Incremental Value Research Articles

Validation of Left Ventricular Filling Pressure Evaluation by Order of Tricuspid and Mitral Valve Opening in Patients With Atrial Fibrillation.

Accurate assessment of left ventricular filling pressure in patients with atrial fibrillation or flutter (AF) remains difficult. A novel 2-dimensional scoring system, visually assessing time difference between mitral valve and tricuspid valve opening (VMT) score, based on temporal analysis of early diastolic valve opening, could be applied to these patients. We aimed to determine the usefulness of the VMT score in patients with AF. We analyzed 119 consecutive patients with AF who underwent cardiac catheterization as a derivation cohort. The diagnostic performance of the VMT score was further evaluated in an external data set containing 189 patients with AF. Elevated left ventricular filling pressure was defined as a mean pulmonary arterial wedge pressure ≥15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0, tricuspid valve first; 1, simultaneous; 2, mitral valve first). When the inferior vena cava was dilated, 1 point was added, and the VMT score was finally graded as 0 to 3. Conventional Doppler parameters to estimate left ventricular filling pressure were also measured. Pulmonary arterial wedge pressure was elevated with an increase in the VMT score (0: 10±3, 1: 13±5, 2: 22±7, 3: 27±6 mm Hg; P<0.001), resulting in a significant rise in pulmonary arterial wedge pressure from VMT score 1 to 2. VMT≥2 predicted elevated pulmonary arterial wedge pressure with an accuracy of 87%, and the diagnostic accuracy of the VMT score was significantly higher than that of conventional Doppler parameters (C index, 0.88 versus 0.54-0.68; P<0.001). In addition, VMT ≥2 showed an incremental predictive value over plasma brain natriuretic peptide levels (C index, 0.79-0.93; P<0.001). In the external validation cohort, VMT≥2 demonstrated acceptable accuracy of 72%. VMT scoring was a useful echocardiographic marker of elevated left ventricular filling pressure and had an incremental benefit over practical biomarkers in patients with AF.

Abstract 4137958: Transthoracic Echocardiography-based Differentiation of Hypertrophic Cardiomyopathy and Cardiac Amyloidosis

Introduction: Hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis (CA) have similar features on transthoracic echocardiography (TTE) which may make the two difficult to distinguish. However, it is recognized that CA presents at an older age compared to HCM. Our aim was to determine optimal TTE parameters for differentiating HCM from CA and the incremental value of age at the time of diagnosis for differentiation of these two disorders. Methods: Patients with CA (N=121) and HCM (N=227)—diagnosed in accordance with guidelines—who underwent TTE were retrospectively identified. TTE parameters—including left ventricular global longitudinal strain (LVGLS), apical sparing ratio (ASR), AMYLoidosis Index (AMYLI), relative wall thickness (RWT) and ejection fraction to strain ratio (EFSR)—were calculated using artificial intelligence software (US2.AI) and validated by a level III echocardiography reader. Univariate and multivariable logistic regressions were used to compare TTE parameters between CA and HCM patients. Receiver operating characteristic curve (ROC) analysis was conducted to determine performance of echo parameters in distinguishing CA and HCM. Findings: CA patients were older compared to HCM ( Figure 1A ). With respect to TTE parameters, CA was associated with lower magnitude of LVGLS and higher value of ASR, AMYLI, and EFSR. LVGLS (AUC 0.865, 95% CI 0.81-0.91) outperformed AMYLI, RWT, and EFSR for differentiation of HCM from CA ( Figure 1B ). For all five TTE parameters, age provided incremental predictive value for LVGLS (p&lt;0.001), ASR (p&lt;0.001), AMYLI (p=0.007), RWT (p&lt;0.001), and EFSR (p&lt;0.001), Figure 2A-C ). LVGLS &lt;-15.8% was 85% sensitive and 79% specific for CA. Conclusion: LVGLS is an optimal echo parameter for differentiating CA from HCM, outperforming all other traditional CA diagnostic markers. Age provides incremental diagnostic value in the differentiation of these two groups with TTE.

