Diagnosis Of Failure Research Articles

Point‐of‐care ultrasound for aiding diagnosis of congestive heart failure in the emergency department: A narrative review

AbstractBackgroundCongestive heart failure (CHF) is a common condition that causes significant diagnostic challenges in the emergency department (ED). Rapid and accurate diagnosis is crucial for the effective management of CHF and improving patient outcomes. This narrative review aims to provide a state‐of‐art review to summarize the current application of PoCUS for aiding the diagnosis of CHF in ED.MethodA targeted literature search in the databases of Ovid (Medline and Embase) and PubMed was performed. The search filters were set to “full text,” “English”, and “15 years.”ResultOne hundred sixty‐four journal articles were retrieved; the articles were reviewed by the author to decide whether they were relevant to this narrative review or not. Finally, 16 articles were selected.ConclusionPoint‐of‐care ultrasound (PoCUS) including focused cardiac, lung, and venous ultrasound plays a pivotal role in aiding the diagnosis of CHF in ED. These modalities offer rapid, noninvasive, and bedside assessments that are helpful in the emergency department setting.

Analysis of signals from air conditioner compressors with ordinal patterns and machine learning

Most machines are equipped with devices that monitor their operation. Air conditioners, in particular, are routinely monitored through various measurements. A desirable outcome of this monitoring is identifying when the device will likely require maintenance. In this study, we present the use of Ordinal Patterns, a symbolic transformation of time series, which allows for the visual assessment of the type of operation. Ordinal Patterns are chosen because they can transform intricate time series into simple and intuitive symbolic representations. The technique is visually appealing, generating points on a plane whose positions reveal hidden dynamics. This approach makes it easier to identify recurring or abnormal patterns in machine operations that may indicate wear or impending failure. Additionally, Ordinal Patterns allow for precise and understandable visualization of operational data, making interpreting results more accessible for professionals who may not be experts in data analysis. We compare two machines under different operational conditions with six measured variables. We analyze the expressiveness of the Ordinal Patterns and identify those variables that best differentiate the two machines. Furthermore, we incorporate machine learning algorithms, such as Artificial Neural Networks, Support Vector Machines, and Decision Trees, to evaluate and validate the effectiveness of Ordinal Patterns as discriminative features. Integrating machine learning methods with a symbolic transformation offers a robust approach for the early and accurate diagnosis of potential failures, enhancing the predictive maintenance of air conditioning equipment.

Assessment of the Level of NT-proBNP in Patients with Arterial Hypertension Aged 80 Years and Older, Depending on the Presence of Heart Failure and Senile Asthenia Syndrome

Objectives. To evaluate the informativeness of the N-terminal brain-promoting natriuretic peptide (NT-proBNP) for the diagnosis of chronic heart failure (CHF), depending on the presence of senile asthenia syndrome (SSA) in patients with arterial hypertension (AH) 80 years and older.Materials and Methods. 320 patients with hypertension, depending on the presence of CHF and SSA, were divided into groups: group 1A — patients with hypertension, SSA and CHF (n=84), group 1B — patients with hypertension, SSA without CHF (n=77), group 2A — patients with hypertension, CHF without SSA (n=84), group 2B — patients with hypertension without CHF and without SSA (n=75). The CSA was identified by the questionnaire “Age is not a hindrance”. The level of NT-proBNP was determined in blood serum by enzyme immunoassay. ROC analysis was used to determine the threshold value of markers.Results. In patients with hypertension and SSA without CHF, the concentration of NT-proBNP in the blood is 2.3 times higher (p=0.003) compared with patients with hypertension without SSA and without CHF, which indicates the effect of SSA on the level of NT-proBNP. In patients with hypertension and CHF without SSA, the level of NT-proBNP is 4.3 times higher compared with patients with hypertension without SSA and without CHF (p<0.001), in whom the concentration of NT-proBNP was noted below the threshold level (106.2 pg/ml). In patients with hypertension and SSA and CHF, the highest concentrations of NT-proBNP were recorded, which are 2.9 times (p<0.001) higher than in “fragile” patients with hypertension without CHF and 1.5 times higher than in “strong” patients with hypertension and CHF (p<0.001). A new threshold level of NT-proBNP has been calculated for the diagnosis of CHF in patients with hypertension and SSA aged 80 years and older — 365.9 pg/ml.Conclusion. For the diagnosis of CHF in patients with hypertension 80 years and older without CSA, the NT-proBNP marker is informative, since, according to the data obtained, its level did not depend on the age of the patients. When using NT-proBNP to detect CHF in patients with hypertension and SSA 80 years and older, the calculated threshold marker level (365.9 pg/ml) should be used, since in these patients the concentration of NT-proBNP is increased, regardless of the presence of CHF.

Individual heart failure patient variability in nocturnal hypoxia and arrhythmias.

