Cardiothoracic Ratio Research Articles

Transthoracic Device Closure, Transcatheter Device Closure, and Surgical Repair via Right Submammary Thoracotomy for Restrictive Ventricular Septal Defect, a Respective Comparative Study

Background Few comparative studies have focused on the advantages and disadvantages of transthoracic device closure, transcatheter device closure, and surgical repair via right submammary thoracotomy for restrictive ventricular septal defect (VSD). In this article, we compared the safety, efficacy, and clinical effects of these three treatments. Methods: The clinical data of 192 pediatric patients with a restrictive VSD in our hospital from January 2017 to May 2018 were retrospectively collected and analyzed. According to the different treatments, the patients were divided into three groups (the surgical and device groups). Results: There was no significant difference in the demographic characteristics, VSD size, mean pulmonary artery pressure, or cardiothoracic ratio. In addition, there were significant differences in the duration of mechanical ventilation, operation, hospitalization, and ICU stay between the two device groups and the surgical group, but there were no significant differences between the two device groups. Conclusions: Transthoracic device closure, transcatheter device closure, and surgical repair via right submammary thoracotomy for restrictive VSD repair are all safe and feasible. These three treatments have their own disadvantages and advantages and should be selected according to individual patients.

New formula for cardiothoracic ratio for the diagnosis of cardiomegaly on post-mortem CT.

The cardiothoracic ratio (CTR) is considered to be a reliable detector of cardiomegaly on computed tomography for livings, with a threshold of 0.5. Our study aimed to establish an adjusted CTR-based score to predict cardiac hypertrophy at PMCT. We selected adult's autopsy cases examined between 2009 and 2016. Two groups were considered, a normal heart weight group and an overweighed heart group. The CTR was measured on axial images. Logistic regression analysis was performed to investigate the discriminating power of the CTR between groups when adjusted to the confounding factors. Sixty-six cases with normal heart weight and 94 cases with overweighed heart were analyzed. The factors associated to the cardiac hypertrophy are CTR (p value 0.003, OR 3.57), BMI (p value 0.055, OR 1.09), age (p value < 0.001, OR 1.67), and gender (p value 0.002, OR 4.85). The area under the ROC curve (receiver operating characteristic curve) was 0.77 when using CTR alone and 0.88 when considering BMI, age, and gender. In conclusion, CTR alone cannot be used to discriminate between normal heart weight and overweighed heart at PMCT. A new formula has been developed, including age, gender, and BMI. Dilatation of the cardiac chambers, which is a subjective evaluation, influences the CTR measure and could be not related to a pre-existing cardiac hypertrophy. This new score formula allows to overpasses this subjective step. We proposed a cut-off value of the score of 32 for the diagnosis of cardiac hypertrophy. The Internet/smartphone application (http://calc.chuv.ch/CTR) facilitates its routine application.

Prenatal and postnatal ultrasound assessment and clinical prognostic analysis for Ebstein anomaly

Objective: To investigate the echocardiographic features of fetal Ebstein's anomaly (EA) and to analyze its clinical outcome and prognosis. Methods: A retrospective case-control study was conducted to analyze the echocardiographic features in fetus with EA. Thirty-five EA fetuses (EA group) and 35 normal fetuses matched for gestational age (control group) were enrolled. The main echocardiographic parameters of the two groups were collected and compared. According to the direction of blood flow in the ductus arteriosus (DA),fetuses in EA group were divided into DA reverse perfusion subgroup (n=11) and normal DA blood flow subgroup (n=24). The echocardiographic parameters and GOSE scores were compared between the two subgroups. The echocardiographic features of EA and the difference of fetal hemodynamics were summarized,and the clinical outcome of EA fetus was evaluated by GOSE score. Chi-square test Rank sum test or t test were used for comparison between groups. Results: Nineteen (54%) of the 35 patients terminated the pregnancy and 16 (46%) continued pregnancy until delivery during follow-up. Compared with the normal fetus group,the cardiothoracic ratio was significantly higher (0.47±0.11 vs. 0.34±0.01, t=6.640, P<0.01) and the transverse diameter ratio of right atrium to left atrium was significantly greater (1.42±0.38 vs. 1.08±0.11, t=5.030, P<0.01) in the EA group, and the ratio of pulmonary artery diameter to aortic diameter was significantly lower in the EA group (1.04±0.21 vs. 1.20±0.15, t=-3.770, P<0.01). Compared with the normal DA blood flow subgroup,the GOSE scores ≥ 1.5 was more frequently seen (7/11 vs. 3/24, P=0.004) and the ratio of pulmonary artery diameter to aortic diameter was significantly lower (0.91±0.18 vs. 1.24±0.20, t=-4.696, P=0.002) in the DA reverse perfusion subgroup. Six of the 16 delivery cases underwent EA corrective surgery after birth with 100% successful rate of operation. Among the 6 cases,two had preoperative GOSE score of ≥1.5 who were considered as severe cases,and four had low GOSE score of<1.5. The remaining ten cases who had not undergone the corrective surgery were followed up routinely. Conclusion: Prenatal hemodynamics of EA combined with GOSE score can more accurately evaluate the severity and prognosis of fetal EA, reduce unnecessary labor induction, and improve postpartum cure rate and clinical outcomes.

