Cut Off Research Articles

The assessment of myopenia and muscle biopsy in pediatric patients with liver disease awaiting liver transplantation – A cross-sectional analysis

Little is known about the skeletal muscle characteristics (fibre type proportion and size, location of nuclei, presence of fat infiltration) in children with liver disease with radiologically determined myopenia (low muscle mass). During liver transplantation (LTx) surgery, biopsies from the rectus abdominis muscle were collected. Muscle fibre types (I, I/IIA, IIA, IIA/X, IIX) and CSA index (µm/m2) were determined using immunofluorescence staining. Triacylglycerol (TAG) and phospholipid content of muscle was determined using gas chromatography. Myopenia was defined using study-specific cut offs (skeletal muscle index <-2SD) from age-sex matched healthy control scans. Myopenia was prevalent in 41% of children. Children also had a high prevalence of high muscle adiposity (37%). Children with myopenia were older (8.4 vs. 0.7 yrs; p<0.001), had smaller total (median 595 vs. 844 µm/m2; p=0.04) and hybrid IIA/X (612±143 vs. 993±341 µm/m2; p=0.04) muscle fibre size index, lower prevalence of type I fibres (53 vs. 64%; p=0.01) and higher prevalence of type IIA/X hybrid fibres (median 7.5 vs. 0%; p=0.04). Children with myopenia also had a higher prevalence of elevated TAG content (>75 percentile) within the muscle compared to children without myopenia (36% vs 0%; p=0.009). Percent of muscle fibres with centralized nuclei were not different between groups. In conclusion, children with myopenia experience differences in skeletal muscle biological characteristics when compared to children without myopenia at LTx and these findings may have implications for dietary and exercise rehabilitation pre-and post-LTx.

Do obese patients undergoing extracorporeal membrane oxygenation have a higher mortality ? a systematic review and meta-analysis

Abstract Background While ECMO is a life-saving intervention for patients with severe respiratory or cardiac failure, the impact of obesity on its efficacy and associated risks remains unclear. Purpose We aimed to perform a systematic review and meta-analysis comparing whether obese individuals undergoing ECMO face higher mortality and morbidity risks compared to their non-obese counterparts. Methods PubMed, Embase, and Cochrane were searched in December 2023 for studies comparing the outcomes between obese versus non-obese patients undergoing extracorporeal membrane oxygenation. We computed mean differences (MD) for continuous outcomes and odds ratios (OR) for binary outcomes, with 95% confidence intervals (95%CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R version 4.2.3. Results Twenty-two studies comprising 39,322 participants were included in the meta-analysis. We divided the exposure and the control into 4 pairwise meta-analyses including BMI cut-off values of <25 kg/m², <30 kg/m², <35 kg/m², <40 kg/m². There were no significant differences between groups with a BMI <25, <30, <35 in all-cause mortality (<25: OR 0.96; 95% CI 0.76 - 1.21; p: 0.708 / <30: OR 0.88; 95% CI 0.68 - 1.14; p: 0.340 / <35: 0.97; 95% CI 0.80 - 1.19) p: 0.784) respectively; but with an increasing tendency towards favoring a higher BMI. On the other hand, the higher BMI analysis (<40) demonstrated a significant association between higher BMI and less mortality (OR 0.52; 95% CI 0.29 - 0.95; p: 0.034). Conclusion In patients undergoing ECMO, a higher BMI is associated with decreased all-cause mortality.Figure 1.Cut off <25; Cut off <30Figure 2.Cut off <35; Cut off <40

Role of CT-derived global longitudinal strain in identifying left ventricular dysfunction in patients with severe aortic stenosis and preserved left ventricular ejection fraction

Abstract Introduction In patients with severe aortic stenosis, LVEF <50% is a current class 1 indication for aortic valve replacement. There are however studies showing increased mortality in patients with asymptomatic severe aortic stenosis and LVEF between 50-59% [1, 2]. Global longitudinal strain (GLS) has emerged as a more sensitive predictor of systolic dysfunction than ejection fraction in a wide number of cardiac diseases [3]. Purpose The aim of our study was to analyze left ventricular global longitudinal strain (GLS) by cardiac computed tomography (CT) in patients with severe aortic stenosis. We hypothesized that a larger portion of patients with LVEF 50-59% have signs of systolic dysfunction by GLS as compared to patients with LVEF ≥60%. Methods We identified 238 patients (median age 81, 51.3% females) with severe aortic stenosis, assessed by cardiac CT before undergoing transcatheter aortic valve replacement at Uppsala University hospital between 2016-2019. Patients in atrial fibrillation was excluded due to suboptimal image quality. Left ventricular mass index (LVMi), EF and peak GLS were calculated. The patients were divided into three groups based on LVEF (Reduced LVEF <50%, Low-Normal LVEF 50-59% and Normal LVEF ≥60%) and compared with each other regarding GLS, biomarkers and background variables. The cut off for significantly reduced GLS was set at <16%, in accordance with recently proposed criteria [4]. Results As expected GLS was significantly reduced in all patients with LVEF <50%. Among patients with Low-Normal LVEF, 62.3% had significantly reduced GLS as compared to only 3.8% patients with Normal LVEF >60% (p < 0.001). Median GLS in Low-Normal LVEF was 15.5% (IQR 14.1 - 17.4) as compared to 20.2% (IQR 18.4 - 21.9) in Normal LVEF (p < 0.001). Patients with Low-Normal LVEF had a significantly higher LV mass as compared to patients with Normal LVEF (median LVMi 85.8 g/m² vs. 75.8 g/m², p < 0.001). NT-pro-BNP was significantly higher in patients with Low-Normal LVEF compared to Normal LVEF (median 1130 vs. 664 ng/l, p = 0.003). Conclusions Almost two third of patients with severe aortic stenosis and lower range of normal LVEF (50-59%) had abnormally reduced GLS, reflecting systolic LV dysfunction, which was uncommon among those with LVEF >60%. Patients with LVEF 50-59% also presented with higher LV mass index and higher levels of NT-pro-BNP than patients with normal LVEF >60%, reflecting hypertrophic response of the myocardium to pressure overload which over time may lead to progressive myocardial decompensation. LVEF in the range of 50-59% might be an early sign of LV decompensation in severe aortic stenosis.