Traditional heart failure research often uses daytime population parameter estimates to assess hypoxia and arrhythmias. This approach might not accurately represent heart failure patients as nighttime cardiac behaviors offer crucial insights into their health, especially regarding oxygen levels and heart rhythms. We conducted a prospective study on nocturnal oxygen saturation and heart rate in home-dwelling heart failure patients over 6 nights. Patients were recruited from the Walter Reed National Military Medical Center heart failure clinic. Criteria included a clinical diagnosis of heart failure, a New York Heart Association (NYHA) classification of I to III, ages between 21 to 90, cognitive intactness, capability to use the wearable device, and willingness to use the device for 6 consecutive nights. Average oxygen saturation was 92% with individual readings ranging from 40% to 100%. The mean heart rate was 72 beats per minute (bpm), but individual rates ranged from 18 bpm to a high of 296 bpm. A significant drop in oxygen levels and sleep arrhythmias were consistently observed among participants. Heart failure patients demonstrate notable and variable desaturations and arrhythmias across multiple nights. A single-night sleep study or a 24-hour heart rate monitor may not comprehensively depict patients' oxygenation and heart rate irregularities. Our research highlights wearable devices' potency in medical research for capturing essential nocturnal data. In only 6 nights, we gleaned invaluable clinical insights for optimizing patient care. This study is pioneering, being the first to intensively examine nighttime oxygen levels and heart rates in home-based heart failure patients.

Recommendations for early identification of heart failure in patients with diabetes: Consensus statement of the Swiss Society of Endocrinology and Diabetology and the Heart Failure Working Group of the Swiss Society of Cardiology.

Diabetes is a well-recognised risk factor for the development of heart failure, with a prevalence higher than 30% in patients with diabetes aged over 60 years. Heart failure often emerges as the primary cardiovascular manifestation in patients with type 2 diabetes and appears to be even more prevalent in type 1 diabetes. In Switzerland, there are approximately 500,000 individuals with diabetes, and the number of affected people has been steadily rising in recent years. Therefore, the consequences of heart failure will affect an increasing number of patients, further straining the Swiss healthcare system. Early lifestyle modification and initiation of appropriate treatment can prevent or at least significantly delay the onset of symptomatic heart failure by several years. These facts underscore the urgent need for early detection of individuals with subclinical heart failure, which often remains undiagnosed until the first episode of acute heart failure requiring hospital admission occurs. To address this issue, the European Society of Cardiology, the American Diabetes Association (ADA) and other international professional societies have published recommendations on heart failure screening, diagnosis and management. To address this issue in Switzerland, experts from the Swiss Society of Endocrinology and Diabetology, the Swiss Society of Cardiology and the General Internal Medicine specialty met and prepared a consensus report including a simple diagnostic algorithm for use in everyday practice.

Diagnosis and Treatment of Acute Heart Failure: A Retrospective Observational Study and Medical Audit.

Background: Acute Heart Failure (AHF) is a leading cause of hospitalizations and remains a significant socioeconomic burden. Despite advances in medical care, mortality and rehospitalization rates remain high. Previous AHF audits have revealed regional differences and a poor adherence to guidelines. This study aimed to assess guideline adherence in a public teaching hospital to identify areas for improvement. Methods: This retrospective observational study examined clinical routine data of patients hospitalized for AHF at a Swiss public teaching hospital between 2018 and 2019. AHF management was evaluated against the relevant guidelines of the European Society of Cardiology. Results: The study included 760 AHF cases of 726 patients (median age 84 years, range 45-101, 50% female). NT-pro-BNP levels were measured in 92% of the cases. Electrocardiography was performed in 95% and chest X-rays in 90% of cases. Echocardiography was conducted in 54% of all cases and in 63% of newly diagnosed AHF cases. Intravenous furosemide was initiated in 76%. In the subgroup of cases with reduced ejection fraction (HFrEF), 86% were discharged with beta-blockers and 69% with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Among cases with left ventricular ejection fraction ≤ 35%, mineralocorticoid receptor antagonists were prescribed in 55%. Conclusions: We observed generally good adherence to guideline recommendations. However, several improvements are needed in initial assessment and documentation, diagnostic procedures such as echocardiography, discharge medication, and lifestyle recommendations. Compared to other studies, our diagnostic workup was more aligned with guidelines, the use of intravenous diuretics was similar, and the duration of hospital stay and mortality rates were comparable.