Prenatal diagnosis and management of homozygous hemoglobin constant spring disease.

To describe fetal management of homozygous hemoglobin constant spring (Hb CS). Six fetuses with homozygous Hb CS disease undergoing intrauterine transfusion (IUT) were comprehensively reviewed. Additionally, when combined with 8 cases previously reported, a total of 14 cases were analyzed. The first clues of diagnosis were hydropic changes suggesting fetal anemia. Increased cardiothoracic diameter ratio (CTR) was the most sensitive sonographic marker but slowly changed after IUT, whereas MCA-PSV was the most sensitive in response to IUT. Pre-IUT Hb varied from 1.1% to 6.8%. Gestational age at diagnosis was 17-29 (22.8 ± 3.3) weeks. Rates of adverse obstetric outcomes were relatively high; preterm birth: 35.7%, low birthweight: 42.9%, and fetal growth restriction: 28.6%. All showed good response to IUT with disappearance of hydropic signs and all survived without short-term complications. Their anemia gradually improved in childhood and transfusion independent. Homozygous Hb CS can cause severe fetal anemia. Early diagnosis and IUT can improve neonatal outcomes, probably preventing adult diseases caused by fetal programming.

Reverse Remodeling of Pulmonary Arterioles After Pulmonary Artery Banding in Patients ≥ 2 Years Old with Severe Pulmonary ArterialHypertension and Congenital Heart Disease.

The purpose of this study was to evaluate the pathological changes of the pulmonary arterioles in patients ≥ 2 years of age who first underwent a pulmonary artery banding (PAB) procedure, followed by bidirectional Glenn or Fontan according to their specific conditions. This was a prospective study of 15 children diagnosed and treated with PAB at the Department of Cardiothoracic Surgery of Anzhen Hospital between January 2009 and December 2012. The percentage of media area (%MS) of pulmonary arteriole, the percentage of media thickness (%MT), and pulmonary arterial density (APSC) were calculated from lung tissue sections. Pulmonary artery pressure decreased significantly after PAB surgery (P < 0.01). Postoperative mean pulmonary artery pressure declined significantly (P < 0.01), the cardiothoracic ratio was reduced (P < 0.05), and percutaneous oxygen saturation (inhaled air) decreased to 80-85% (P < 0.01). %MT (from 35.1 ± 5.6% to 26.9 ± 4.3%, P < 0.01), %MS (from 51.4 ± 6.7% to 32.2 ± 7.4%, P < 0.01), and APSC (from 108.3 ± 38.5 to 83.6 ± 19.6, P < 0.01) were decreased significantly after PAB. Five patients underwent the bidirectional Glenn procedure and four underwent Fontan. In conclusion, the results suggest that PAB can reduce pulmonary artery pressure and that pulmonary arterial lesions can be reversed after PAB.

