Low T2 Research Articles

Impaired coronary microvascular reactivity in youth with bipolar disorder.

Cardiovascular disease (CVD) is excessively prevalent and premature in bipolar disorder (BD), even after controlling for traditional cardiovascular risk factors. The increased risk of CVD in BD may be subserved by microvascular dysfunction. We examined coronary microvascular function in relation to youth BD. Participants were 86 youth, ages 13-20 years (n = 39 BD, n = 47 controls). Coronary microvascular reactivity (CMVR) was assessed using quantitative T2 magnetic resonance imaging during a validated breathing-paradigm. Quantitative T2 maps were acquired at baseline, following 60-s of hyperventilation, and every 10-s thereafter during a 40-s breath-hold. Left ventricular structure and function were evaluated based on 12-15 short- and long-axis cardiac-gated cine images. A linear mixed-effects model that controlled for age, sex, and body mass index assessed for between-group differences in CMVR (time-by-group interaction). The breathing-paradigm induced a significant time-related increase in T2 relaxation time for all participants (i.e. CMVR; β = 0.36, p < 0.001). CMVR was significantly lower in BD v. controls (β = -0.11, p = 0.002). Post-hoc analyses found lower T2 relaxation time in BD youth after 20-, 30-, and 40 s of breath-holding (d = 0.48, d = 0.72, d = 0.91, respectively; all pFDR < 0.01). Gross left ventricular structure and function (e.g. mass, ejection fraction) were within normal ranges and did not differ between groups. Youth with BD showed evidence of subclinically impaired coronary microvascular function, despite normal gross cardiac structure and function. These results converge with prior findings in adults with major depressive disorder and post-traumatic stress disorder. Future studies integrating larger samples, prospective follow-up, and blood-based biomarkers are warranted.

Biomarker-guided withdrawal of inhaled corticosteroids in asthma patients with a non-T2 inflammatory phenotype – a randomized controlled trial study protocol

BackgroundNon-T2 asthma is characterized by the absence of elevated type 2 inflammatory biomarkers such as blood-eosinophils, total and allergen-specific Immunoglobulin E and Fractional exhaled Nitric Oxide (FeNO). According to guidelines, inhaled corticosteroids (ICS) are the cornerstone of asthma management. However, ICS treatment is associated with a risk of local side effects, including hoarseness and thrush, and long-term high-dose therapy may cause systemic adverse effects. Furthermore, whereas treatment with ICS is highly effective in T2 asthma, studies have shown a markedly reduced ICS efficacy in patients with a lower degree of T2 inflammation, thus posing a clinical challenge in this subgroup of patients. Hence, owing to the ICS dosage step-up approach in current clinical guidelines, patients with low T2 biomarkers are at risk of being exposed to high doses of ICS, and by that at risk of side effects. Thus, an ICS-treatment regime guided by biomarkers that reflects the inflammatory phenotype is warranted in order to reduce the corticosteroid burden in patients with non-T2 asthma. This study combines a panel of non-T2 inflammatory markers (low periostin, low blood-eosinophils, and low FeNO), to determine if this group of patients can maintain asthma control during ICS withdrawal.MethodsThis is an ongoing prospective multicenter open-label randomized, controlled trial aiming to assess if ICS can be safely tapered in patients with non-T2 asthma. The patients are randomized 1:1 to either standard of care or an ICS tapering regimen (n = 55 in each group) where the initial ICS dose is reduced by 50% for 8 weeks followed by total ICS removal. The primary endpoint is change in asthma control questionnaire (ACQ) from baseline to post-tapered ICS. The secondary endpoints are time from baseline to drop-out caused by loss of asthma control, changes in serum-periostin, blood-eosinophils, FeNO, Forced Expiratory Volume in 1 s (FEV1) and in sputum-eosinophils.DiscussionThis study aims to provide data on ICS tapering in non-T2 asthma patients and to contribute to a more individualized and corticosteroid-sparing treatment regime in this group of patients.Trial registrationClinicaltrials.gov Identifier: NCT03141424. Registration date: May 5th, 2017.