Abstract 4121039: Refining the American Heart Association Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations using depression and anxiety disorder

Background: Growing evidence has suggested associations of common mental health conditions including depression and anxiety disorder with CVD, but no studies have examined their incremental predictive values in PREVENT (AHA Predicting Risk of CVD EVENTs). Research questions: Does including anxiety and/or depression improve the PREVENT predictive performance? Aims: We used a range of measures of anxiety and depression and combinations to examine whether these conditions improved the prediction performance of PREVENT. Methods: New risk prediction models were developed and internally validated using 60% and 40% of the UK Biobank cohort data, respectively. Mental health predictors included: depressive symptom score based on the four-item Patient Health Questionnaire and self-reported and record-based anxiety and depression diagnoses before baseline. CVD events were ascertained through hospital admission and death certificate data after baseline. The Cox proportional hazards models were used to calculate coefficients and 95% confidence intervals. The incremental predictive values were examined by adding the mental health predictors to the PREVENT predictors based on Harrell’s C-indices, sensitivity, specificity, positive and negative predictive values, and net reclassification improvement indices (NRIs). Results: Of the 502,366 UK Biobank participants, 195,489 were included in the derivation set and 130,326 were included in the validation set. In the validation set, the inclusion of each mental health measure produced an increase in C-index and higher sensitivity, specificity, and positive and negative predictive values compared with the PREVENT equations, with the greatest improvements for depressive symptom score. Depressive symptom score produced the greatest improvements in net reclassification overall (NRI 0.84, 95% CI 0.46–1.20) and this was further improved by adding recorded anxiety and depression (NRI 0.89, 95% CI 0.52–1.24). In addition, depressive symptom score showed better discrimination and NRI in both female and male validation sets. Conclusions: Our findings suggest that including depressive symptom score in PREVENT could improve the prediction of CVD with low cost and without invasive procedures.

Abstract 4136784: Diagnostic significance and prognosis prediction of electrocardiogram plane QRS-T angle in patients with non-ST segment elevation acute coronary syndrome

Objective: For patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS), the diagnostic efficacy of traditional ECG is not sensitive and specific. Plane QRS-T angle (PQRS-Ta) can be used as a supplement to the current diagnostic criteria of ECG. Methods: The patients with recurrent chest pain in our hospital were analyzed retrospectively, and the plane QRS-T angle of the patients was calculated. The main results were as follows: (1) the clinical indexes of the two groups were analyzed according to the angle of QRS-T. (2) all patients were divided into three groups according to the final diagnosis. The diagnostic efficacy of QRS-T angle combined with standard ECG diagnostic criteria was analyzed, and the incremental diagnostic value of the new standard relative to the original standard was calculated. (3) the patients were scored by Gensini, and the differences of plane QRS-T angle among patients with different scores were compared. (4) the frequency of MACE was recorded, and the prognostic effect of QRS-T angle on the study population was analyzed. Results: After analyzing the data, there was a difference in the value of plane QRS-T angle between NSTE-ACS population and non-ACS population (p &lt; 0.001). It was found that every 1 °increase of plane QRS-T angle increased the risk of NSTE-ACS by 2.5% (χ 2, 27.59, P &lt; 0.001). The diagnostic accuracy of AUC quantified plane QRS-T angle combined with standard ECG in the diagnosis of NSTE-ACS was 0.68 (CI [0.64 ~ 0.70]). Through the analysis of NRI and IDI index, the relative NRI of the new model to the original model is 6.67%, 95% CI is 3.91%, and the CI is 9.42% (P &lt; 0.001). The IDI is 6.30%, the CI is 4.65%, and the CI is 7.95% (P &lt; 0.001). The new model improves the prediction effect by 6%. When the QRS-T angle increased by 1 °, the Gensini score increased by 0.199 points (95% CIRV 0.149) (Fidel60.975 (P &lt; 0.001). Comparing prognosis of the three groups, there was a statistical difference in the overall survival time among the three groups (χ 2 = 19.090 P &lt; 0.001). Conclusion: Compared with the original standard, the new diagnostic standard can improve the diagnostic efficiency of ECG. QRS-T angle can predict the prognosis of patients with NSTE-ACS. The higher the value of QRS-T angle, the greater the probability of major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome.

Abstract 4113573: Long Noncoding RNAs to Predict COVID-19 Neuro-Cardio-Vascular Outcomes