Cardiac Trabeculae Parameters and Implications for Cardiovascular Health

Quantitative data describing the cardiac trabecular muscle architecture and its variation between individuals are practically absent in the technical literature. Consequently, the relationship of trabecular muscle variation to cardiovascular diseases is largely unknown. Modeling work, using simulations of simplified heart morphology, has previously demonstrated the likely importance of the trabecular layer for enhanced cardiac output, and secondary findings indicated that variation in trabecular mass, diameter, and orientation are impactful on heart functioning. Measurements of variation in trabecular muscle are therefore of potential interest in both a clinical and basic science context. Using a large cadaveric sample, we have quantified the variability in trabecular mass in the left ventricle and investigated its correlation with one known factor in cardiovascular health ‐ relative heart size.With permission from the Keck School of Medicine at the University of Southern California and the USC Anatomical Gift Program, 74 human cadavers managed by the Integrative Anatomical Sciences Department were utilized in the study. The donor population all had known cause of death and a brief summary of pathologies. A standardized region of trabeculae was examined on the posterior‐medial wall of the left chamber where the interventricular septum and posterior papillary muscle meet the apex of the heart.Images were taken of the standardized area and analyzed using ImageJ. Thresholding was used to calculate trabecular density as a ratio of trabeculated area to total area. Use of a fixed threshold, in combination with standardization of lighting, camera position, and region of interest, allowed us to produce a robust comparative metric. Relative trabecular area was the primary comparison of interest since the specific values are dependent on the thresholding value (which was chosen for methodology ease and was biologically arbitrary). Cardiothoracic ratios were also obtained for all individuals. The maximal horizontal thoracic diameter was standardized at rib seven, and the cardiac diameter was taken at the longest basal diameter of the heart using digital calipers.The fraction of trabeculation varied from 64.50–82.12%, demonstrating that trabecular muscle density is highly variable between individuals. Qualitatively, there was also large variations in diameter, layering, and average orientation of trabecular muscle. We found that there is a relatively strong correlation (Pearson Product Moment Coefficient of 0.43, p&lt;0.08) between relative trabecular area and cardiothoracic ratio. Based on these results, it is plausible that variations in cardiac trabeculae have an impact on overall heart health and long‐term risk for cardiovascular disease. Trabecular muscle variation could be a useful correlate in understanding individual variation in cardiac efficiency, development, and disease. Our work provides a framework for future analysis of this understudied aspect of human variation. Future work on this problem should include trabecular orientation and diameter as additional variables. Digital imaging to source data may also provide a more complete picture of trabecular morphology and predictors of cardiac efficiency.Support or Funding InformationUSC Provost's OfficeThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Efficacy of Long-term Selenium Supplementation in the Treatment of Chronic Keshan Disease with Congestive Heart Failure

Few effective treatments for chronic Keshan disease have been available till now. The efficacy of long-term selenium supplementation in the treatment of chronic Keshan disease with congestive heart failure is inconclusive. This study aimed to determine whether selenium supplementation is associated with a decreased risk of cardiac death in chronic Keshan disease with congestive heart failure by ten years of follow-up. A retrospective long-term follow-up analysis was performed on a monitored cohort consisting of 302 chronic Keshan disease patients with a mean age of 40.8±11.4 years. Of the 302 chronic Keshan disease patients, 170 (56.3%) were given selenium supplementation until the end point of follow-up. Cox proportional hazards regression models were used to identify the independent predictors of cardiac events. Our results showed that during the follow-up, there were 101 deaths of patients with chronic Keshan disease in the selenium supplementation group (101/170, 59.4%) and 98 in non-selenium supplementation group (98/132, 74.2%). Multivariate analyses suggested that selenium supplementation was associated with a decreased risk of cardiac death (HR 0.39, 95% CI 0.28-0.53) after adjustment for baseline age, sex, cigarette smoking, family history of Keshan disease, body mass index (BMI), heart rate, electrocardiogram (ECG) abnormalities, blood pressure, initial cardiothoracic ratio, left ventricular ejection fractions (LVEF) and whole-blood selenium concentration. Our ten-year follow-up analysis indicated that selenium supplementation, specifically combined with the use of angiotensin-converting enzyme inhibitor and beta blocker therapy, improved the survival of patients with chronic Keshan disease with congestive heart failure. BMI, selenium deficiency, male, combined ECG abnormalities, LVEF, and fast heart rate increased the risk of cardiac events.