7606 Partial Xp Duplication and Xq Deletion in a Patient with Premature Ovarian Failure: A Rare Case Report

Abstract Disclosure: A. Pataco: None. C.S. Moniz: None. C. Chaves: None. R. Medeiros: None. M. Ponte: None. B.D. Pereira: None. J. Anselmo: None. I. Sousa: None. Premature ovarian failure (POF) is a heterogeneous condition characterized by the cessation of ovarian function leading to amenorrhea before age 40. While the etiology of POF is diverse, the majority of cases are idiopathic, with a likely genetic basis. Xq abnormalities are commonly linked to POF, whereas Xp abnormalities are rare and infrequently reported.We describe a case of a 30-year-old woman with a personal history of depression, presenting to the Endocrinology department with an 8-month history of amenorrhea. Notably, her menstrual cycles had been irregular since menarche. Previously, a gynecological assessment led to the initiation of bromocriptine 5 mg/day for suspected microprolactinoma, indicated by symptoms of galactorrhea, elevated prolactin levels (112 ng/mL; Normal: 5.18-26.53), and a pituitary MRI showing a 3.5mm microadenoma. It is important to note her concurrent use of risperidone, sertraline, and lorazepam at that time.In the first evaluation at the Endocrinology department, the patient reported amenorrhea and denied galactorrhea. The physical examination was unremarkable with no evidence of hirsutism. The blood tests indicated hypergonadotropic hypogonadism, low levels of prolactin and Anti-Müllerian hormone: FSH 17 mIU/mL (Normal: 3.03-8.08), LH 8.30 mIU/mL (Normal: 1.80-11.78), 17-Beta Estradiol 11 pg/mL (Normal: 21-251), Total testosterone 20.1 ng/dL (Normal: 7.21-79.31), TSH 1.84 uIU/mL (Normal: 0.35-4.94), T4L 1.06 ng/dL (Normal: 0.70-1.48), PRL 1.8 ng/mL (Normal: 5.18-26.53), ACTH 21 pg/mL (Normal: 7.2-63.3), Cortisol 11.5 ug/dL (Normal: 3.7-19.4), IGF-1 130.2 ng/mL (Normal: 177-382), Anti-Müllerian hormone <0.1 ng/mL (Normal: 0.3-11.2).A diagnosis of premature ovarian failure was established. Bromocriptine was discontinued, and the hyperprolactinemia was attributed to the iatrogenic effects of her medications. A pelvic ultrasound showed no abnormalities. Cytogenetic analysis revealed an abnormal karyotype: 46 chromosomes with one X chromosome showing an anomalous configuration—partial deletion of the long arm and partial duplication of the short arm [duplication X(p22.33p11.23) with over 100 genes and deletion X(q24q28) including the FMR1 gene].The patient started hormone replacement therapy with estradiol valerate and medroxyprogesterone acetate, achieving regular menstruation thereafter. Literature review reveals that POF cases involving both partial Xp duplication and partial Xq deletion are exceedingly rare (only 6 reported cases). Genetic counseling is recommended for these patients, particularly for those considering parenthood. It is also advisable to assess the chromosomal alteration in parents to determine if the change is inherited and to evaluate the risk to other family members. Presentation: 6/2/2024

7606 Partial Xp Duplication and Xq Deletion in a Patient with Premature Ovarian Failure: A Rare Case Report

Abstract Disclosure: A. Pataco: None. C.S. Moniz: None. C. Chaves: None. R. Medeiros: None. M. Ponte: None. B.D. Pereira: None. J. Anselmo: None. I. Sousa: None. Premature ovarian failure (POF) is a heterogeneous condition characterized by the cessation of ovarian function leading to amenorrhea before age 40. While the etiology of POF is diverse, the majority of cases are idiopathic, with a likely genetic basis. Xq abnormalities are commonly linked to POF, whereas Xp abnormalities are rare and infrequently reported.We describe a case of a 30-year-old woman with a personal history of depression, presenting to the Endocrinology department with an 8-month history of amenorrhea. Notably, her menstrual cycles had been irregular since menarche. Previously, a gynecological assessment led to the initiation of bromocriptine 5 mg/day for suspected microprolactinoma, indicated by symptoms of galactorrhea, elevated prolactin levels (112 ng/mL; Normal: 5.18-26.53), and a pituitary MRI showing a 3.5mm microadenoma. It is important to note her concurrent use of risperidone, sertraline, and lorazepam at that time.In the first evaluation at the Endocrinology department, the patient reported amenorrhea and denied galactorrhea. The physical examination was unremarkable with no evidence of hirsutism. The blood tests indicated hypergonadotropic hypogonadism, low levels of prolactin and Anti-Müllerian hormone: FSH 17 mIU/mL (Normal: 3.03-8.08), LH 8.30 mIU/mL (Normal: 1.80-11.78), 17-Beta Estradiol 11 pg/mL (Normal: 21-251), Total testosterone 20.1 ng/dL (Normal: 7.21-79.31), TSH 1.84 uIU/mL (Normal: 0.35-4.94), T4L 1.06 ng/dL (Normal: 0.70-1.48), PRL 1.8 ng/mL (Normal: 5.18-26.53), ACTH 21 pg/mL (Normal: 7.2-63.3), Cortisol 11.5 ug/dL (Normal: 3.7-19.4), IGF-1 130.2 ng/mL (Normal: 177-382), Anti-Müllerian hormone <0.1 ng/mL (Normal: 0.3-11.2).A diagnosis of premature ovarian failure was established. Bromocriptine was discontinued, and the hyperprolactinemia was attributed to the iatrogenic effects of her medications. A pelvic ultrasound showed no abnormalities. Cytogenetic analysis revealed an abnormal karyotype: 46 chromosomes with one X chromosome showing an anomalous configuration—partial deletion of the long arm and partial duplication of the short arm [duplication X(p22.33p11.23) with over 100 genes and deletion X(q24q28) including the FMR1 gene].The patient started hormone replacement therapy with estradiol valerate and medroxyprogesterone acetate, achieving regular menstruation thereafter. Literature review reveals that POF cases involving both partial Xp duplication and partial Xq deletion are exceedingly rare (only 6 reported cases). Genetic counseling is recommended for these patients, particularly for those considering parenthood. It is also advisable to assess the chromosomal alteration in parents to determine if the change is inherited and to evaluate the risk to other family members. Presentation: 6/2/2024