Introduction/Background: Cardiovascular and neurological diseases develop in a significant proportion of COVID-19 patients. Minimally invasive tools to predict outcome after SARS-CoV-2 infection would enable personalized healthcare, potentially easing the disease burden. We showed that blood levels of the long noncoding RNA lymphoid enhancer-binding factor-1 antisense 1 (LEF1-AS1) predict COVID-19 in-hospital mortality. Hypothesis: LEF1-AS1 is associated with long-term clinical outcomes of COVID-19. Aim: Test the capacity of LEF1-AS1 to predict neuro-cardio-vascular outcomes post-SARS-CoV-2 infection. Methods/Approach: We enrolled 104 primo-infected COVID-19 patients aged 18+ recruited from April to December 2020 in the PrediCOVID national cohort for which 12-month follow-up data were available (Ethics Committee approvals 202003/07 and 202310/02-SU-202003/07). Whole blood samples were collected at baseline and expression levels of LEF1-AS1 were assessed by quantitative PCR. Results/Data: Of the 104 patients, 35 had at least one neurological symptom and one cardiovascular symptom at month 12. Levels of LEF1-AS1 at baseline were lower (p=0.019) in patients who developed neurological and cardiovascular symptoms as compared to patients who did not. Lower LEF1-AS1 was associated with symptoms development with an odds ratio of 0.48 (95% CI 0.28-0.83) from logistic regression model adjusted for age, sex, comorbidities and disease severity at baseline. Addition of LEF1-AS1 to a clinical model including age, sex, comorbidities and baseline severity yielded an incremental predictive value as attested by an increased AUC from 0.79 to 0.83 (likelihood ratio test p=0.005), a net reclassification index of 0.54 (p=0.007) and an integrated discrimination improvement of 0.08 (p=0.009). Conclusion: Blood levels of LEF1-AS1 predict 12-month neurological and cardiovascular outcomes of COVID-19 patients. This needs to be validated in larger populations.

Abstract 4136032: Digital Biomarkers Associated With Coronary Artery Calcium And Traditional Risk Factors Extracted From Facial Photos Through Multi-Label Deep Learning For Detecting Coronary Artery Disease

Background: Biomarkers like coronary artery calcium (CAC) and traditional risk factors are well-validated for coronary artery disease (CAD) assessment but not always available, and with limited workup efficiency and potential radiation risk. Facial features contain biological information related to atherosclerosis. Aims: We aim to extract CAC and traditional risk factor-associated digital biomarkers from facial images and evaluate their value in predicting CAD status compared with conventional clinical approaches. Methods: Suspected individuals referred for confirmatory CAD evaluation across nine centers were included. Participants in one center constituted the derivation set. External validation included one dataset of participants from a different time period in the derivation center and the other dataset from the other eight centers. We developed a multi-label deep-learning model to extract digital biomarkers from facial photos based on a multi-dimensional label of CAC score and eight traditional risk factors to comprehensively represent coronary atherosclerosis risk profile. The extracted digital biomarkers were evaluated for both effectiveness in reflecting components of the multi-dimensional label and clinical value in predicting obstructive CAD. Results: A total of 13248 facial photos from 3312 eligible participants (mean age, 58.5 years; 517 [25.9%] female) were included. In external validation, a set of digital biomarkers (FacialCAD) were extracted, effectively reflecting components of the multi-dimensional label, especially for CAC stratification (CAC&gt;0, AUC 0.919 [0.885 – 0.949]; CAC≥100, AUC 0.906 [0.876 – 0.933]) and nearly perfect prediction for the age and sex. The performance of the FacialCAD in predicting obstructive CAD (AUC 0.721 [0.694–0.748]) significantly outperformed two guideline-recommended CAD models (0.721 vs. 0.653, P&lt;0.001; 0.721 vs. 0.686, P=0.032), with further significant improvement when combined with these models (△AUC= +0.085, P&lt;0.001; △AUC= +0.068, P&lt;0.001). Conclusion: FacialCAD, a set of CAC and risk factors-associated novel digital biomarkers extracted from facial images, exhibited superior and incremental value to conventional clinical approaches in predicting CAD status.

What are the priorities of consumers and carers regarding measurement for evaluation in mental healthcare? Results from a Q-methodology study.

The purpose of this study was to identify and describe common views of people with lived experience of mental health challenges - consumers and carers, families and supporters - of what they consider the most important measures to include in health economic evaluations which assess the incremental value of competing options in mental health care. Participants (n = 111) were people living in the state of Victoria, Australia, who identified as consumers of mental healthcare (n = 38); carers, family members and/or supporters (n = 43); or both (n = 30). Factor analysis based on Q-Methodology was used to identify clusters of people who hold similar viewpoints. Common viewpoints were described in terms of the characteristics of the group, and a qualitative interpretation was conducted on the basis of distinguishing statements and quotes provided in participants' own words. We identified four common views: (1) safety before all else, prioritizing physical, sexual and psychological safety; (2) hope and partnership in processes of care; (3) physical and emotional health and wellbeing; and (4) care access, continuity and partnership with families. Although different priorities were identified for each viewpoint, key priority areas that were common to all views were having an environment in the health service that fosters respect and dignity, and that consumers feel heard and listened to. In sub-group and qualitative analyses, differences were observed regarding the likelihood of consumers and carers holding each of the views, as well as by age group. While some differences were noted between the views of consumers and carers and different age groups, there was also common ground regarding what outcomes are of most importance to measure. Including these measures in evaluation frameworks would provide a way of focussing mental healthcare decisions on the aspects of mental healthcare that are of most value to consumers and carers, thereby addressing an important shortcoming of current approaches to decision-making in mental healthcare.