Increased Aortic Arch Calcification and Cardiomegaly is Associated with Rapid Renal Progression and Increased Cardiovascular Mortality in Chronic Kidney Disease

Vascular calcification and cardiomegaly are highly prevalent in chronic kidney disease (CKD) patients. However, the association of the combination of aortic arch calcification (AoAC) and cardio-thoracic ratio (CTR) with clinical outcomes in patients with CKD is not well investigated. This study investigated whether the combination of AoAC and CTR is associated with poor clinical outcomes in CKD stages 3–5 patients. We enrolled 568 CKD patients, and AoAC and CTR were determined by chest radiography at enrollment. Rapid renal progression was defined as estimated glomerular filtration rate (eGFR) decline over 3 ml/min/1.73 m2 per year. Both AoAC score and CTR were significantly associated with rapid renal progression. High CTR was correlated with increased risk for cardiovascular mortality. We stratified the patients into four groups according to the median AoAC score of 4 and CTR of 50%. Those with AoAC ≥ 4 and CTR ≥ 50% (vs. AoAC score < 4 and CTR < 50%) were associated with eGFR decline over 3 ml/min/1.73 m2/year and cardiovascular mortality. AoAC and CTR were independently associated with eGFR slope. In conclusion, the combination of increased AoAC and cardiomegaly was associated with rapid renal progression and increased cardiovascular mortality in patients with CKD stage 3–5 patients. We suggest that evaluating AoAC and CTR on chest plain radiography may be a simple and inexpensive method for detecting CKD patients at high risk for adverse clinical outcomes.

Analysis of risk factors of infant mortality in the case of fetus' Ebstein's anomaly: results of a multicenter study

Objectives. To analyze retrospectively the factors of high and low risks of infant mortality in the case of fetus' Ebstein's anomaly. Materials. Photos and video materials, and the information from specially designed questionnaires from the participants of the multicenter study were used. In the paper was presented the comparison of echographic parameters among 14 fetuses died antenatally and during the first year of life, and among 13 fetuses that survived during the period of 3 month till 9 years old alive. The ultrasound diagnostics were performed mainly on the facilities of Voluson hardware (General Electric). Results. Sensitivity about 100 % and specificity about 100 % to unfavorable prognosis of Ebstein's anomaly of fetus were in two combinations of 3 parameters: cardiothoracic diameter ratio  0,6 + heart axis (HA) &gt; 60° + diameter of pulmonary artery to diameter of aorta (PA/Ao) &lt; 1,0; Celermajer index  0,9 + HA &gt; 70° + ЛА/ Ао &lt; 1,0. Conclusions. The prenatal diagnosis of Ebstein's anomaly in fetus requires expert detailed echocardiography to identify and analyze the factors of high and low risks of perinatal and infant mortality. The prognostic risk factors of infant mortality, discovered in this study, could be recommended for prenatal family consultation and for the planning of further prenatal care.

Clinical course of dilated cardiomyopathy in children

Background: Dilated cardiomyopathy (DCM) in children is a serious disorder. Here authors study the risk factors for predicting prognosis of dilated cardiomyopathy in children.Methods: An observational case series study done in Institute of child health and research centre, Government Rajaji hospital, Madurai during September 2012 to August 2014. The diagnosis of DCM was based on clinical examination and echocardiographic evidence. Patients were followed up and grouped according to the outcome as improved or cured (group I), no change in clinical status (group II) and worsened or dead (group III).Results: 31 children less than 12 years of age were diagnosed as DCM. 13 children came under group I with a mean age of 2.15±2.5 and the mean cardiothoracic diameter ratio in chest X-ray was 59.8±3.3. The mean left ventricular ejection fraction at the time of admission was 38.7±3.04 and was 52.1±2.7 on last follow up. 11 children came under Group III with a mean age of 5.35±4.4 and the mean cardiothoracic diameter ratio was 65.3±2.7. The mean left ventricular ejection fraction was 35.8±3.7 at admission and 32.6±2.9 on last follow up. Only two children came under Group II and hence their comparison is negligible.Conclusions: Children with higher age at the time of diagnosis, higher cardiothoracic diameter ratio in chest X-ray and a low left ventricular ejection fraction on serial echocardiogram were associated with a poor outcome.

