management and Real Earnings Management on Environmental, Social, and Governance (ESG) Reporting Performance

This research aims to offer empirical insights into variations in earnings management within companies categorized in the Environmental, Social, and Governance (ESG) score ranking, and seeks to establish a correlation between earnings management practices and Environmental, Social, and Governance (ESG) performance. The study scrutinizes accrual earnings management alongside real earnings management. The Environmental, Social, and Governance (ESG) score ranking comprises four categories: low, medium, high, and severe. Accrual earnings management is gauged through the modified Jones model, while real earnings management is assessed using three proxies ABNCFO, ABNPROD, and ABNDISC. The research focuses on manufacturing companies possessing Environmental, Social, and Governance (ESG) scores and adopts a purposive sampling approach. The outcomes reveal distinctions between ABNCFO and ABNPROD real earnings management in the severe and low ESG rating groups, whereas no differences exist in accrual earnings management and ABNPROD real earnings management. Additionally, the study establishes that ABNCFO and ABNDISC real earnings management significantly influence Environmental, Social, and Governance (ESG) performance positively. Conversely, accrual earnings management shows no adverse impact on Environmental, Social, and Governance (ESG) performance, and ABNPROD real earnings management exhibits a positive albeit insignificant effect on Environmental, Social, and Governance (ESG) performance. The practical implication of this research is that when the company has a high ESG score which reflects the uncertainty of the company's future operations, the company tends to carry out real earnings management in the form of abnormal cash flow operations (ABNCFO) and abnormal discretionary expenses (ABNDISC).

Clinical Outcome of Monochorionic Diamniotic Twins with Intrauterine Growth Restriction.

This study investigated the clinical outcome of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR). International Peace Maternal and Child Health Hospital of Shanghai ultrasound database was investigated to identify all MCDA delivered from January 2013 to December 2017. After identifying 43 pairs of MCDA twins with sIUGR and 282 pairs of normal MCDA twins, we compared clinical outcomes between the two groups. Compared with normal twins, sIUGR fetuses had significantly shorter gestational age at delivery, smaller average birth weight of both twins, more significant intertwin difference in birth weight, lower Apgar scores, and higher intrauterine fetal demise (IUFD) rate, and smaller placental weight. The rate of abnormal umbilical cord insertions and abnormal blood flow in the ductus venosus (DV) and middle cerebral artery (MCA) is significantly higher in the sIUGR group. In addition, the subtype analysis of sIUGR groups indicated the poorest outcomes in type II with no significant difference between type I and III. MCDA twins with sIUGR generally exhibited limited clinical outcomes than normal MCDA twins. These limitations are mainly associated with abnormal umbilical cord insertions and blood flow in the DV and MCA. Clinical outcomes differed among the three types of sIUGR, with type II having the worst prognosis and the highest IUFD rate. · sIUGR generally exhibited limited clinical outcomes than normal MCDA twins.. · These limitations are mainly associated with blood flow of the DV and MCA.. · sIUGR with type II has the worst prognosis and the highest IUFD rate..

Maternal serum fatty acid binding protein-4 level is upregulated in fetal growth restriction with abnormal Doppler flow patterns.

This study aimed to determine fatty acid binding protein-4 (FABP-4) concentrations in maternal serum of fetal growth restriction (FGR) pregnancies and controls of normal pregnancies. Furthermore, we hypothesized that the alterations in FABP-4 levels might correlate with FGR severity. We performed this prospective case-control study with 83 pregnant women. The study groups included 26 FGR pregnancies without abnormal fetal Doppler flow patterns and 25 pregnancies complicated with FGR accompanied by abnormal fetal Doppler flow patterns. The median serum FABP-4 concentrations were significantly higher in the FGR cases with abnormal Doppler flow pattern group (2.09 ng/mL) than in the FGR cases without abnormal Doppler flow pattern group (1.62 ng/mL) and the control group (1.20 ng/mL, p < 0.001). A significant negative correlation was observed between maternal serum FABP-4 levels and time to birth from blood sample collection (r = -0.356 and p = 0.001), gestational week at birth (r = -0.386 and p < 0.001), and birth weight (r = -0.394 and p < 0.001). A 1.35 ng/mL cut-off value of serum FABP-4 level could be used to discriminate FGR cases with a 78.4% sensitivity and 60.6% specificity. The optimal cut-off value of FABP-4 levels as an indicator for the diagnosis of FGR with abnormal Doppler flow pattern was estimated to be 1.76 ng/mL, which yielded a sensitivity of 84.0% and a specificity of 75.8%. FABP-4 is a crucial biomarker in the diagnosis and determining the severity of pregnancies with restricted fetal growth. We consider that FABP-4 is a powerful, reliable, and unique biomarker to diagnose FGR pregnancies.