Elevated GDF-15 is associated with stroke severity, myocardial injury and poor clinical outcome in patients after acute ischemic stroke

Abstract Background GDF-15 is emerging as a biomarker of cardiometabolic risk and disease burden. Increased concentrations of circulating GDF-15 are associated with increased mortality in patients with acute coronary syndromes or heart failure. Purpose We aimed to describe relation between GDF-15 elevation with stroke severity, myocardial injury and poor clinical outcome in patients after acute ischemic stroke (AIS). Methods Patients after AIS were enrolled in our study. Blood samples were obtained from patients at the time of admission, 24 and 48 hours later to determine the plasma levels of GDF-15 and high-sensitive troponin I (hs-cTnI). Receiver-operating characteristic (ROC) curve analysis was used to determine the diagnostic accuracy and optimal elevation cut-off values of GDF-15 on day 1 for the severity of acute stroke defined by NIHSS score. The optimal cut off in our group was 1776 pg/ml (Sensitivity 0,8, Specificity 0,52). Myocardial injury was defined by fourth universal definition of myocardial infarction using hs-cTnI. Demographic characteristics, clinical data, functional outcome, and all-cause mortality at 1 year were compared between groups according to GDF-15 levels. National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following the patient’s discharge from the hospital were used to assess stroke severity and clinical outcome. All analyses were performed with SPSS 29.0 (SPSS Inc). Results Between August 2020 and August 2022, 177 patients after AIS were enrolled. Elevated GDF-15 was observed in 71 patients (40,1%). Most common comorbidities included arterial hypertension, dyslipidemia, type 2 DM and atrial fibrillation. In analysis, we observed a connection between elevated GDF-15 with unfavourable outcome evaluated by mRS at 90 days (HR 2.57, 95% CI 1,44 to 4,57, p=0.001) and with all-cause death at 1 year (HR 4.479, 95% CI 1,81 to 11,09, p=0.001). GDF-15 elevation was associated with myocardial injury (Figure 1C). Moreover, individuals with moderate to severe and severe strokes (NIHSS 16-42) displayed higher GDF-15 levels compared to those with minor to moderate stroke (Figure 1D). The Kaplan-Meier survival curve accentuated a significantly elevated all-cause mortality among patients with increased GDF-15 (p < 0.001) (Figure 2). In multivariate regression analysis elevated GDF-15 was associated with atrial fibrillation and high-sensitive troponin I elevation. Conclusion The conclusions drawn suggest that heightened GDF-15 is associated with increased stroke severity, myocardial injury and unfavourable outcome.