Abstract WP256: Administration of Cilostazol Clarifies the Burden Atrial Fibrillation in Non-Cardioembolic Stroke

Introduction: The survey of atrial fibrillation (AF) is routinely recommended in acute stroke case, even in patients without AF on admission, because the AF leads to a sever stroke. Cilostazol is often used for stroke patients without AF in Japan; however, it has the adverse events of palpitation due to the vessels dilatation by increased nitric oxide. We hypothesized that administration of cilostazol may clarify the burden AF in stroke patients without AF. Methods: From our prospective randomized control study, (randomized to dual antiplatelet therapy using cilostazol and aspirin or aspirin alone targeted patients for non-cardioembolic stroke [ADS]), patients assessed the presence of AF were retrospectively analyzed. Presence of AF was detected using ECG monitoring and Holter ECG. All patients were divided into the AF group and the non-AF group and imaging and laboratory findings were compared between the 2 groups. Multivariate regression analysis was conducted to evaluate the independent factors related to new AF. Results: 1194 patients (793 [66%] men; median age [IQR] of 69 [61-77] years, NIHSS score 2 [1-4], onset-to-admission 10.8 [4.7-20.5] hours) patients were included. AF was newly detected in 41 patients (3 by ECG, 21 by the ECG monitoring and 17 by the Holter ECG) during hospitalization. Patients randomized to the combined cilostazol and aspirin therapy frequently had the AF than those to aspirin alone (29/596 [5%] vs. 12/598 [2%], p=0.007). AF group was older than the non-AF group (76 [72-82] vs. 68 [60-77] years, p&lt;0.001). NIHSS score was similar between AF and non-AF group (5 [3-12] vs. 4 [2-6] p=0.062). Serum brain natriuretic peptide (BNP) level was higher in AF group (65.9 [31.7-145.5] vs. 25.6 [13.1-52.5] ng/ml. p&lt;0.001). Regarding imaging findings, cardio-thoracic ratio (CTR) was elevated (p&lt;0.001), multiple infarcts was frequent (p=0.003) and the infarcts size was larger (&gt;1.5cm) (p&lt;0.001) in AF group. By multivariate regression analysis, cilostazol administration was the independent factor for new AF detection (odds ratio 2.81, 95%CI: 1.30-6.09, p=0.009) adjusting for age, infarct size and number, CTR, BNP, and NIHSS score. Conclusion: Administration of cilostazol increases the detectability of AF in acute non-cardioembolic stroke.

Prenatal diagnosis of fetal intraabdominal extralobar pulmonary sequestration: a 12-year 3-center experience in China

To provide useful information for diagnosing and predicting fetal intraabdominal extralobar pulmonary sequestration (IEPS), a retrospective review of diagnostic approaches was conducted. Ultrasonography was performed serially in 21 fetuses with IEPS from 2005 to 2017. Prenatal sonographic features, treatment, and outcomes of each case were evaluated and collected. These cases of IEPS were also compared to 43 cases previously reported by other researchers from 1986 to 2017. Of the 21 sonographic features, 14 (67%) were hyperechoic, 21 (100%) were well circumscribed, and 17 (81%) depicted a mass that shifted with fetal breaths/hiccups non-synchronized with adjacent organs (sliding sign). Feeding arteries were detected prenatally in 18 patients (86%). The lesion volume was 10.17 ± 4.66 cm3, the congenital cystic adenomatoid malformation volume ratio and cardiothoracic ratio were in normal range. The gestational age at diagnosis, location and echotexture of the lesion, and rate of surgical treatment were similar to previous studies, but with a significantly higher rate of detected feeding arteries (P < 0.01), and associated anomalies (P < 0.01). All infants who underwent surgery after birth had satisfactory outcomes. The sliding sign and feeding artery are essential features of IEPS in prenatal diagnosis.