Sucrose substitution in cake systems is not a piece of cake

Successful sucrose replacement in cake systems requires thorough understanding of its functionality. Time-domain 1H NMR showed that water in the viscous aqueous phase isolated from cake batter by ultracentrifugation [i.e. the batter liquor (BL)] exhibits low mobility by its low T2 relaxation time (T2,D RT). This is due to its interactions with sucrose or sucrose replacers. The T2,D RT itself is positively related with the effective volumetric hydrogen bond density of sucrose or sucrose replacers. Sucrose additionally co-determines the quantity and viscosity of cake BL and thereby how much air the batter contains at the end of mixing. Like sucrose, maltitol and oligofructose provide adequate volumes of BL with low water mobility and thus sufficient air in the batter, while the rather insoluble mannitol and inulin do not. Differential scanning calorimetry and rapid viscosity analysis revealed, however, that, in contrast to sucrose and maltitol, oligofructose fails to provide appropriate timings of starch gelatinisation and protein denaturation, resulting in poor cake texture. The shortcomings of mannitol and oligofructose in terms of respectively ensuring appropriate gas content in batter and biopolymer transitions during baking can be overcome by using mixtures thereof. This work shows that successful sucrose substitutes or substitute mixtures must provide sufficient BL with low water mobility and ensure appropriate timings of starch and protein biopolymer transitions during baking.

Monitoring settling of anaerobic digestates using low-field MRI profiling and NMR relaxometry measurements

Dewatering of anaerobic digestate from red meat processing was assessed using low field MRI profiling and NMR relaxometry. Samples were flocculated using a cationic flocculant (EM640CT) at dosing range (0 to 1.6% v/v) and monitored during the initial 30 min of settling via MRI profiling to assess changes in water fraction, settling time and initial settling velocity. The profiles showed decreasing settling time and increasing initial settling velocity with increased dosing, while sample porosity was observed to increase up to the optimal dosing point (0.8% v/v). Significant increases in sample variability were observed past this point due to flocculant overdosing. The samples were then analysed in terms of turbidity and NMR relaxometry. Increasing flocculant concentration caused turbidity to decrease from 210 to 13 NTU. The relaxation rate of free water showed a strong positive correlation with turbidity. T2 peaks observed before overdosing could be assigned to different water structures (free, interstitial, vicinal and hydration). An additional T2 population emerged in the T2 distributions at the optimal dosing point. Multivariate exploratory data analysis (MEDA) showed that this T2 population from the solids layer was strongly correlated with the total solids layer height and turbidity of the watery layer. This T2 peak formation may therefore be used to study opaque flocculated solids to monitor for water structures associated with flocculant overdosing. Further studies using this technique will aim to assess the potential of low field T2 relaxometry monitoring inline before mechanical dewatering, to monitor optimal flocculant dosing during continuous operations on systems with high solids concentration.

A FEM-Based Comparative Study of the Effect of Rotor Bar Designs on the Performance of Squirrel Cage Induction Motors

Induction motors (IM) are the most frequently used type of motor in the industry. The number of rotor slots, bar geometry, and conductivity of bar material have a strong impact on the torque profile and efficiency characteristics of induction motors. This study focused on investigating the effect of different rotor bar designs on motor performance by the finite element method (FEM). The IMs have been designed using the same stator core, winding, and core lengths. The total rotor bar cross-section areas are also fixed throughout all designs. In addition to the change in the number of rotor bars and geometry, the effect of copper and aluminum bar materials on motor performance was also investigated, both for single and double-layered squirrel-cage structures. The results of the study indicate that the starting torque of the motor in a 36/30-slot aluminum single-cage structure was obtained as 96.26 Nm, while the starting torque of a 36/46-slot aluminum double-cage structure was found to be 115.34 Nm. It is also found that the starting torque of the initial design can be increased by up to 19.82% by changing only the rotor bar numbers and material with the same stator and rotor size. The efficiency of the motors was determined as 86.6% for both designs. In addition to efficiency, the output torque ripple has been decreased to 2.63, which equals a 67.32% decrease in the ripple of the initial design. The improved design has an approximately 8 °C lower T2 due to better cooling performance as a result of a higher number of rotor slots.