Short-term outcome after isolated tricuspid valve surgery: prognostic role of right ventricular strain.

To assess the incremental prognostic value of right ventricular free wall longitudinal strain over conventional risk scores in predicting the peri-operative mortality in patients with severe tricuspid regurgitation (TR) undergoing isolated tricuspid valve (TV) surgery. We retrospectively enrolled 110 consecutive patients with severe TR who underwent isolated TV surgery between November 2016 and July 2022 at San Raffaele Hospital, Milan, Italy. Exclusion criteria were previous TV surgery, urgent surgery, complex congenital heart disease, active endocarditis and inadequate acoustic window. Baseline clinical data were included, as well as laboratory tests and clinical risk score, as TRI-SCORE and MELD-XI. The clinical outcome was peri-operative mortality, defined as all-cause mortality within 30 days. The final cohort included 79 patients. The endpoint occurred in 7 patients (9%), who died within 30-days after isolated TV surgery. ROC curves analysis showed that, among parameters of right ventricular function, right ventricular free wall longitudinal strain was the best parameter to predict peri-operative mortality (AUC: 0.854, 95% CI 0.74-0.96, p = 0.005, sensitivity 68%, specificity 100%) At univariable analysis, left ventricular ejection fraction, diabetes mellitus, creatinine, estimated glomerular filtration rate, serum sodium, MELD-XI, TRI-SCORE, right ventricular areas, right ventricular global longitudinal strain, right ventricular free wall longitudinal strain, fractional area change and the ratio between right ventricular free wall longitudinal strain/pulmonary arterial systolic pressure were significantly associated with the endpoint. The combination of TRI-SCORE and right ventricular Strain, evaluating right ventricular systolic function with speckle-tracking echocardiography, outperformed classic TRI-SCORE in outcome prediction (AUC 0.874 vs 0,787, p value=0.05). Right ventricular free wall longitudinal strain has an incremental prognostic value over conventional parameters and significantly improves the ability of clinical scores to predict peri-operative mortality in patients undergoing isolated TV surgery.

NT-proBNP improves prediction of cardiorenal complications in type 2 diabetes: the Hong Kong Diabetes Biobank.

N-terminal pro B-type natriuretic peptide (NT-proBNP) is a natriuretic peptide that is strongly associated with congestive heart failure (CHF). The utility of NT-proBNP for prediction of cardiovascular events and renal endpoints, compared with clinical risk factors, has not been evaluated in detail. We hypothesise that NT-proBNP can improve risk stratification and prediction of cardiorenal events in type 2 diabetes, beyond that provided by clinical risk factors. NT-proBNP was measured in 1993 samples from the Hong Kong Diabetes Biobank, a multicentre prospective diabetes cohort and biobank. A cut-off of ≥125 pg/ml was used to define elevated NT-proBNP. Associations between elevated NT-proBNP and incident cardiovascular and renal endpoints were examined using Cox regression, adjusted for sex, age and duration of diabetes, as well as other covariates. Prognostic and incremental predictive values of NT-proBNP in diabetes cardiorenal complications, compared with those of the Joint Asia Diabetes Evaluation risk equations for CHD, CHF and kidney failure, were evaluated using the concordance index (C index), net reclassification improvement index, integrated discrimination improvement index and relative integrated discrimination improvement index. A total of 24.7% of participants had elevated NT-proBNP. Participants with elevated NT-proBNP at baseline had a more adverse cardiometabolic profile, with 2-4-fold higher frequency of complications at baseline. Adjusting for age at baseline, sex and duration of diabetes, elevated NT-proBNP was associated with incident atrial fibrillation (HR 4.64 [95% CI 2.44, 8.85]), CHD (HR 4.21 [2.46, 7.21]), CVD (HR 3.32 [2.20, 5.01]) and CHF (HR 4.18 [2.18, 8.03]; all p<0.001). All these associations remained significant after further adjustment for additional covariates. Elevated NT-proBNP had good discriminative ability for various cardiorenal endpoints, with C index of 0.83 (95% CI 0.76, 0.90) for CHD, 0.88 (0.81, 0.94) for atrial fibrillation, 0.89 (0.83, 0.95) for CHF, 0.81 (0.77, 0.84) for 40% drop in eGFR and 0.88 (0.84, 0.92) for kidney failure. Models incorporating NT-proBNP had improved prediction compared with established clinical risk models. Sensitivity analyses including alternative cut-off of NT-proBNP, as well as use of other risk engines of CHD, yielded similar results. NT-proBNP demonstrated a promising ability to serve as a prognostic marker for a variety of cardiorenal complications in type 2 diabetes. Considering NT-proBNP in clinical assessments could potentially help identify high-risk individuals who may benefit from more intensive therapies.