7306 Impact of Hypoglycemia in Heart Failure: National Inpatient Sample Analysis

Abstract Disclosure: B. Neupane: None. S. Karki: None. A. Bhandari: None. U. Farooq: None. K. Rajamani: None. Introduction:Hypoglycemia is one of the frequently encountered phenomena in hospitalized patients, mainly with diabetes mellitus; however, it is sometimes seen in patients without diabetes mellitus. Risk factors like advanced age, comorbid diseases, aggressive hyperglycemia therapy, etc., can play a role in the contribution of hypoglycemia. Heart failure is a significant healthcare burden in the United States; mortality due to heart failure has been increasing, and the lifetime risk of heart failure has risen to 24%. There are limited studies investigating how hypoglycemia affects outcomes in heart failure. Methods: We conducted a retrospective analysis using a national inpatient sample from 2017 to 2020. For diseases/comorbidities, International Classification of Disease (ICD-10) codes were used. Data analysis was done using STATA. Multivariate regression analysis was used to calculate the adjusted odds ratio. The primary outcomes of the study were mortality, and secondary outcomes were length of stay (LOS), total cost of hospitalization, septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI). Results: There was a total of 21,258,175 patients with a diagnosis of heart failure. There were 158,175 patients with a diagnosis of hypoglycemia. There were significant outcomes in patients with hypoglycemia on rates of mortality (adjusted mean difference=3.64, 14.55% vs. 4.91%, p<0.001), LOS (adjusted mean difference =2.03, 8.50% vs. 6.22%, p<0.001), the total cost of hospital stays (adjusted mean difference=$21530, $103,773 vs. $77057, p<0.001), septic shock( aOR=4.05, 14.22% vs. 3.84%, p<0.001), ARF(aOR =1.75, 24.71% vs. 15.88%, p<0.001), mechanical ventilation (aOR=2.84, 14.84% vs. 5.21%, p<0.001), ARDS( aOR=2.15, 0.57% vs. 0.24%,p<0.001), and AKI(aOR=1.65, 41.38% vs. 29.89%,p<0.001) compared to patients without hypoglycemia. There were no significant outcomes in the rate of pulmonary edema (aOR=1.09, 0.54% vs.0.46%, p=0.24). Conclusion: Hypoglycemia increases mortality, duration of hospital stays, health care cost, and health care burden. Hypoglycemia nevertheless results in worse hospital outcomes and higher expenses as compared to non-hypoglycemia due to higher mortality rates, LOS, cost, and hospital outcomes. Blood sugar levels should be monitored frequently to minimize hospitalization complications and improve outcomes. Presentation: 6/1/2024

Wind Turbine Bearing Failure Diagnosis Using Multi-Scale Feature Extraction and Residual Neural Networks with Block Attention

Wind turbine rolling bearings are crucial components for ensuring the reliability and stability of wind power systems. Their failure can lead to significant economic losses and equipment downtime. Therefore, the accurate diagnosis of bearing faults is of great importance. Although existing deep learning fault diagnosis methods have achieved certain results, they still face limitations such as inadequate feature extraction capabilities, insufficient generalization to complex working conditions, and ineffective multi-scale feature capture. To address these issues, this paper proposes an advanced fault diagnosis method named the two-stream feature fusion convolutional neural network (TSFFResNet-Net). Firstly, the proposed method combines the advantages of one-dimensional convolutional neural networks (1D-ResNet) and two-dimensional convolutional neural networks (2D-ResNet). It transforms one-dimensional vibration signals into two-dimensional images through the empirical wavelet transform (EWT) method. Then, parallel convolutional kernels in 1D-ResNet and 2D-ResNet are used to extract multi-scale features, respectively. Next, the Convolutional Block Attention Module (CBAM) is introduced to enhance the network’s ability to capture key features by focusing on important features in specific channels or spatial areas. After feature fusion, CBAM is introduced again to further enhance the effect of feature fusion, ensuring that the features extracted by different network branches can be effectively integrated, ultimately providing more accurate input features for the classification task of the fully connected layer. The experimental results demonstrate that the proposed method outperforms other traditional methods and advanced convolutional neural network models on different datasets. Compared with convolutional neural network models such as LeNet-5, AlexNet, and ResNet, the proposed method achieves a significantly higher accuracy on the test set, with a stable accuracy of over 99%. Compared with other models, it shows better generalization and stability, effectively improving the overall performance of rolling bearing vibration signal fault diagnosis. The method provides an effective solution for the intelligent fault diagnosis of wind turbine rolling bearings.