Effect of different sweeteners on the thermal, rheological, and water mobility properties of soft wheat flour and their application to cookies as an alternative to sugar

The effects of different sweeteners on the physicochemical properties of soft wheat flour were investigated mainly in terms of thermal, rheological, and water mobility features, and their feasibilities as an alternative to sugar were evaluated in the cookie system. Kestose significantly reduced the solvent retention capacity of wheat flour, followed by sucrose, fructose, and allulose. Thermal analysis showed that the sucrose and kestose distinctly led to an increase in the gelatinization temperature of wheat flour, which was explained by lower T2 relaxation times. In addition, the pasting viscosities and thermo-mechanical properties of wheat flour containing kestose became lower compared to allulose, and these differences were morphologically confirmed by the real-time microscopic measurements during heating. Furthermore, when the sweeteners were incorporated into the cookie formulations, kestose played a positive role as a sugar replacer in the cookie system by presenting a comparable spread factor, texture, and color to cookies with sucrose.

Crystalline Arrays of Copper Porphyrin Qubits Based on Ion-Paired Frameworks.

Molecular electronic spin qubits have great potential for use in quantum information science applications because their structure can be rationally tuned using synthetic chemistry. Their integration into a new class of materials, ion-paired frameworks, allows for the formation of ordered arrays of these molecular spin qubits. Three ion-paired frameworks with varying densities of paramagnetic Cu(II) porphyrins were isolated as micron-sized crystals suitable for characterization by single-crystal X-ray diffraction. Pulse-electron paramagnetic resonance (EPR) spectroscopy probed the spin coherence of these materials at temperatures up to 140 K. The crystals with the longest Cu-Cu distances had a spin-spin relaxation time (Tm) of 207 ns and a spin-lattice relaxation time (T1) of 1.8 ms at 5 K, which decreased at elevated temperature because of spin-phonon coupling. Crystals with shorter Cu-Cu distances also had lower T1 values because of enhanced cross-relaxation from qubit-qubit dipolar coupling. Frameworks with shorter Cu-Cu distances exhibited lower Tm values because of the increased interactions between qubits within the frameworks. Incorporating molecular electronic spin qubits in ion-paired frameworks enables control of composition, spacing, and interqubit interactions, providing a rational means to extend spin relaxation times.

Applications of Diffusion-Weighted MRI to the Musculoskeletal System.

Diffusion-weighted imaging (DWI) is an established MRI technique that can investigate tissue microstructure at the scale of a few micrometers. Musculoskeletal tissues typically have a highly ordered structure to fulfill their functions and therefore represent an optimal application of DWI. Even more since disruption of tissue organization affects its biomechanical properties and may indicate irreversible damage. The application of DWI to the musculoskeletal system faces application-specific challenges on data acquisition including susceptibility effects, the low T2 relaxation time of most musculoskeletal tissues (2-70 msec) and the need for sub-millimetric resolution. Thus, musculoskeletal applications have been an area of development of new DWI methods. In this review, we provide an overview of the technical aspects of DWI acquisition including diffusion-weighting, MRI pulse sequences and different diffusion regimes to study tissue microstructure. For each tissue type (growth plate, articular cartilage, muscle, bone marrow, intervertebral discs, ligaments, tendons, menisci, and synovium), the rationale for the use of DWI and clinical studies in support of its use as a biomarker are presented. The review describes studies showing that DTI of the growth plate has predictive value for child growth and that DTI of articular cartilage has potential to predict the radiographic progression of joint damage in early stages of osteoarthritis. DTI has been used extensively in skeletal muscle where it has shown potential to detect microstructural and functional changes in a wide range of muscle pathologies. DWI of bone marrow showed to be a valuable tool for the diagnosis of benign and malignant acute vertebral fractures and bone metastases. DTI and diffusion kurtosis have been investigated as markers of early intervertebral disc degeneration and lower back pain. Finally, promising new applications of DTI to anterior cruciate ligament grafts and synovium are presented. The review ends with an overview of the use of DWI in clinical routine. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.