Incremental Prognostic Value of Left Ventricular and Left Atrial Strain in Moderate Aortic Stenosis.

Patients with moderate aortic stenosis (AS) show a poor prognosis if they have high-risk features. We investigated the incremental prognostic value of left ventricular (LV) and left atrial (LA) strain in patients with moderate AS. In a cohort of 923 patients with moderate AS (median age 74 years, men 55%, aortic valve area 1.18 [IQR 1.08-1.30] cm2, mean pressure gradient 25 [IQR 23-30] mmHg), LV global longitudinal strain (LV-GLS) and LA reservoir strain (LARS), were measured using speckle-tracking echocardiography. Absolute values of myocardial strain were used. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization.During a median of 5.9 years, the primary endpoint occurred in 186 patients (20.2%). The median LV-GLS and LARS were 17.7% (IQR 14.8-19.7) and 24.5% (IQR 18.7-29.3). LV-GLS (adjusted HR 0.92, 95% CI 0.87-0.97) and LARS (adjusted HR 0.97, 95% CI 0.95-0.99) were significant predictors of the primary outcome, independent of clinical and echocardiographic variables including LV ejection fraction. Notably, the prognostic value of LV-GLS was stronger than that of LARS, remaining significant after further adjustment for LARS. LV-GLS<17% and LARS<22% were identified as optimal cutoffs for the primary outcome. Patients with both reduced LV-GLS and LARS had the worst outcome (log-rank p<0.001). LV-GLS<17% and LARS<22% had incremental prognostic value on top of other clinical and echocardiographic variables. In moderate AS, reduced LV-GLS and LARS have incremental prognostic value, and can refine risk stratification to identify high-risk patients.

Cognitive Engagement and Subjective Well-Being in Adults: Exploring the Role of Domain-Specific Need for Cognition

Need for Cognition (NFC) is an investment trait reflecting interindividual differences in intrinsically motivated engagement in cognitive endeavors. While other motivational constructs like the ability self-concept are typically conceptualized domain-specific, NFC was initially conceived to describe domain-general behavior. Building on a previous study reporting the relevance of domain-specific aspects of NFC in the school context, we investigated the domain-specificity of NFC in predicting various aspects of subjective well-being across three samples with N = 1074 participants and subsamples of students and professionals ranging from n = 140 to n = 346. Our findings reveal positive associations of both domain-general and domain-specific NFC with positive affect, life satisfaction, and job- and study-related satisfaction. In part, domain-specific NFC was more strongly related to domain-specific life satisfaction compared to domain-general NFC. Additionally, we found evidence for small incremental values of domain-specific NFC over and above domain-general NFC in predicting subjective well-being. Confirming previous research, self-control and the emotion regulation strategy reappraisal partially mediated the prediction of well-being by NFC. Our results indicate that additionally considering NFC as domain-specific can meaningfully complement the domain-general conceptualization.

Integrating myocardial CT perfusion with coronary CT angiography improves risk stratification in patients with dialysis-dependent end-stage renal disease.

Risk stratification for incidence of major adverse cardiovascular events (MACE) in patients with dialysis-dependent end-stage renal disease (dd-ESRD) is challenging. Moreover, the usefulness of coronary CT angiography (CCTA) is often limited because of high calcification. This study aimed to investigate the prognostic value of comprehensive cardiac CT in patients with dd-ESRD for predicting MACE. This retrospective analysis included 92 patients with dd-ESRD who underwent comprehensive cardiac CT.Obstructive coronary artery disease (CAD) was defined by CCTA with > 50% stenosis. Global myocardial blood flow (MBF) and summed stress score (SSS) were obtained through dynamic CTP. Cox regression analysis was used to assess correlation with MACE. Kaplan-Meier curves were used to estimate cumulative event rates, and the global Chi-square test was used to assess the incremental value of dynamic CTP over CCTA. During a median follow-up of 2.3years, 43 patients experienced MACE. Univariate analysis revealed that presence of obstructive CAD, higher SSS, and lower global MBF were significantly associated with increased risk of MACE. In multivariable analysis, lower global MBF and presence of obstructive CAD were independently associated with MACE (p = 0.02, and p = 0.04, respectively). CCTA and dynamic CTP combination had incremental value over CCTA alone for predicting MACE, respectively (global Chi-square score, 19.3 and 11.7, respectively). Presence of obstructive CAD on CCTA and lower global MBF on dynamic CTP are independently associated with increased risk of MACE in patients with dd-ESRD. The addition of dynamic CTP to CCTA may improve risk stratification in this population.