Prognostic impact of fibrinogen in patients with resistant hypertension.

In this study, we investigated the long-term prognostic effects of fibrinogen levels in patients with resistant hypertension. A total of 266 patients with resistant hypertension who had serum fibrinogen measurements and 5 years of follow-up information were retrospectively included in the study. The patients were stratified according to their fibrinogen levels, which were then divided into tertiles. Clinical outcomes for major adverse cardiovascular events (MACE) were assessed at 5 years. MACE was defined as all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction (MI), non-fatal stroke, a new diagnosis of heart failure, or hospitalization for heart failure and peripheral arterial disease. The incidence of MACE at 5 years in patients with resistant hypertension was higher in the highest tertile of fibrinogen. Multivariate analysis identified fibrinogen as an independent predictor of MACE in patients with resistant hypertension (odds ratio = 1.002; 95% CI: 1.001-1.004; p = 0.009). Compared to the lowest tertile, MACE was approximately 2.5 times higher in tertile 2 and approximately 6.9 times higher in the highest tertile. Fibrinogen was able to predict MACE in patients with resistant hypertension (AUC for MACE 0.662 (95% CI 0.596-0.727; p < 0.001) based on receiver operating characteristic curve analysis. In the Kaplan-Meier curve showing follow-up without MACE (MACE-free) according to the fibrinogen cut-off value, the 5-year incidence of MACE was significantly higher in the high fibrinogen group (p < 0.001). Fibrinogen is a risk marker for MACE in patients with resistant hypertension. Antihypertensive therapy aimed at lowering fibrinogen levels may improve prognosis.

A-018 Diagnostic Performance of the Novel Beckman-Coulter NT-proBNP-assay in the Early Diagnosis of Acute Heart Failure

Abstract Background The diagnostic performance of the novel Beckman Coulter N-terminal pro-B-type natriuretic peptide (NT-proBNP) assay in the early diagnosis of acute heart failure (AHF) is unknown. Methods This major unmet clinical need was addressed in a secondary analysis using frozen plasma samples obtained in a prospective diagnostic study, enrolling patients presenting with acute dyspnea to the emergency department (ED). Two independent cardiologists/internists centrally adjudicated the final diagnosis using all individual patient's information. NT-proBNP-Beckman Coulter plasma concentrations were measured blinded and directly compared to NT-proBNP-Elecsys concentrations. Agreement analysis was performed by Bland Altman plot. The primary endpoints were the diagnostic accuracy of both assays using the Area-under-the-Receiver-Operating-Curve and the comparison of the performance for diagnosing AHF using the validated NT-proBNP-Elecsys clinical decision values (&amp;lt;300ng/L for rule-out, age-adjusted &amp;gt;450/900/1800ng/L for rule-in). The secondary endpoint included the application of the recently suggested NT-proBNP-Elecsys clinical decision values for obese patients. Results 1400 patients (46% 3women, median age 76 years, BMI 25.9m2/kg, LVEF 53%) had both NT-proBNP measurements on presentation to the ED. Of those 744 (53%) had an adjudicated diagnosis of AHF. The agreement analysis showed overall higher concentrations for the NT-proBNP-Beckman assay. The diagnostic accuracy of both assays was excellent (AUC: 0.915 vs 0.922; P = 0.006, respectively). In the clinical application less patients were ruled-out using the Beckman assay compared to the Elecsys assay (18.7% vs 26.3%) with comparable sensitivities (98.9% vs 98.5%). Regarding rule-in NT-proBNP-Elecsys had a significantly higher specificity (78.8% vs 70.9%) and positive predictive value (83.1% vs 78.7%; both P&amp;lt;0.001; Figure 1). Similar findings were obtained in recently suggested cutoffs for obese patients. Conclusions In comparison to established NT-proBNP-Elecsys cutoffs, a derivation of Beckman-specific cutoffs is needed to implement NT-proBNP-Beckman Coulter clinical decision values providing a higher rule-out proportion and an optimal specificity for diagnosing AHF.