Radiographic assessment of cardiothoracic ratio in apparently healthy adults in Maiduguri

Background: Cardiothoracic ratio (CTR) is an easy and cheap diagnostic tool in the estimation of the cardiac sizes which is used for the screening and diagnosis of cardiac diseases. Objectives: The study objectives were to assess the normal cardiac size in apparently healthy adults and establish reference ranges in our population for comparison when investigating cardiac diseases. Materials and Methods: Radiographic evaluations of the cardiac size were performed from March 2017 to February 2018 in 172 apparently healthy individuals who were referred to the Radiology Department, Federal Neuro-Psychiatric Hospital, Maiduguri, in Nigeria, for medical examinations. The individuals were divided into the following five age groups: 18–27, 28–37, 38–47, 48–57 and 58 years and above, in order to determine the influence of age on cardiac size. Results: The mean CTR for males and females was 45.10% and 45.71%, respectively, and was statistically insignificant (0.362). The mean CTR of the general population was 45.6%, and the mean CTR value increased with age until the fourth decade when it reduces with age. Conclusion: The result of this study has established the CTR of the Nigerian population in Maiduguri. The CTR gradually increased with age until the fourth decade when it reduces with age. Therefore, establishing normal ranges of CTR is necessary for comparison in a condition where a possible cardiac disease is being examined.

Automatic Cardiothoracic Ratio Calculation With Deep Learning

Deep learning is a growing trend in medical image analysis. There are limited data of deep learning techniques applied in Chest X-rays. This paper proposed a deep learning algorithm for cardiothoracic ratio (CTR) calculation in chest X-rays. A fully convolutional neural network was employed to segment chest X-ray images and calculate CTR. CTR values derived from the deep learning model were compared with the reference standard using Bland-Altman analysis and linear correlation graphs, and intra-class correlation (ICC) analyses. Diagnostic performance of the model for the detection of heart enlargement was assessed and compared with other deep learning methods and radiologists. CTR values derived from the deep learning method showed excellent agreement with the reference standard, with mean difference 0.0004 ± 0.0133, 95% limits of agreement -0.0256 to 0.0264. Correlation coefficient between deep learning and reference standard was 0.965 (P <; 0.001), and ICC coefficient was 0.982 (95% CI 0.978-0.985) (P <; 0.001). Measurement time by deep learning was significantly less than that of the manual method [0.69 (0.69-0.70) VS 25.26 (23.49-27.44) seconds, P <; 0.001]. Diagnostic accuracy, specificity, and positive predictive value were comparable between the two methods. However, deep learning showed relatively higher sensitivity and negative predictive value (97.2% vs 91.4%, P = 0.004; and 96.0% vs 89.0%, P = 0.006; respectively) compared with the manual method. Performance of this computer-aided technique was demonstrated to be more reliable, time and labor saving than that of the manual method in CTR calculation.

HEART MEASUREMENTS OF NON-HUMAN PRIMATES BY RADIOGRAPHIC TECHNIQUES

Abstract Thoracic Radiology is a diagnostic technique used to study several aberrations, including cardiac abnormalities, which can be determined by VHS (vertebral heart size). The heart length and width are measured, and the CTR (cardiothoracic ratio) is calculated, by comparing the heart width to the thoracic diameter. This study aimed at measuring the cardiac silhouette of non-human primates (PNH) belonging to the genus Sapajus sp., and the Alouatta guariba species through VHS and CTR. From among the eight animals assessed, it was evident that in both the Sapajus sp. and the Alouatta guariba, the highest HSV change index was observed, depending upon the age of the animal. However, although the individuals of the Alouatta guariba species are bigger in size and heavier, the animals of the genus Sapajus sp. have a larger heart size in proportion to their body.

Correlation between Aortic Calcification Score and Biochemical Parameters in Hemodialysis Patients.