Identity disturbance in dimensional and categorical models of personality disorder: The incremental value of self-rated identity and narrative identity.

Identity disturbance is increasingly considered to drive personality disorder (PD) onset. Previous research has investigated how identity relates to PD using either self-report scales or narratives to assess identity. Few studies have investigated how both operationalizations relate to one another and to models of PD. More so, no study has investigated whether a narrative identity assessment offers additional explanatory power in understanding PD, beyond what is captured by a self-rated identity assessment, or vice versa. We aimed to address these gaps by administering a rating scale measuring (mal)adaptive identity alongside a prompt to write a narrative about a turning point event to 331 individuals aged 18-30 (72.2% female, Mage = 22.56). Using this multimethod approach, we investigated (a) associations of narrative identity dimensions (agency, communion, exploratory processing) with self-rated identity, self- and interpersonal dysfunction, and symptoms of borderline and antisocial PD, and (b) whether these narrative identity dimensions could explain unique variance in self- and interpersonal dysfunction, and borderline and antisocial PD symptoms, above and beyond self-rated identity, and vice versa. Results revealed significant associations among narrative identity, self-rated identity, and models of PD. Furthermore, communion demonstrated incremental value in explaining PD features, beyond what was accounted for by self-rated identity. However, narrative identity did not offer additional explanatory power in understanding self- and interpersonal dysfunction, beyond self-rated identity. Self-rated identity showed incremental value in explaining all PD models, beyond narrative identity. These results emphasize the importance of employing different methodologies for assessing identity in elucidating how identity disturbance manifests in personality pathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Growth inhibition and recovery of Pinus massoniana in Chongqing since the 1980s

Over recent decades, the forest ecosystems of southern China have been substantially affected by acid rain, a principal biogeochemical driver. Despite recent efforts to mitigate acid rain, the long-term adaptive responses of trees of varying ages remain insufficiently understood. In this study, we employed the tree-ring basal area increment (BAI), δ13C, δ15N, and δ18O values to identify patterns in growth inhibition and recovery in young and mature Pinus massoniana within acid rain-afflicted zones in China. A marked growth inhibition phase occurred from 1983 to 2010, characterized by a significant decline in BAI, particularly in mature trees. A growth recovery phase occurred from 2011 to 2020, with considerable BAI increases. Throughout the growth-inhibition phase, the intrinsic water-use efficiency (iWUE) increased, whereas δ15N levels were stable, suggesting gradual stomatal closure influenced by both acid rain and elevated CO2 levels. During this phase, mature and young trees exhibited differing strategies in response to environmental stressors. The growth recovery phase was characterized by significant reductions in both iWUE and δ15N, leading to a more closed nitrogen cycle. Structural equation modeling and correlational analyses identified SO42−, NO3−, and precipitation as key determinants of growth variations in both young and mature trees. Our findings underscore the effect of prolonged acid rain exposure on growth suppression across P. massoniana age groups, highlighting iWUE as a reliable predictor of tree growth, although age should be considered. With the ongoing reduction in acidic gas emissions, subtropical P. massoniana forests have exhibited significant resilience, highlighting rapid ecological recovery. We advocate for continued large-scale monitoring and model-based assessments of acid rain effects, emphasizing the need for long-term evaluations to comprehend the ecological resurgence and carbon sequestration potential within these ecosystems.

Prognostic value of left ventricular mass measured on coronary computed tomography angiography