Anemia and sideropenia in patients with decompensated heart failure

Abstract Introduction Anemia is highly prevalent in patients with heart failure (HF). In the latest ESC guidelines, intravenous. iron supplementation is recognized as substantial for improving quality of life, exercise capacity and reducing the risk of future hospitalizations in patients diagnosed with HF of reduced ejection fraction (HFrEF). We hypothesized that patients diagnosed with HF of preserved EF (HFpEF) and midly reduced EF (HFmrEF), who also exhibit iron deficiency, may benefit from intravenous iron supplementation. Method We evaluated the prevalence and parameters of anemia from medical histories of hospitalized patients with HFrEF and HFmrEF/HFpEF, from March 2023 to January 2024, and compared them to NTproBNP levels. Results We included 134 hospitalized patients with HF, mean age 71 ± 10 (41% women). Of total 134, 77 patients exhibited acute worsening of chronic HFrEF or were newly diagnosed HFrEF (group A), whereas 57/134 patients had decompensated HFmrEF/HFpEF (11 and 46, respectively - group B) whose iron status was analyzed on admission. General prevalence of anemia in all HF patients was 50.8% (cut off value - hemoglobin concentration less than 12 g/dL in women, and less than 13 g/dL in men), 54.4% of HFpEF/HFmrEF group and 48.1% of HFrEF group had anemia, 46.6% patients with anemia had EF>40%, without any statistical difference among groups (hemoglobin concentration group A/group B – 12.33±2.54/11.89­±2.63 g/dL, CV 0.2). Reduced transferrin saturation, which is defined as less than 20.0%, had 44.0% of all HF patients, and that was more common in HFrEF patients (62.0%), but statistically insignificant (group A/group B - 0.1843±0.10/0.1877±0.11, CV 0.6). Among group A and group B - 63.6% and 62.5% had transferrin saturation less than 0.2, respectively. There was no difference in the prevalence of serum ferritin <100 μg/L in group A and B (41.6% and 47.4% respectively; group A/group B – 177.26±176.7/137.01±126.6, CV 0.9). Spearman’s rank test implied no correlation between NTproBNP levels and serum ferritin or transferrin saturation. Serum iron had a mild negative (coefficient -2.8) correlation with NTproBNP levels (p<0.01). Hemoglobin concentration was associated with strong negative correlation with NTproBNP levels but with less statistical significance (coefficient -0.9 p<0.05). Conclusion Results of our study suggest that anemia and sideropenia are common in our HF population, with no difference between the spectrum of HF subgroups based on EF. There seems to be a correlation between anemia and serum iron and level of NTproBNP which may imply that anemia and low iron worsen the degree of HF decompensation.

Echocardiography in acute pulmonary embolism for the prediction of subsequent CTEPH

Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a long term complication of acute pulmonary embolism (APE) with poor outcomes if untreated. Identifying already at APE diagnosis patients at risk of subsequent CTEPH can lead to earlier goal-directed management. Since standard echocardiography (TTE) is frequently performed during APE episode for short term risk stratification we aimed to asses prediction vale of echocardiography for subsequent CTEPH. Methods We analyzed retrospectively TTE performed at admission due to APE in consecutive patients, without known CTEPH who were anticoagulated for at least 3 months and were followed up for at least 24 months. After follow-up all patients underwent diagnostic workup for CTEPH according to ESC recommendations. We tried to define a set of echocardiographic parameters recorded during the acute episode predictive for CTEPH. Results The study included consecutive 625 patients with APE diagnosed at computed tomography pulmonary angiogram and managed according to ESC recommendations. During follow up 25 (4%) pts were diagnosed with CTEPH. At APE diagnosis CTEPH(+) group presented more prominent echocardiographic signs of right ventricular (RV) overload than pts without CTEPH (CTEPH(-))(table 1). However, multivariate analysis revealed that only increased TRPG and RV/LV ratio were significant CTEPH predictors with AUC 0.792 (95% CI: 0.683-0.900), p<0.001 and 0.777 (95% CI: 0.675-0.878), p<0.001 respectively (fig 1). Using Youden index in ROC analysis we defined following cut off values useful to identify patients at CTEPH risk and subjects with low probability of CTEPH development. TRPG >44mmHg and RV/LV>1.15 showed PPV for CTPEH 12.9 (95% CI: 9.8-16.7) and 13.8 (95% CI: 10.4-18.1), with high NPV of 98.4 (95% CI: 97.1-99.2) and 98.2 (95% CI: 96.8-99.0) respectively. Importantly, in the group of 61 (9.7%) patients with both signs of RV overload present in the acute phase CTEPH during follow-up was diagnosed in 14 patients (23.0%). Conclusion TRPG above 44 mmHg recorded at APE diagnosis identifies patients at risk of subsequent CTEPH especially in patients with increased RV/LV ratio.

Combined 3D left ventricular-arterial coupling and 3D left atrial-ventricular coupling indices could better predict MACE in young patients with STEMI

Abstract Background Left ventricular arterial coupling index (VAC) proved to be a key determinant of cardiovascular performance. Previous trials also emphasized the prognostic value of left atrial-ventricular coupling index (LACI) that was independently associated with cardiovascular death and all-cause mortality. Both indices have been associated with disease severity and adverse outcomes. Purpose We aimed to evaluate the prognostic role of 3D VAC, 3D LACI and their combination assessed by 3D echocardiography in a cohort of young patients with STEMI. Patients and methods In this prospective study we enrolled 76 young consecutive patients (under 50 years old) with STEMI treated by primary PCI who underwent both 2D and 3D echocardiography. 3D VAC was calculated as the ratio between arterial elastance (EA) and end-systolic left ventricular elastance (EES), based on a formula proposed by Chen. 3D LACI was determined as the ratio between 3D left atrial end-diastolic volume (minimal atrial volume) and 3D left ventricular end-diastolic volume. Patients were followed up for one year after STEMI and the primary endpoint was the occurrence of MACE defined as death from cardiovascular causes, heart failure requiring hospital admission, or repeat revascularisation. Results Out of 76 patients, 15.8% had an adverse event during the 12 months follow up period. We divided the patients in two groups according to the presence or absence of MACE. Patients with MACE had higher VAC (2.15±0.62 vs. 1.25±0.29%, p<0.0001) and higher LACI (25.1±7.17% vs. 18.3±6.58%, p=0.002). In ROC analysis VAC and LACI combined had the best AUC for MACE prediction (AUC 0.961, p<0.0001), followed by VAC (AUC 0.922, P<0.0001), and then, LACI (AUC 0.772, P<0.001). For each variable we determined a cut off value. A value over 1.7 for VAC and 23.83% for LACI can predict unfavourable outcome with 83.3% sensitivity and 97.1% specificity for VAC and 67% sensitivity and 80% specificity for LACI. In both univariate and multivariate COX regression analysis, both VAC and LACI remained independent predictors for MACE. Moreover, their combination proved to have better predictive value for adverse events compared to each taken separately. We divided the study population into 4 groups: Group 1: VAC < 1.7 and LACI < 23.83%. Group 2: VAC <1.7 and LACI > 23.83%. Group 3: VAC > 1.7 and LACI < 23.83% and Group 4: VAC > 1.7 and LACI >0.23.83%. Kaplan Meier analysis shows significant differences among groups (log rank χ2 = 35.48, p < 0.0001). Calculation of Kaplan-Meier curves for the four groups indicated that the combination of the VAC > 1.7 and LACI > 23.83% had the strongest predictive power for MACE. Conclusion In conclusion 3D VAC and 3D LACI combined are better at predicting adverse events than each variable taken separately and could be used for a more accurate risk stratification in young patients with STEMI.