The purpose of this study was to determine the correlation between aortic calcification and demographic and biochemical parameters in hemodialysis patients. Calcification scores of the aortic arch and abdominal aorta were determined from multi-slice computed tomography scans and evaluated according to the Agatston score. The associations between demographic and biochemical parameters and aortic calcification score were determined. In total, 190 patients were included in the study. There was a significant positive correlation between aortic calcification scores and age, duration of hemodialysis, cardiothoracic ratio, normalized protein catabolic rate, brachial-ankle pulse wave velocity (baPWV), serum markers of mineral metabolism, and inflammation. A significant negative correlation was found between aortic calcification scores and platelet count. Multivariate analysis showed that age, duration of hemodialysis, baPWV, phosphate, calcium and phosphate (Ca×P) product, parathyroid hormone, and C-reactive protein levels were independent risk factors for calcification of the aortic arch, while baPWV and Ca×P product were independent risk factors for calcification of the abdominal aorta. Key Messages: Aortic calcification scores correlate with age, duration of hemodialysis, and several biochemical parameters of inflammation and mineral metabolism.

Correlation of age and weight with radiographic cardiac indices and cardiothoracic ratio in goats

Correlation of age and weight with radiographic cardiac indices and cardiothoracic ratio in goats

Cardiothoracic area ratio for evaluation of ejection fraction in patients

Cardiothoracic area ratio for evaluation of ejection fraction in patients

Changes in bioimpedance analysis components before and after hemodialysis.

BackgroundThis study compared nutritional parameters in hemodialysis (HD) subjects and controls using bioimpedance analysis (BIA) and investigated how BIA components changed before and after HD.MethodsThis cross-sectional study included 147 subjects on maintenance HD from two hospitals and 298 propensity score-matched controls from one healthcare center. BIA was performed pre- and post-HD at mid-week dialysis sessions.ResultsExtracellular water/total body water (ECW/TBW) and waist-hip ratio were higher in the HD patients; the other variables were higher in the control group. The cardiothoracic ratio correlated best with overhydration (r = 0.425, P < 0.01) in HD subjects. Blood pressure, hemoglobin, creatinine, and uric acid positively correlated with the lean tissue index in controls; however, most of these nutritional markers did not show significant correlations in HD subjects. Normal hydrated weight was predicted to be higher in the pre-HD than post-HD measurements. Predicted ultrafiltration (UF) volume difference based on pre- and post-HD ECW/TBW and measured UF volume difference showed a close correlation (r2 = 0.924, P < 0.01). Remarkably, the leg phase angle increased in the post-HD period.ConclusionThe estimated normal hydrated weight using ECW/TBW can be a good marker for determining dry weight. HD subjects had higher ECW/TBW but most nutritional indices were inferior to those of controls. It was possible to predict UF volume differences using BIA, but the post-HD increase in leg phase angle, a nutritional marker, must be interpreted with caution.

Evaluation of effectiveness and safety of the first Russian-manufactured generic bosentan use in patients with pulmonary arterial hypertension

Objective. To study effectiveness and safety of generic bosentan use for 24 weeks in patients with pulmonary arterial hypertension (PAH). Materials and methods. The study included 42 patients. In 22 patients Bosentan therapy (Bosenex®, Sotex, Russia) was used for the first time. In 20 patients switching therapy from original bosentan (Tracleer, Аctelion Pharmaceuticals Ltd., Switzerland) was performed. The patients were followed up for 24±2 weeks. Results. After 24 weeks of treatment percent of patients with functional class (FC) III decreased from 55 to 30%, percent of patients with FC II increased from 45 to 55%, some patients (15%) achieved FC I, and the 6-minute walk distance increased on 52.1 meters. In the group of therapy change heart failure FC stabilization was observed, 6-minute walk distance increased on +14.8 meters (р&gt;0.05). Echocardiography in the first group showed significant decrease of pulmonary artery systolic pressure (PASP) at -4 mm Hg and of right atrium area on 0.9 cm2. In the switched therapy group the difference was not significant. According to chest X-ray examination change of cardio-thoracic ratio, Murray and Lupi indexes was not significant in both groups. According to results of right heart catheterization improvement of mean pulmonary arterial pressure (-6.7 mm Hg), mean right atrial pressure (-1.6 mm Hg with reference value reached), and pulmonary vascular resistance (-293.2 dynes×sec/cm-5) was achieved; р