BackgroundLeft ventricular (LV) mass is a well-established prognostic indicator for cardiovascular risk. Measurement of LV mass on coronary computed tomography angiography (CCTA) is considered optional. We aimed to assess for associations between LV mass measured on CCTA with all-cause mortality (ACM) risk and to determine age- and sex-specific distributions. MethodsWe evaluated patients without known coronary artery disease (CAD) who underwent CCTA at a single center. We assessed age- and sex-specific distributions (10th, 25th, 50th, 75th, and 90th percentiles) of LV mass index. ACM, the primary endpoint, was recorded over a median period of 5.1 [interquartile range: 1.4–8.4] years. The association between LV mass and mortality risk was assessed using multivariable Cox models adjusted for age, sex, medical history, coronary artery calcium (CAC) score and CCTA stenosis. Results4187 patients (mean age: 61.9 ​± ​11.7, 63 ​% male) were included. Male sex, African American ethnicity, Hypertension, CAC>400, and smoking were independent predictors of increased LV mass index. During the median 5.1 years of study follow, 265 (6.3 ​%) deaths occurred. Increased LV mass index percentiles were associated with increased risk of ACM. The addition of LV mass index percentiles improved discrimination and reclassification for mortality prediction over a model with age, sex, conventional risk factors, CAC score and CCTA stenosis severity (X2 improvement: 22.68, NRI: 28 ​%, both p ​< ​0.001). ConclusionIn a large sample of patients without known CAD who underwent CCTA, increased LV mass index provided independent and incremental prognostic value for all-cause mortality. Assessment of LV mass by CCTA, considering age and gender distribution, can be utilized clinically to identify patients with high myocardial mass.

Utility of Tau PET in the diagnostic work up of neurodegenerative dementia among Indian patients

Background and objectivesTau PET is being increasingly appraised as a novel diagnostic modality for dementia work up. Given limited data among South Asians, we assessed the frequency, patterns, phenotypic associations and incremental value of positive Tau PET scans in clinically diagnosed neurodegenerative dementia. MethodsThis cross-sectional study recruited consecutive patients of Alzheimer's disease (AD) and non-AD syndromes (September 2021 to October 2022, India). Participants underwent clinical interview, cognitive assessment, MRI brain and tau PET scan ([F-18]ML-104). Visual read in a priori regions of interest was used to identify patterns of tau deposition in the brain. ResultsWe recruited 54 participants (mean age: 63.2 ± 9.2 years, 70.4 % men, 77.8 % dementia, 70.4 % early onset cases, 37.8 % APOE4+). The analysis identified abnormal tau uptake in 40/54 (74.1 %) participants; with uptake in AD signature areas in 27/40 (67.5 %) cases [cortical subtype (74.1 %), limbic (14.8 %), combined cortical/limbic (11.1 %)], and patterns not conforming to AD in 13/40 (32.5 %) cases. Tau PET substantiated the diagnosis of AD among 17/19 (89.5 %) cases with clinically diagnosed AD dementia, 8/23 (34.8 %) cases with suspected non-AD cause, and 2/12 (16.7 %) cases with mild cognitive impairment. A trend for increasing proportion of early onset cases, and worsening cognition, behavior and functional ability was seen, from ‘limbic’ to ‘combined cortical/limbic’ to ‘cortical’ subgroups. ConclusionTau PET is a useful modality to differentiate AD dementia from other neurodegenerative causes in the Indian setting where amyloid biomarkers are not widely available. Biological subtypes of AD map well onto clinical phenotypes and need study in larger cohorts.

A nomogram incorporating linezolid and metabolite concentrations for predicting linezolid induced thrombocytopenia in patients with renal impairment

A nomogram to estimate the risk of linezolid-induced thrombocytopenia in patients with renal impairment is not available. The aim of the study is to develop a nomogram for predicting linezolid-induced thrombocytopenia in patients with renal impairment and to investigate the incremental value of PNU-142300 concentration beyond clinical factors and linezolid trough concentration (Cmin) for risk prediction. Logistic regression was used to identify independent risk factors for linezolid-induced thrombocytopenia in patients with renal impairment and nomograms were established. The performance of the nomograms was assessed in terms of area under the receiver operating characteristic curve (AUROC), net reclassification improvement (NRI), integrated discrimination improvement (IDI) , decision curve analysis (DCA) and calibration. Internal validation and external validation of the nomograms were also performed. Four nomograms were created: nomogram A including total bilirubin, creatinine clearance and concomitant mannitol use; nomogram B containing linezolid Cmin additionally; nomogram C containing total bilirubin, concomitant mannitol use, linezolid Cmin, and PNU142300 concentration; nomogram D including total bilirubin, concomitant mannitol use, and PNU142300 concentration. Nomogram C improved the prediction performance than nomogram A (AUROC 0.881 vs. 0.749; NRI 0.290; IDI 0.226) and nomogram B (AUROC 0.881 vs. 0.812; NRI 0.152; IDI 0.130) in the training cohort. DCA analysis showed that nomogram C yielded a greater net benefit. Compared with nomogram A and nomogram B, nomogram C also showed superior discriminatory efficacy, good calibration and clinical usefulness in the external validation cohort. The nomogram containing PNU-142300 concentration and linezolid Cmin had better predictive capability than that containing linezolid Cmin for predicting linezolid-induced thrombocytopenia in patients with renal impairment.