Prevalence of stage B heart failure in healthy adults and people with type 2 diabetes

Abstract Introduction People with Type 2 Diabetes (T2D) are at increased risk of heart failure, and as such are classified as having Stage A Heart Failure (SAHF). Those with additional evidence of raised filling pressures, biochemical or structural cardiac changes, without heart failure symptoms, are deemed to have Stage B heart failure (SBHF). Identifying patients with SBHF may help determine those at highest risk of disease progression. Purpose The aim of this work was to assess the prevalence of SBHF in a cohort of asymptomatic healthy volunteers and people with T2D characterised according to current American Heart Association/American College Cardiology/Heart Failure Society of America. Methods A single-centre, prospectively recruited cohort of middle-aged asymptomatic adults with T2D and healthy volunteers, with no history or signs of cardiovascular disease, underwent comprehensive cardiac phenotyping with transthoracic echocardiography and circulating brain natriuretic peptide. Healthy volunteers with risk factors for heart failure, including hypertension and obesity, were excluded from analysis. Prevalence of SBHF was determined by comparing cardiovascular data to proposed standards, left ventricular ejection fraction and global longitudinal strain parameters were omitted from analysis due to data availability. Results We included 383 T2Ds (diabetes duration 9(5,15) years) and 65 healthy volunteers (Table 1); 91% of those with T2D and 65% of healthy volunteers met ≥1 criteria for SBHF (Table 2). Median number of SBHF criteria met in the T2D cohort was 3 (2,4); in particular, a large proportion of the cohort met defined cut offs for relative wall thickness (70.6%), lateral e’ (62.2%), septal e’ (54.1%) and LV wall thickness (47.4%). Of the 65 healthy volunteers, median number of SBHF criteria met was 1 (0,2.5). In healthy volunteers, SBHF was most commonly defined by lateral e’ (40.0%), septal e’ (38.3%), relative wall thickness (32.2%), left atrial volume indexed (22.4%) and serum brain natriuretic peptide (23.3%). Of note, brain natriuretic peptide levels met current SBHF parameters in 18.8% of healthy volunteers and 9.9% people with T2D, which may be attributable to the exclusion of obesity in the healthy volunteer group. Conclusion Using currently proposed standards, a high proportion of middle-aged asymptomatic people with T2D, and healthy volunteers without any risk factors for heart failure, would be categorised as having SBHF. These data strongly suggest that the majority of the proposed parameters for the definition of SBHF are not specific for a UK population and if applied will incorrectly classify many asymptomatic people at high risk of developing heart failure.

Right ventricular myocardial work predicts heart failure hospitalizations irrespective of ejection fraction