A-021 Evaluation of a Novel N Terminal Pro B Type Natriuretic Peptide Assay as an aid in the Diagnosis of Acute Heart Failure in the Emergency Department

Abstract Background The signs and symptoms of acute heart failure (AHF) may overlap with other conditions and lead to diagnostic difficulty in the undifferentiated patient with dyspnea. The particularly high negative predictive value (NPV) of natriuretic peptides (NPs) in excluding AHF have rendered these assays especially useful in evaluating dyspnea in acute care setting. This study was conducted to assess the diagnostic performance of a novel N-terminal pro-B type natriuretic peptide (NT-proBNP) assay in the intended use patient population in the emergency department (ED). Methods A multicenter study was conducted in the U.S. on individuals presenting to the ED with dyspnea and a suspicion of AHF. Blood specimens were collected and tested using the Beckman Coulter Access NT-proBNP assay on the DxI 9000 Immunoassay Analyzer. Test results were compared to an adjudicated diagnosis clinical endpoint performed by an independent Clinical Events Committee blinded to the Access NT-proBNP result. Performance included NPV and sensitivity of an age-independent cut point of &amp;lt;300 ng/L to exclude AHF, and the positive predictive value (PPV) of the age-dependent cut points of &amp;gt;450, &amp;gt;900, and &amp;gt;1800 ng/L for ages &amp;lt;50 years, 50-75 years, and &amp;gt;75 years, respectively, for the diagnosis of AHF. The sample size required to achieve a 95% two tailed confidence interval (CI) was 150 subjects per age group to provide clinical performance at 90% (±10%) sensitivity. Sample size was based upon CLSI EP24-A2, Assessment of the Diagnostic Accuracy of Laboratory Tests Using Receiver Operating Characteristic Curves. Sensitivity and specificity were calculated at a series of cutoff points and plotted in separate receiver operation curves (ROC) for an overall age-independent rule-out analysis and for individual age-dependent groups separately. Area under the receiver operator characteristic curve (AUROC) was reported with 95% 2-sided CI. NPV and PPV with respective 95% 2-sided score CI was computed for the overall age-independent cut point and for each age group cohort. Results Of 490 enrolled patients, 41% were adjudicated with AHF with a median (Q1, Q3) age of 60 (47-76) years, and distributions of 46.1% female, 60.8% White and 38.2% Black. The assay had an AUROC for AHF of 0.88 (P&amp;lt;0.001), comparable to other commercially available NT-proBNP assays. The rule-out cut point of &amp;lt;300 ng/L had 96% sensitivity and NPV of 95%. Age-dependent cut points had sensitivity of 84%, 90%, and 87%, specificity of 81%, 70% and 61%, and PPV of 72%, 62%, and 74%, respectively. Conclusions The Access NT-proBNP assay demonstrated high clinical performance in the diagnosis and exclusion of acute HF in the undifferentiated dyspneic patient population and performed similarly well to validated assays used in current clinical practice. Given the continued increase in importance and reach of natriuretic peptide testing, these results are useful to extend availability of this assay to a larger audience.

Investigation of diesel particulate filter performance under typical failure conditions

Diesel particulate filter (DPF) is one of the most effective particulate reduction components in diesel engine aftertreatment systems. However, prolonged utilization of a DPF might result in a deterioration in performance or even failure, such as ash-clogging, melting, breakage, and catalyst deactivation. It is crucial to conduct research on DPF performance degradation across a series of partially failed conditions. In this study, the morphology and chemical composition of the ash in the DPF samples were characterized. The effects of degree-varying clogging and unplugged-breakage failure on exhaust characteristics as well as DPF temperature, filtration and pressure drop characteristics were investigated. Finally, the sensitivity differences between DPF performance parameters and failure index parameters were examined using a canonical correlation analysis (CCA). When four factors were considered, the ash loading index and breakage index had the greatest impact on DPF temperature difference and filtration efficiency, while the exhaust mass flow rate had the greatest impact on pressure drop. Besides, the influence of the DPF inlet temperature on the pressure drop, filtration efficiency, and temperature difference was not significant. These findings contribute to the prediction of DPF performance in partially failed conditions and the development of DPF failure diagnosis methods.

Failure analysis of photovoltaic strings by constructing a digital multi-twin integrating theory, features, and vision

Timely and accurate failure analysis of photovoltaic (PV) systems is crucial forensuring the stable operation of power grids. However, existing failure analysis and diagnosis algorithms based on deep neural networks excessively rely on high-quality failure state data collected by sensors. This is extremely difficult to achieve in real photovoltaic power plants that are commonly equipped with self-protection mechanisms. To address this issue, we propose a Digital Multi-Twin integrating Theory, Features, and Vision (TFV-DMT) for failure analysis of PV strings in PV systems. This method first constructs theoretical simulation twins, feature twins, and visual twins based on the concept of digital twins, specifically tailored for actual PV systems, and designs a multi-twin collaborative model for model updating and failure diagnosis. Secondly, to better construct the visual twin, we introduce a Two-Dimensional Gram Angle Field Transformation Algorithm (TDGAF) to achieve targeted two-dimensional mapping of PV feature data, facilitating a more direct expression of failure characteristics. Furthermore, by constructing a Swish-activated Deep Convolutional Generative Adversarial Network (SDCGAN) to achieve balanced augmentation of mapping data, the model bias of theoretical simulation twins can be reduced. Finally, we propose a Swin-LT network that incorporates a Lightweight Dual-Channel Attention Module (LDAM) to better analyze the features of the visual twin, enabling more precise fault diagnosis. The algorithm has been validated on a real 250 kW grid-connected PV system, with results indicating that the proposed digital twin model is effective, achieving a diagnosis accuracy rate of 98.8 % for string failures.