Enhancing Urban Connectivity and Regeneration of Historic Areas: Case Study of Heart of Sharjah

This study employs the integrative design process of sustainable urban regeneration of the historical district in Sharjah city in UAE by It also improves physical and visual connectivity and integration within the neighbourhood and among the surrounding areas to encourage walkability in the district provides a liveable community, and increase accessibility and social interaction. Applying comprehensive design strategies to promote connectivity and revitalize the public places in historical district. The study employs a combination of field studies and parametric simulation tools to investigate the district and identify opportunities for improvement. By optimizing the master plan, the research aims to enhance integration and connectivity within the neighbourhood. The study yielded several significant findings; most notable was the increment of the integration value of the optimized master plan by approximately 41% in comparison with Shurooq proposed master plan 2025, as a result of improving the urban configuration, the street network enhances the connection between the old district and the waterfront, and introducing a central plaza to be connected with Al Rola park to achieve the holistic desired approach. The study's outcomes offer practical implications for urban planners and policymakers in the Gulf Region, highlighting the importance of integrative design strategies in fostering sustainable urban regeneration and improving social interactions within historical districts. The study contributes to the promotion of sustainable urban development methods in the Gulf Region by providing insights into how to improve social interactions, promote a holistic approach to urban regeneration in historical districts, and enhance urban sustainability.

Optimising Interannual Sea Ice Thickness Variability Retrieved From CryoSat‐2

AbstractSatellite radar altimeters like CryoSat‐2 estimate sea ice thickness by measuring the return‐time of transmitted radar pulses, reflected from the sea ice and ocean surface, to measure the radar freeboard. Converting freeboard to thickness requires an assumption regarding the fractional depth of the snowpack from which the radar waves backscatter . We derive sea ice thickness from CryoSat‐2 radar freeboard data with incremental values for , for the 2010–2021 winter periods. By comparing these to sea ice thickness estimates derived from upward‐looking sonar moorings, we find that values between 35%–80% result in the best representation of interannual variability observed over first‐year ice, reduced to 55% over multi‐year ice. The underestimating bias in retrievals caused by optimizing this metric can be removed by reducing the waveform retracking threshold to 20%–50%. Our results pave the way for a new generation of ‘partial penetration’ sea ice thickness products from radar altimeters.

Effect of left atrial function on cardiovascular outcome in non-dilated left ventricular cardiomyopathy

Abstract Background This study aimed to determine whether atrial function and strains can provide the greatest or joint incremental prognostic value in patients with non-dilated left ventricular cardiomyopathy (NDLVC) over a long follow-up period. Methods One hundred sixty-four NDLVC patients were included retrospectively. Comprehensive clinical evaluation and echocardiographic investigations were obtained, including measurements of strain derived left atrial (LA) reservoir, conduit, booster strain. All patients were followed up for adverse cardiac events (MACE) including all-cause mortality, hospitalization due to heart failure aggravation. The predictors of MACE were examined with univariable and multivariable Cox regression analysis. Subsequently, nested Cox regression models were built to evaluate the incremental prognostic value of strain parameters. Patient survival was illustrated by Kaplan–Meier curves and differences were evaluated by log-rank test. Results During a median follow-up of 3.8 years, MACEs were identified in 34 (21%) patients. Cox regression models showed that the predictive value of LA conduit strain was independent from and incremental to LAVi and baseline variables. Age, E/e', RASP and LA reservoir and conduit strain were univariably associated with the outcome (all P &amp;lt; 0.05). LA conduit strain was a stronger predictor of outcome compared with reservoir strain. LA conduit strain, age, RASP remained associated in the multivariable model (LA conduit strain HR: 2.14 [95% CI: 1.37-3.87; P &amp;lt; 0.007]; age HR: 1.05 [95% CI: 1.01-1.10; P = 0.020]; and RASP HR: 1.07 [95% CI: 1.01-1.14; P = 0.021]), whereas LVEF, LAVi were not. Adding LA conduit strain to other independent predictors (age and LAVi) improved the prediction of MACEs. (p &amp;lt; 0.05). Also, when a Kaplan Meier graph was obtained for the occurrence of MACE based on LA conduit strain 17%, a significant difference was shown between the two groups. Conclusion LA conduit strain provided the good prognostic value and added incremental value to conventional clinical predictors for patients with NDLVC.Incremental value of LA strainKM according to LA strain 17%