A study of the transaction volume prediction problem based on recurrent neural networks

With the rapid development of artificial intelligence technology, intelligent fintech scenarios based on big data are receiving more and more attention, and through the analysis of massive financial class data, accurate decision support can be provided for its various scenarios. By predicting the transaction volume of a financial product of a bank, abnormal transaction flow and gradual change trend can be found 1 day in advance to provide decision support for business department program development, and provide decision support for system expansion and contraction, thus reducing system online pressure or releasing unnecessary system resources. Linear algorithms such as AR model, MA model, ARMA model, etc. have poor prediction results for transaction volumes during holidays in the non-stationary dataset handled in this study due to strong assumptions on historical data. In this paper, we design and implement an LSTM-based trading volume prediction model LSTM-WP (LSTM-WebPredict) using deep learning algorithm, which can improve the accuracy of prediction of holiday trading volume by about 8% based on the linear algorithm by discovering and learning the features of historical data, and the learning ability of the model will gradually increase with the increasing of training data; Not only that, the research of this algorithm also provides corresponding technical accumulation for other business scenarios of time series problems, such as trend prediction and capacity assessment.

INDUCTION OF CARDIAC ARRHYTHMIAS DURING BICYCLE ERGOMETRY IN THE DIAGNOSIS OF CORONARY HEART DISEASE

HighlightsThe frequency of arrhythmias during bicycle ergometry was compared in patients with and without coronary heart disease. Their diagnostic significance in diagnosing this disease was analyzed separately for men and women. AbstractAim. To determine the diagnostic significance of exercise-induced cardiac arrhythmias (CAs) during bicycle ergometry (BEM) in patients with suspected coronary heart disease (CHD).Methods. For the retrospective study, 384 case histories of patients discharged from the cardiology department between 2011 and 2020 were selected according to the inclusion and exclusion criteria. The data of BEM and coronary angiography were studied. The correlation between the occurrence of induction of different types of CAs during BEM and the presence of coronary artery blood flow abnormalities was investigated. Indicators of the diagnostic significance of CAs in the diagnosis of coronary artery disease, such as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) results, were determined separately for men and women. The statistical significance of the results was assessed.Results. Statistically significant specificity and PPV for the induction of ventricular arrhythmias (VAs) without taking into account rare single monomorphic ventricular extrasystoles (VEs) in the diagnosis of CHD in men were 83.5% and 73.1%, respectively. The same indicators for VAs, excluding all single VEs, were 95.3% and 82.6% in men.Conclusion. The induction of VAs in men on BEM, with the exception of rare single monomorphic VEs, is diagnostically significant in the detection of CHD and allows us to qualify the result of BEM as “positive”. The induction of other CAs on BEM has not shown diagnostic significance in the detection of CHD.

Popliteal artery aneurysm ultrasound criteria for reporting characteristics.

Duplex ultrasound (DUS) is the modality of choice for surveillance of popliteal artery aneurysms (PAAs). However, noninvasive vascular laboratories have no standard guidelines for reporting results. This study assessed reports of PAA DUS for inclusion of information pertinent to operative decision-making and timing of surveillance. This study was a retrospective review of a multi-institutional repository that was queried for all patients with a PAA from 2008 to 2022 and confirmed via manual chart review. DUS reports were abstracted and images were individually annotated for features of interest including dimensions, flow abnormalities, and percent thrombus burden. A total of 166 PAAs in 130 patients had at least one DUS available for viewing. Postoperative surveillance of PAAs was performed at several intervals: the first at 30 months (IQR 3.7-113, n = 44), the second at 64 months (IQR 20-172, n = 31), and the third at 152 months (IQR 46-217, n = 16) after the operation. The largest diameter of operative PAAs (median 27.5 mm, IQR 21.8-38.0) was significantly greater than nonoperative PAAs (median 20.9 mm, IQR 16.7-27.3); p < 0.01. Fewer than 33 (21%) reports commented on patency of distal runoff. We calculated an average percent thrombus of 60% (IQR 19-81) in nonoperative PAAs, which is significantly smaller than 75% (IQR 58-89) in operative PAAs; p < 0.01. In this multi-institutional retrospective study, PAAs are often not followed at intervals recommended by the Society for Vascular Surgery guidelines and do not include all measurements necessary for clinical decision-making in the multi-institutional repository studied. There should be standardization of PAA DUS protocols performed by all noninvasive vascular laboratories to ensure completeness of PAA DUS images and inclusion of characteristics pertinent to clinical decision-making in radiology reports.