Imaging Spectrum of the Developing Glioblastoma: A Cross-Sectional Observation Study.

Glioblastoma (GBM) has the typical radiological appearance (TRA) of a centrally necrotic, peripherally enhancing tumor with surrounding edema. The objective of this study was to determine whether the developing GBM displays a spectrum of imaging changes detectable on routine clinical imaging prior to TRA GBM. Patients with pre-operative imaging diagnosed with GBM (1 January 2014-31 March 2022) were identified from a neuroscience center. The imaging was reviewed by an experienced neuroradiologist. Imaging patterns preceding TRA GBM were analyzed. A total of 76 out of 555 (14%) patients had imaging preceding TRA GBM, 57 had solitary lesions, and 19 had multiple lesions (total = 84 lesions). Here, 83% of the lesions had cortical or cortical/subcortical locations. The earliest imaging features for 84 lesions were T2 hyperintensity/CT low density (n = 18), CT hyperdensity (n = 51), and T2 iso-intensity (n = 15). Lesions initially showing T2 hyperintensity/CT low density later showed T2 iso-intensity. When CT and MRI were available, all CT hyperdense lesions showed T2 iso-intensity, reduced diffusivity, and the following enhancement patterns: nodular 35%, solid 29%, none 26%, and patchy peripheral 10%. The mean time to develop TRA GBM from T2 hyperintensity was 140 days and from CT hyperdensity was 69 days. This research suggests that the developing GBM shows a spectrum of imaging features, progressing through T2 hyperintensity to CT hyperdensity, T2 iso-intensity, reduced diffusivity, and variable enhancement to TRA GBM. Red flags for non-TRA GBM lesions are cortical/subcortical CT hyperdense/T2 iso-intense/low ADC. Future research correlating this imaging spectrum with pathophysiology may provide insight into GBM growth patterns.

Assessment of articular cartilage of ankle joint in stable and unstable unilateral weber type-B/SER-type ankle fractures shortly after trauma using T2 relaxation time.

Early detection of post-traumatic cartilage damage in the ankle joint in magnetic resonance images can be difficult due to disturbances to structures usually appearing over time. To study the articular cartilage of unilateral Weber type-B/SER-type ankle fractures shortly post-trauma using T2 relaxation time. Fifty one fractured ankles were gathered from consecutively screened patients, compiled initially for RCT studies, and treated at Oulu University Hospital and classified as stable (n = 28) and unstable fractures (n = 23) based on external-rotation stress test: medial clear space of ≥5mm was interpreted as unstable. A control group of healthy young individuals (n = 19) was also gathered. All ankles were imaged on average 9 (range: 1 to 25) days after injury on a 3.0T MRI unit for T2 relaxation time assessment, and the cartilage was divided into sub-regions for comparison. Control group displayed significantly higher T2 values in tibial cartilage compared to stable (six out of nine regions, p-values = .003-.043) and unstable (six out of nine regions, p-values = .001-.037) ankle fractures. No differences were detected in talar cartilage. Also, no differences were observed between stable and unstable fractures in tibial or talar cartilage. Lower T2 relaxation times of tibial cartilage in fractured ankles suggest intact extra cellular matrix (ECM) of the cartilage. Severity of the ankle fracture, measured by ankle stability, does not seem to increase ECM degradation immediately after trauma.