Abstract Hospitalization for heart failure worsening (HFW) associates with increased subsequent rehospitalization rate and mortality irrespective of left ventricular ejection fraction (EF). However there’s little evidence regarding predictors of HFW to timely apply preventive measurements. Since right ventricular (RV) dysfunction often associates with more advanced stages of HF we assumed that RV myocardial work (MW) assessment might be used in prediction of HFW. Methods 158 patients with HF (48% female) 58±7 years on guideline directed medical therapy in sinus rhythm and with at least one hospitalization in the last 6 months were enrolled in the study. Patients with HFrEF, HFmrEF and HFpEF were evenly represented. All patients were appropriately decongested prior to the study. The primary outcome was rehospitalization, HFW or cardiovascular death. RVMW was derived from RV global strain, including interventricular septum, and noninvasively estimated pulmonary arterial pressure (PAP). Systolic PAP (sPAP) was measured as the sum of maximum RV and right atrial (RA) pressure gradient (PGmax) from tricuspid regurgitation (TR) jet peak velocity and mean right atrial pressure (RAP) estimated from diameter and collapsing of inferior vena cava. Mean PAP (mPAP) was measured as the sum of PGmean RV-RA by tracing TR jet and RAP. Diastolic PAP was estimated as dPAP = 1.5 × [mPAP − (sPAP/3)]. Then RV global work index (RVGWI), constructive (RVGCW), and efficient work (RVGWE) were derived by the software dedicated for left ventricular MW. Left ventricular global longitudinal strain, left atrial (LA) reservoir strain (LAS), LA pump strain, LA volume index (LAVi), B lines, inferior vena cava, NT-pro-BNP, TAPSE/sPAP and RVMW were also measured. Patients followed up for 12 months. Results 53 events were registered at 12 months of which 42 rehospitalizations due to HFW and 11 CV deaths. Among all parameters in the multivariate analysis lower RVGCW was associated with HFW (HR 0.978, 95% CI 0.973–0.998, p = 0.014). RVGCW was the most powerful predictor of CV events (AUC 0.91) with cut off value of 148 mmHg% that had 96% sensitivity and 88% specificity. Number of patients who died with RVGCW < 148 mmHg% was 8 of 11 (73%) total deaths (HR 0.421, 95% CI 0.083–0.986, p = 0.028). Conclusion RVGCW was a predictor of HFW and 1 year mortality in patients with HF irrespective of EF.

Frailty and quality of life in italian older adults: implications for public health interventions

Abstract Background The increasing focus on frailty in older adults underscores the significance of a timely multidimensional assessments and early detection to avert adverse outcomes. The primary aim is to integrate digital technologies, specifically online assessment tools, for the identification of frailty and the assessment of Quality of Life (QoL) in elderly individuals. Methods A nationwide multicentric study was conducted. Seven Italian centers and regions evaluated frailty in older adults residing in the community, through a prospective observational cohort study. The chosen questionnaires, Sunfrail+ and SF-12, were implemented through an easily accessible online tool, swiftly generating final scores for each test. The cross-sectional analysis included 503 older adults. The cut off to define a person “frail” is 3 positive alerts in Sunfrail baseline items, according to the literature. Results In this sample an average of 2.31 positive alerts were generated. Significant associations were established between the number of positive warnings and SF-12 physical and mental indexes, indicated by X2=53.1 (p < 0.001) and X2=25.1 (p < 0.001), respectively. The difference between two groups (frail and not frail) in relation to QoL is statistical significantly (U di Mann Whithney p < 0.001). Mean QoL mental and physical indexes are 46.3 and 39.3 in frailty group, versus 51.7 and 46.5 in non frailty group, respectively. The correlation is conceptually consistent: as frailty increases, QoL decreases. Conclusions The frailty assessment associated with the QoL assessment provides relevant information to monitor the impact of prevention interventions at community level. The assessment of frailty leads the prevention intervention whose impact could be assessed also through QoL tools. This study underlines a meaningful association between assessment tools, substantiated by conceptual correlations. Key messages • Sunfrail and SF-12 are easily accessible online tool useful for identification of frailty and the assessment of Quality of Life (QoL) in elderly individuals. • The older population in Europe is increasing a timely assessment of frailty must be a public health priority.

Left ventricular myocardial work predicts clinical course in patients with heart failure with mildly reduced ejection fraction

Abstract Heart failure with mildly reduced ejection fraction (HFmrEF) often represents a movable patients subset that changes its HF category by increasing or reducing EF. Course prediction is challenging due to insufficient evidence to date. We studied multiple newly established parameters in order to find predictors of clinical course of HFmrEF. Methods 135 patients (61 women) 62±5 years with HFmrEF NYHA II-III on GDMT were enrolled. Longitudinal (GLS), circumferential (GCS) and radial strain (GRS), peak LV twist (LVTR) were measured by speckle tracking from apical and short axis views. Left ventricular (LV) global myocardial work (GW) index (GWI) was obtained from pressure-strain loops derived from LV GLS and supine systemic blood pressure measured right before the image acquisition. Then constructive GW (GCW) as the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation, wasted GW (GWW) as energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation and GW efficiency (GWE) as the percentage ratio of constructive work to the sum of constructive work and wasted work were obtained by dedicated software. All parameters were analyzed offline by one experienced specialist. Patients were followed up for 1 year. Results 38 (28%) patients improved EF to the value ≥50%, 31 (23%) reduced EF to ≤40%. Patients with improved EF had significantly higher absolute values of GLS (17.3±2.2 vs 15.8±3.1%, p<0.03), GCS (18.9±2.6 vs 16.1±1.9%, p<0.02), GRS (42.5±7.2% vs 31.3±4.7%, p<0.02), LVT (6.2±2.5° vs 5.3±2.3°, p<0.03), GCW (2253±121 vs 1872±132 mmHg%, p<0.001) and lower GWW (108±7 vs 128±12 mmHg%) compared with patients with later reduced EF. Multivariate analysis showed that lower GCW was associated with EF reduction (HR 0.982, 95% CI 0.969–0.996, p = 0.012). GCW was the powerful predictor of CV events (AUC 0.94) with cut off value of 1495 mmHg% that had 98% sensitivity and 86% specificity. Conclusion LV GCW predicts EF changes in patients with HFmrEF.