Diagnostic and therapeutic practice for HFpEF across continents and regions: An international survey.

This study aims to evaluate the worldwide variations in the diagnosis and treatment of heart failure with preserved ejection fraction (HFpEF), using an HF survey distributed internationally to physicians, including both cardiologists and non-cardiologists. A group of HF specialists designed an independent, academic web-based survey focusing on HFpEF care and diagnosis, which was distributed via scientific societies and various social networks between 1 May 2023 and 1 July 2023. The survey included 1459 physicians (1242 cardiologists and 217 non-cardiologists) from 91 countries, with a mean age of 42 (34-49) years and 61% male. Most physicians (89.2%) defined HFpEF as left ventricular ejection fraction ≥50%. Significant regional variations were observed in HFpEF management (P<0.001 for all comparisons unless stated otherwise). Cardiologists managed 63.1% of HFpEF patients overall, with significant variability across regions (P < 0.001). The estimated HFpEF prevalence was highest in Eastern Asia and Western Europe and lowest in Africa and South America. Diagnostic practices varied: natriuretic peptide use ranged from 70%-74% in Africa to 95%-97% in Southern/Western Europe. Echocardiographic parameters showed regional differences, with diastolic stress testing used most in South-Eastern Asia (47% vs. 13-36% elsewhere). HFpEF scoring systems were most common in South-Eastern Asia (78%) and least in Africa (30.1%). Coronary artery disease screening approaches differed, with Eastern Asian physicians more likely to always perform routine angiograms (52%) compared with Northern Europeans (12%). Treatment preferences also varied regionally. Sodium glucose co-transporter-2 inhibitors (SGLT2i) was the preferred first-line treatment (45%-70% across regions), followed by diuretics. In an ideal setting, 52% would primarily use SGLT2i, 33% loop diuretics, and 22% beta-blockers. Drug availability differed significantly: SGLT2i was most available (88% overall), while ARNI was least available (61%). South America and Middle Eastern/Northern Africa reported lower availability of guideline-directed therapies. Multidisciplinary HF programmes were most common in Asia (70%) and least in Africa (24%). The perceived benefit of atrial flow regulator devices also showed significant regional differences. There are considerable global variations in the diagnosis and management of HFpEF. Most physicians favour SGLT2i despite regional disparities in health care resources and guideline adherence. Harmonized practices and improved access to comprehensive care can enhance outcomes of HFpEF patients worldwide.

Chromosomal abnormalities in oocyte donor candidates: a French survey of over 8200 karyotypes

To study karyotypes of more than 8,200 oocyte donor candidates in nulliparous or multiparous women compared to a reference population. A retrospective observational multicentric study. The study included two cohorts of oocyte donor candidates recruited between January 2005 and October 2021: multiparous women with at least one child at the time of recruitment, and nulliparous women. Both were compared to a reference population composed of female newborns from literature. Not applicable. Blood lymphocyte karyotype. A total of 8229 oocyte donor candidates from 22 fertility centers were included in this study. Nulliparous women (n=1890) and multiparous ones (n=6339) were compared to 8102 female newborns. Overall, 65 candidates were carriers of chromosomal abnormalities and were therefore excluded from the donation process (0.79%, 95% CI: 0.60-0.98). The occurrence of balanced structural chromosomal rearrangements was globally increased in the study population (0.49%, 95% CI: 0.34-0.64) compared to female newborns (0.24%, 95% CI: 0.34-0.64, p=0.0086). The number of reciprocal translocations was increased 5-fold in nulliparous oocyte donor candidates (0.37%, 95% CI: 0.10-0.64, p=0.013). The incidence of sex chromosome mosaicism was notably increased in multiparous oocyte donor candidates, with 17 cases (0.27%, 95% CI: 0.14-0.40, p=0.0052). Among chromosomal aberration carriers only two nulliparous women (one reciprocal translocation and one sex chromosome mosaicism) had fertility issues with a diagnosis of premature ovarian failure. In this comprehensive 16-years French experience of karyotyping in oocyte donor candidates, we confirmed an increased incidence of balanced structural chromosomal rearrangements, especially among those without children at the time of recruitment. Karyotyping could be considered to identify any chromosomal abnormalities that may not be easily detectable through medical questioning. These abnormalities pose an inherent genetic risk for gamete recipients if left undetected.

The transition from hypertension to hypertensive heart disease and heart failure with preserved ejection fraction: a retrospective cross-sectional study of myocardial magnetic resonance strain and tissue characteristics.