Pituitary abscess: a case report and systematic review of 488 cases

BackgroundPituitary abscess (PA) is a rare condition and not well understood. We aimed to describe a case and perform a comprehensive systematic review to explore presenting symptoms, radiological findings, endocrine abnormalities and mortality.AimTo identify presenting symptoms, radiological findings, endocrinological abnormalities and predictors of mortality for PA.MethodsWe systematically reviewed the literature to identify all case reports of PA. Data regarding presentation, mortality, radiological findings, endocrinological abnormalities and treatment was extracted.ResultsWe identified 488 patients from 218 articles meeting the inclusion criteria. Mortality was 5.1%, with days to presentation (OR 1.0005, 95% CI 1.0001–1.0008, p < 0.01) being the only identified independent predictor of mortality. Mortality rates have decreased over time, with cases published prior to 2000 having higher mortality rates (OR 6.92, 95% CI 2.80–17.90, p < 0.001). The most common symptom was headache (76.2%), followed by visual field defects (47.3%). Classical signs of infection were only present in 43%. The most common imaging feature on magnetic resonance imaging (MRI) was high T2 and low T1 signal of the pituitary gland with peripheral contrast enhancement. Over half (54.8%) were culture negative, with the most common bacterial organism being staphylococcus aureus (7.8%) and fungal organism being aspergillus (8.8%). The most common endocrine abnormality was hypopituitarism (41.1%), followed by diabetes insipidus (24.8%). Whilst symptoms resolved in most patients, persistent endocrine abnormalities were present in over half of patients (61.0%).ConclusionPA is associated with significant mortality, with delayed presentation increasing risk of mortality. Ongoing endocrinological abnormalities are common. Given the non-specific clinical presentation, the appearance of high T2, low T1 and peripheral contrast enhancement of the pituitary on MRI should prompt consideration of this rare disease.

MR-zero meets RARE MRI: Joint optimization of refocusing flip angles and neural networks to minimize T2 -induced blurring in spin echo sequences.

An end-to-end differentiable 2D Bloch simulation is used to reduce T2 induced blurring in single-shot turbo spin echo sequences, also called rapid imaging with refocused echoes (RARE) sequences, by using a joint optimization of refocusing flip angles and a convolutional neural network. Simulation and optimization were performed in the MR-zero framework. Variable flip angle train and DenseNet parameters were optimized jointly using the instantaneous transverse magnetization, available in our simulation, at a certain echo time, which serves as ideal blurring-free target. Final optimized sequences were exported for in vivo measurements at a real system (3 T Siemens, PRISMA) using the Pulseq standard. The optimized RARE was able to successfully lower T2 -induced blurring for single-shot RARE sequences in proton density-weighted and T2 -weighted images. In addition to an increased sharpness, the neural network allowed correction of the contrast changes to match the theoretical transversal magnetization. The optimization found flip angle design strategies similar to existing literature, however, visual inspection of the images and evaluation of the respective point spread function demonstrated an improved performance. This work demonstrates that when variable flip angles and a convolutional neural network are optimized jointly in an end-to-end approach, sequences with more efficient minimization of T2 -induced blurring can be found. This allows faster single- or multi-shot RARE MRI with longer echo trains.

T2-star (T2*)-weighted magnetic resonance imaging of tenosynovial giant cell tumors

PurposeTenosynovial giant cell tumors (TSGCTs) are benign but aggressive lesions, and the treatment is resection. A low to intermediate signal intensity on both T1- and T2-weighted images of magnetic resonance imaging (MRI) is characteristic, which is similar to the signal intensity of muscle, and therefore can be challenging for lesion detection. T2-star (T2*)-weighted MR images reflect paramagnetic deoxyhemoglobin, methemoglobin, or hemosiderin. MethodsIn 23 TSGCT patients (6 male and 17 females), the T2*MRI findings were analyzed. The tumor locations involved 10 large joints including nine knees and one ankle, 10 small joints including six fingers and four toes, as well as three wrists/hands. ResultsTen diffuse and 13 localized tumors were predominantly located in the large joints and small joints, respectively. The T2*-weighted images indicated three signal patterns of low, iso and high signal intensity compared to muscle. Low-, iso- and high-signal intensities were seen in 22 (96 %), 23 (100 %) and 12 (52 %) of the locations, respectively. To distinguish TSGCTs from the surrounding tissue, the low intensity T2*-weighted images and low to intermediate intensity T1-weighted images when compared to muscle and fluid, respectively were useful for the large joints. Low to intermediate intensity on T1- or T2-weighted images was useful to distinguish TSGCTs from subcutaneous tissue in the small joints. ConclusionsMRI using T2*-, as well as T1- and T2-weighted images, may be useful to detect lesions and assess the extent of TSGCTs in a tissue-specific manner, which is important for surgical planning.