The relationship between serum lumican levels and myocardial fibrosis in patients with hypertrophic cardiomyopathy

Abstract Background Hypertrophic cardiomyopathy (HCM) is the leading cause of sudden cardiac death in young individuals and an important cause of heart failure at any given age. Lumican, is an indicator of fibrosis and has been studied in various cardiac conditions. In this study, we aimed to evaluate the relation between serum Lumican levels and presence and extent of myocardial fibrosis in HCM. Methods The patients diagnosed with HCM between June 2022 and March 2023 were enrolled consecutively in this prospective study. Age and gender-matched healthy individuals formed control group. Additionally, HCM patients divided into two groups according to extent of late gadolinium enhancement (LGE). Results A total of 114 patients (62.3% male, 54.5±9.4 mean age) were enrolled in this prospective study. 64 patients formed HCM (+) and 50 patients formed HCM (-) group. The HCM (+) group is divided into two groups as LGE (+) and LGE (-) according to LGE involvement. Serum Lumican [p=0.018, β: 1.561, OR (95% CI): 1.080-2.257], NT-proBNP [p=0.043, β: 1.209, OR (95% CI): 1.079-2.527] and maximum wall thickness (MWT) [p=0.033, β: 1.322, OR (95% CI): 1.023-1.707] were revealed as independent risk factors associated with LGE by multivariate logistic regression analysis (Figure 1). ROC curve analysis was performed to identify the optimal cut-off value and calculate area under the curve (AUC) for Lumican, troponin (Tn) and NT-proBNP in order to predict the presence and extent of LGE in patients with HCM. A cut off value of 9.06 for Lumican was associated with 67.8% sensitivity and 65.5% specificity in prediction of LGE. A cut-off value of 932.4 for NT-proBNP was associated with 60% sensitivity, 60% specificity in prediction of LGE. Conclusion Myocardial fibrosis is one of the important mechanisms in HCM pathophysiology. Although LGE on cardiac magnetic resonance imaging(CMR) allows comprehensive evaluation of myocardial fibrosis, the support of diagnosis with a biomarker would be beneficial in clinical practice.Our study revealed that serum Lumican level is an independent predictor of severe LGE in HCM patients. Lumican can be used in addition to CMR for evaluating extence of myocardial fibrosis in HCM patients and may help clinicians in guiding follow-up and treatment.

Diastolic hyperemia-free ratio for the assessment of intermediate coronary artery stenosis in patients with hemodialysis

Abstract Background Diastolic hyperemia-free Ratio (DFR) is new resting index and uses a pragmatic definition by including areas below the average aortic pressure with negative slope. Hemodialysis (HD) exhibits left ventricular hypertrophy and impaired microcirculation. The relationship between DFR and fractional flow reserve (FFR) in the patients with HD has not been yet investigated. Purpose We aimed to compare the rate of physiological discordance between HD patients and non-HD patients, and to elucidate the best DFR cut-off value predicting less than 0.80 of FFR in HD patients. Methods We enrolled 761 consecutive patients (1033 vessels) who underwent both DFR and FFR in the intermediate coronary artery stenosis between July 2020 and December 2023 in our hospital. The cutoff values of DFR 0.89 or less and FFR 0.80 or less were used for the study. We compared the DFR values with FFR values between HD group and Non-HD group. Results HD group consisted of 110 patients and Non-HD group consisted of 651 patients. A good correlation between DFR and FFR was observed in HD group (R=0.780 ; p < 0.0001) and Non-HD group (R=0.770 ; p < 0.0001). The rate of physiological discordance between HD group and non-HD group was each 31.3% and 20.5% (p < 0.01). Receiver operating characteristic curve showed that a suitable cut off value of DFR for equivalent FFR value of 0.80 was 0.84 in HD group and 0.89 in Non-HD group, respectively (Figure). Conclusion In the patients with HD, DFR may overestimate intermediate coronary artery stenosis and the suitable cut off value was 0.84.2024 ESC HD DFR Figure

Relationship between diastolic hyperemia-free ratio and fractional flow reserve in patients with aortic valve stenosis