Due to the variability of symptoms and signs associated with heart failure, along with the lack of specific tests for definitive diagnosis, the noninvasive diagnosis of heart failure with preserved ejection fraction (HFpEF) continues to pose significant clinical challenges. This investigation was designed to elucidate the clinical manifestations of HFpEF and to analyze cardiac magnetic resonance (CMR)-derived myocardial strain metrics and tissue characteristics in a cohort exhibiting HFpEF with hypertension (HFpEF-HTN). This retrospective analysis consisted of 128 patients diagnosed HFpEF-HTN, 78 individuals with hypertensive heart disease (HHD), 89 individuals with hypertension (HTN), and 60 normotensive healthy controls and was conducted from August 2021 to February 2024. All participants were recruited from The First Hospital of Lanzhou Universityand underwent laboratory examinations and 3.0 T CMR. The study compared clinical features and CMR-derived structural and functional parameters across different groups. Logistic regression was employed to determine the association between CMR parameters and HFpEF-HTN. Spearman correlation coefficient analysis was used to clarify the relationship between myocardial strain parameters and left ventricular (LV) ejection fraction and right ventricular (RV) ejection fraction. Additionally, the area under the curve (AUC) from receiver operating characteristic (ROC) analysis was used to compare the diagnostic performance of different CMR parameters for HFpEF-HTN. Patients diagnosed with (HFpEF-HTN) were characterized by an older demographic profile, a higher prevalence of smoking history, elevated systolic and diastolic blood pressure, increased levels of N-terminal pro-brain natriuretic peptide, and more advanced New York Heart Association functional class as compared to other studied groups. In terms of myocardial deformation, individuals with HFpEF-HTN exhibited pronounced impairments in both LV and RV function, as evidenced by significantly reduced longitudinal strain (LS), circumferential strain (CS), and radial strain (RS), relative to HTN, HHD, the control cohorts (all P values <0.001). Patients with HFpEF-HTN showed significantly elevated levels of late gadolinium enhancement, native T1, and extracellular volume fraction (ECV) indicative of myocardial interstitial fibrosis as compared to patients with HHD. Additionally, as compared to ECV, LV GCS emerged as a superior diagnostic indicator, demonstrating greater diagnostic accuracy in differentiating HFpEF-HTN patients from those with HHD (AUC =0.85; P<0.001). Moreover, LVEF showed a mild correlation with CMR-derived LV GLS (R=-0.43; P<0.001), LV GCS (R=-0.42; P<0.001), and LV GRS, (R=0.56; P<0.001) in all patients. Myocardial strain, T1 mapping, and ECV can be used for the quantitative evaluation of LV and RV ventricular remodeling, dysfunction, and tissue characteristics in patients with HFpEF-HTN and thus hold significant potential for the diagnosis of these patients.

Possibilities of mitochondrial dysfunction diagnosis in chronic heart failure

The article presents preliminary study results of association of direct ultrastructural characteristics of mitochondria (MTC) in cardiomyocytes and indirect signs of mitochondrial dysfunction with clinical course and outcomes of chronic heart failure (CHF). According to electron microscopy of the myocardium a violation of the ultrastructure of MTC of cardiomyocytes is accompanied by a decrease in the rate of oxygen absorption by mitochondria of leukocytes of peripheral blood, separation of oxidation and phosphorylation processes, an increased rate of radiopharmaceuticals leaching from myocardium, indicating mitochondrial membrane damage, low tolerance to physical load and reduced oxygen consumption at peak of load test, which confirms the feasibility of studying associations of indirect signs of mitochondrial dysfunction with ultrastructural changes in the mitochondrial cardiomyocytes and clinical manifestations of heart failure.

Catheter ablation vs antiarrhythmic therapy for atrial fibrillation in heart failure with preserved ejection fraction

BackgroundClinical outcomes of patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) treated with catheter ablation (CA) vs antiarrhythmic therapy (AAT) are not well known. ObjectiveThis study compared morbidity and mortality of patients with AF and HFpEF treated with CA vs AAT. MethodsAF and HFpEF patients from January 2017 to June 2023 were identified in TriNetX, a large global population-based database. Patients with prior diagnosis of heart failure with reduced ejection fraction (HFrEF) or crossover between AAT and CA were excluded. Baseline characteristics including age, sex, body mass index, type of AF, comorbidities, and cardiovascular medications were compared. The 2 groups were 1:1 propensity score matched for outcomes analysis. All-cause mortality, cerebrovascular accident/transient ischemic attack, and acute heart failure were compared with Kaplan-Meier curves. ResultsPatients treated with CA (n = 1959) and AAT (n = 7689) were 1:1 propensity score matched, yielding 3632 patients with no significant differences in baseline characteristics. Compared with AAT, CA was associated with decreased mortality (9.2% vs 20.5%; hazard ratio [HR], 0.431; 95% confidence interval [CI], 0.359–0.518; P < .001). In addition, CA was associated with reduced HFpEF (HR, 0.638; 95% CI, 0.550–0.741; P < .001) and acute HFrEF (HR, 0.645; 95% CI, 0.452–0.920; P = .015). There was no difference in composite of cerebrovascular accident/transient ischemic attack (HR, 0.935; 95% CI, 0.725–1.207; P = .607). ConclusionIn this retrospective study of patients with AF and HFpEF, CA was associated with lower mortality and risk of acute heart failure compared with AAT.