Diagenetic History and Timing of Cu and Zn-Pb Sulfide Mineralization in the Permian Kupferschiefer System, Saale Subbasin, Eastern Germany

Abstract The Southern Permian basin in central Europe contains a number of important high-grade sediment-hosted Cu deposits. Laterally extensive stratabound Cu and Zn-Pb sulfide mineralized rocks are located at a major stratigraphic redox boundary, where coarse-grained continental sandstones of the uppermost Rotliegend Group are overlain by carbonaceous mudstones (T1) and limestones (Ca1) of the Zechstein Formation. This study investigates the diagenetic evolution and style of sulfide mineralization in three drill cores that intersect Cu and Zn-Pb sulfide mineralized rocks at three locations (Sangerhausen, Allstedt, and Wallendorf) in the Saale subbasin (Eastern Germany), which is located at the southern margin of the Southern Permian basin. We combine macro- to microscale petrographic data (binocular, transmitted and reflected light, and scanning electron microscopy) with quantitative X-ray diffractometry and bulk-rock geochemical analyses. Petrographic results show extensive, primary-porosity-occluding, early diagenetic calcite cementation that predates both the diagenetic alteration of detrital clasts and sulfide mineralization. The highest-grade Cu and Zn-Pb sulfides (bornite, sphalerite, and galena) replace the calcite cement, with subordinate replacement of dolomite and detrital clasts. Quantitative mineralogical and geochemical data demonstrate that the highest base metal (Cu, Zn, and Pb) concentrations are associated with carbonate-rich samples, mostly as disseminated mineralization in the middle T1. Bulk-rock geochemical results show enrichment and covariation of redox-sensitive trace elements (RSTEs, e.g., Mo) with total organic carbon content toward the lower T1, consistent with highly reducing depositional conditions. Overall, the distribution and dissolution of calcite cement across this stratigraphic redox boundary provided the main control on the lateral migration of base metal-bearing fluids and high-grade Cu and Zn-Pb sulfide mineralization in the Saale subbasin.

Cardiac magnetic resonance phenotypes and cardiovascular prognosis in classical vs cardiac variant of Fabry disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Fabry disease (FD) is an X-linked lysosomal storage disorder due to a deficiency/absence of alfa-galattosidase A enzyme activity. More than 1000 GLA gene mutations have been identified to be causative of classical or late-onset clinical phenotype. Cardiac variants (p.N215S, p.F113L and IVS4+919G&amp;gt;A) cause a predominant late-onset cardiac involvement with minimal systemic manifestations compared to classical phenotype.1 Cardiac magnetic resonance (CMR) is widely used to assess FD cardiac involvement, thanks to its accuracy in quantification of left ventricular mass and to the possibility to perform a non-invasive tissue characterization.2 Since cardiac involvement is the main cause of FD morbidity and mortality,3 CMR findings play a prognostic role in FD. Purpose the aims of this study were: 1) to compare CMR phenotypes of FD patients with classical and cardiac variant of the disease; 2) to compare the prognostic role of CMR parameters in these two groups of FD patients. Methods study population included 128 FD patients (classical variant: 69%, cardiac variant 31%). Clinical characteristics and CMR findings were compared between classical and cardiac variant. CV events during follow-up were abstracted from the patients’ records and only first event after CMR was used for survival analysis. The composite endpoint was defined as the development of one of the following events: a) sustained or non-sustained ventricular tachycardia, b) bradyarrhythmias requiring pacing, c) heart failure hospitalization, d) atrial fibrillation, e) myocardial infarction and f) all-cause mortality. Results compared to patients with cardiac variant, FD patients with classical mutations were younger (39 [26–53] vs 46 [37–57], p = 0,050), with a more severe systemic involvement according to Mainz Severity Score index (MSSI: 20,50 [9,25–27,00] vs 9,00 [2,00–23,00], p = 0,003). Overall, 37% (48/130) of patients assumed FD specific treatment, most of them exhibiting a classical mutation (43/48 patients, p&amp;lt;0,001).No significant differences in CMR parameters were observed comparing the two groups of patients. The percentage of patients with LVH, LGE and low T1 values were similar in classical and cardiac variants. During a median follow-up of 36 [17–57] months, Kaplan Meier curves shows a similar event-free survival probability (Log-rank p = 0,362) between the two phenotypes (Fig. 1). In addition, presence of LVH and LGE were both associated with composite CV endpoint in these two groups of patients. Conclusion patients with cardiac variants of FD showed similar CMR phenotype and CV prognosis compare to patients with classical mutations. The presence of LVH and LGE play the same prognostic impact in both the clinical phenotypes. CMR assessment of cardiac involvement represents a pivotal step in the evaluation of FD patients irrespective of patients’ genotype.