Abstract Background Diastolic hyperemia-free Ratio (DFR) is new resting index and uses a pragmatic definition by including areas below the average aortic pressure with negative slope. Aortic valve stenosis (AS) exhibits left ventricular hypertrophy and impaired microcirculation. The relationship between DFR and fractional flow reserve (FFR) in the patients with AS has not been yet investigated. Purpose We aimed to compare DFR and FFR in each of AS group and Non-AS group and to elucidate a suitable DFR cut-off value predicting less than 0.80 of FFR. Methods We enrolled 761 consecutive patients (1033 vessels) who underwent both DFR and FFR in the intermediate coronary artery stenosis between July 2020 and December 2023 in our hospital. We compared the DFR values with FFR values between AS group and Non-AS group. AS was defined as an aortic valve area of 1.5 cm2 or less, a mean aortic valve gradient of 20 mm Hg or more, or a peak aortic-jet velocity of 3.0 m/s or more. Results AS group consisted of 55 patients and Non-AS group consisted of 706 patients. A good correlation between DFR and FFR was observed in AS group (R=0.713; p < 0.0001) and Non-AS group (R=0.758; p < 0.0001). The patient backgrounds were similar between AS and Non-AS groups (Table). Regarding physiological findings, DFR in AS group was significantly lower than in Non-AS group (0.83 ± 0.12 vs. 0.88 ± 0.11, p < 0.0001), but FFR was similar (0.80 ± 0.07 vs. 0.81 ± 0.10, p = 0.12). Receiver operating characteristic curve showed that a suitable cut off value of DFR for equivalent FFR value of 0.80 was 0.85 in AS group and 0.89 in Non-AS group, respectively (Figure). Conclusion In the patients with AS, DFR may overestimate intermediate coronary artery stenosis and the suitable cut off value was 0.85.2024 ESC AS DFR Table2024 ESC AS DFR Figure

Field evaluation of Yorkool ®, a long-lasting insecticidal net after 12 months of use in Seme, Kisumu County, Kenya

Background: Physical integrity and insecticidal efficacy of long-lasting insecticide-treated nets (LLINs) is influenced by the handling practices during use. This was an evaluation of Yorkool® pyrethroid-based LLINs after 12 months of use to determine the washing and drying practices, physical conditions and bio-efficacy. Methods: This was a cross-sectional household survey in an area where rectangular Yorkool® a pyrethroid LLINs were distributed during national mass net distribution campaign in 2021. Questionnaires were used for data collection and bioassay tests were done from thirty randomly selected nets. Results: 262 household heads were interviewed with their mean age being 46.9 years (SD 17.4 years) and level of education was mainly primary (70.2%). Most households (71.8%) had 1 to 2 sleeping spaces. The households had a total 468 LLINs with 95.1% having been washed at least once. About three-quarters (74.4%) of the LLINs had been washed using local bar soap, with 99.6 % having not been scrubbed on hard surface during washing and 72.1% were dried under a shade. Those evaluated for physical integrity and had at least one hole made up 77.8% of the nets and 57.2% were too torn and requiring replacement. Bio-efficacy test recorded a mean KD of 92% after 1 hour, and mean mortality of 86% after 24 hours. The nets that passed the WHO efficacy cut off for mortality (≥80%) after 24 hours were 83.3% and 70% passed the KD (≥95%) cut off after 1 hour. Conclusions: While more than a half of the Yorkool® LLINs needed replacement due to poor physical integrity after one year of use in the households, the bio-efficacy of the LLINs was relatively high with the mortality on vectors meeting the WHO threshold

Diagnostic accuracy of bone marrow blood evaluation in haemophagocytic lymphohistiocytosis paediatric patients.

Haemophagocytic lymphohistiocytosis (HLH) is a rare and serious immunological syndrome that involves a strong activation of cytotoxic T lymphocytes and macrophages. HLH determines a cytokine-mediated tissue injury with a contemporary multi-organ failure and a high fatality rate. A retrospective study was performed considering the medical records of paediatric patients who underwent a bone marrow aspirate for suspect HLH. The biomarkers evaluated were among those included in the HLH-2004. Lactate dehydrogenase (LD) was also evaluated. Haemophagocytosis was evaluated in bone marrow blood smear slides. Enrolled were 11 patients included in the HLH group and 8 patients as controls. Haemoglobin and fibrinogen resulted lower in HLH patients than in controls, while blood triglycerides, serum ferritin and LD resulted increased. Blood triglycerides and fibrinogen discriminated HLH cases perfectly, with a sensitivity and specificity of 100%. Ferritin had a sensitivity of 100% and a specificity of 83% (cut off ≥3,721µg/L) and LD of 73% and of 100% (the cut off ≥1,903U/L). Haemoglobin was found to have a sensitivity of 75% and a specificity of 100% (cut off ≤ 96g/L). Total haemophagocytes cell counts were not different between patients and controls. Only the increased number of phagocytized nucleated red blood cells (NRBC) was found to be significantly increased in the patients. Erythrocytes phagocytosis (≥4/1,000 cells) only tended towards significance. The blood biomarkers showed better diagnostic performance than the morphological evaluation. Among the different cell lineages engulfed by haemophagocytes, the best diagnostic performance was obtained by phagocytosed mature erythrocytes and immature nucleated erythrocytes.

Numerical computation of cut off wave number in polygonal wave guide by eight node finite element mesh generation approach

This study proposes a two-dimensional, eight-noded automated mesh generator for precise and efficient finite element analysis (FEA) in microwave applications. The suggested method for solving the Helmholtz problem employs an optimal domain discretization procedure. MAPLE-13 software's advanced automatic mesh generator was developed specifically for this work. To demonstrate the effectiveness of the approach, three distinct waveguide structures are analyzed, with the results compared to the best available analytical or numerical solutions. The findings indicate that the proposed method yields highly accurate and efficient finite element results, particularly for waveguide structures containing singularities. In microwave applications, this method can significantly enhance energy transmission efficiency.

Assessment of diagnostic accuracy of Gazelle: A point-of-care testing device for screening β-thalassemia trait

Background & objectives Timely detection of population with β-thalassemia trait (BTT) followed by genetic counselling is an advocated method of preventing the birth of a child with β-thalassemia major. In this study we aim to assess the diagnostic accuracy of Gazelle, a point-of-care (POC) testing device, in screening for BTT in hospital laboratory setting. Methods Standards for Reporting Diagnostic Accuracy (STARD) guidelines were followed in developing study design, recruiting study participants and sample size calculation for the current research. A consecutive sample of 446 participants was recruited for this study and was tested for the reference test Gazelle as well as the gold standard cation exchange high performance liquid chromatography (CE-HPLC). Low serum ferritin levels are known to interfere with the production of HbA2 and in turn lead to false negative results. Hence, the study population was divided into two categories with respect to a cut off value of 15ng/dl of serum ferritin and the results were analyzed. Results Overall diagnostic accuracy of Gazelle for detecting BTT was found to be 95.3 per cent with a confidence interval (CI) of (92.9 - 97.1) and the sensitivity was 94.5 per cent with a 95% CI of (84.8 - 98.8). When analyzed by the serum ferritin level the diagnostic accuracy was found to be 94.7 per cent (91.1% - 97.1%) and 95.7 per cent (91.8% - 98.1%) for participants with serum ferritin level as > 15 ng/ml and < 15 ng/ml, respectively. Interpretation & conclusions This study found Gazelle to be a good screening tool for β-thalassemia trait with high sensitivity, specificity and accuracy. However, it is recommended that the final confirmation of the diagnosis done by a diagnostic test like HPLC or Capillary Zone Electrophoresis (CZE).

The association between triglyceride-glucose index and gallstones: NHANES 2017-2020

ObjectsIt remains unclear whether the triglyceride-glucose (TyG) index has correlations with gallstones. This study aimed to investigate the association between TyG index and gallstones.MethodsData was obtained from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Participants who provided complete data about TyG index and gallstones were included in the analysis. Multivariable regression analysis and subgroup analysis were preformed to estimate the relationship between TyG index and gallstones. Restricted cubic splines (RSC) was employed to calculate the cut off value.ResultsThe TyG index was independently associated with gallstones and demonstrates a clear positive correlation (OR = 1.10; 95% CI: 1.01–1.21; p = 0.033). The threshold value is 8.98, showing a positive correlation between TyG index and gallstones when the TyG index is less than 8.98 (Log likelihood ratio P < 0.001). Subgroup analysis indicates that the correlation between TyG and gallstones is mainly observed in individuals with obesity, females, younger individuals, and those with normal blood sugar levels, with these subgroups all acting as mediators between TyG and gallstones.ConclusionsHigher TyG index was linked to a higher chance of developing gallstones. Managing insulin resistance (IR) could help reduce the risk of gallstones since the TyG index is an indicator of IR.

Expression of EGFRvIII and its co‑expression with wild‑type EGFR, or putative cancer stem cell biomarkers CD44 or EpCAM are associated with poorer prognosis in patients with hepatocellular carcinoma.

The aberrant expression of HER family members and cancer stem cells (CSCs) have been associated with tumour progression and resistance to therapy. At present, several HER inhibitors have been approved for the treatment of patients with a range of cancers but not for the treatment of patients with hepatocellular carcinoma (HCC). The present study investigated the co‑expression and prognostic significance of HER family members, type‑III deletion mutant EGFR (EGFRvIII), and the putative CSC biomarkers CD44 and epithelial cell adhesion molecule (EpCAM) in 43 patients with HCC. The relative expression of these biomarkers was determined using immunohistochemistry. At a cut off value of >5% of tumour cells stained for these biomarkers, 35% [wild‑type (wt)EGFR], 58% (HER‑2), 0% (HER‑3), 19% (HER‑4), 26% (EGFRvIII), 40% (CD44) and 33% (EpCAM) of patients were positive. In 23, 14 and 9% of the patients, wtEGFR expression was accompanied by co‑expression with HER‑2, EGFRvIII and HER‑2/EGFRvIII, respectively. EGFRvIII expression, membranous expression of CD44 and co‑expression of wtEGFR/EGFRvIII were associated with poor overall survival (OS). By contrast, cytoplasmic CD44 expression was associated with a longer OS time. The present study also investigated the effect of several agents targeting one or more members of the HER family, other growth factor receptors and cell signalling proteins on the proliferation of HCC cell lines. Among agents targeting one or more members of the HER family, the pan‑HER family blocker afatinib was the most effective, inhibiting the proliferation of three out of seven human liver cancer cell lines (LCCLs), while the CDK inhibitor dinacicilib was the most effective agent, inhibiting the proliferation of all human LCCLs tested. Taken together, the present results suggested that EGFRvIII expression and its co‑expression with wtEGFR or CD44 was of prognostic significance. These results also support further investigations of the therapeutic potential of drugs targeting EGFRvIII and other members of the HER family in patients with HCC.