Baseline native T1 values are associated with adverse outcome in a newly diagnosed, hospitalised heart failure patient population

Abstract Funding Acknowledgements Type of funding sources: None. Background Tissue characterisation by T1 mapping on Cardiac Magnetic Resonance (CMR) imaging is a non-invasive assessment of diffuse cardiac fibrosis and has been shown to predict outcome in Heart Failure (HF). Purpose There is a need for improved risk stratification that delivers more personalised care for HF patients. We conducted the first prospective study to investigate novel CMR tissue characterisation biomarkers and correlate to adverse outcome, in a cohort of patients hospitalised with a new HF diagnosis. Methods This was single centre observational study. Inclusion criteria were admission with signs and symptoms of HF, and LVEF ≤50% or elevated plasma NTproBNP and being treated with intravenous furosemide. 43 consecutive eligible participants were included and underwent comprehensive CMR to establish anatomy, function and myocardial tissue characteristics during their presentation admission. Participants were managed according to best practice HF guidelines and underwent reviews at 6, 12–18 and 24–30 months. All clinically relevant event data e.g. death and rehospitalisation were recorded. Baseline CMR volumes, function, presence of Late Gadolinium Enhancement (LGE) and T1 mapping values were compared between the adverse event group and no adverse event group. ‘Adverse event’ was defined as all-cause mortality or HF hospitalisation. Results The median follow-up of 43 participants was 24.4 months. 41 (95%) were diagnosed with HF with reduced EF and 2 (5%) with HF with preserved Ejection Fraction. Baseline clinical, biochemical characteristics and NYHA class were similar between the adverse event and no adverse event groups. There was no significant difference between baseline LVEF (37% vs. 23%; p = 0.339) or NTproBNP levels (4948 vs.5456; p = 0.929) between groups. There was high uptake of HF medical therapy in both groups. (Table 1) 9 participants (21%) experienced adverse events. There was a significantly higher proportion of Ischaemic Cardiomyopathy in the adverse event group (67% vs. 18%; p = 0.008) with lower indexed LV volumes and mass. Native septal T1 (ms) was significantly higher in the adverse event group compared with the no adverse event group (1035 vs.996 p = 0.045). (Table 1) Receiver Operating Characteristic (ROC) analysis indicated a Native T1 cut-off value of 1022ms as most sensitive and specific. Kaplan-Meier survival analysis comparing those with Native T1 &amp;lt;1022ms and those with Native T1 &amp;gt;1022ms on their baseline CMR showed an adverse event-free survival benefit favouring the lower T1 value group (HR 11.4, p = 0.003 - Figure 1). Conclusions In a cohort of all-comer hospitalised patients with a new diagnosis of HF, followed up over a 24-month period, there was a high rate of adverse events. A higher native T1 value on baseline CMR was associated with worse outcome in terms of all-cause mortality or HF hospitalisation.

#5630 SCREENING AND DIAGNOSIS STRATEGY FOR FABRY DISEASE IN TAIWANESE PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Fabry disease (FD) is not uncommon in patients with chronic kidney disease (CKD) who are on dialysis or have stroke at a young age, left ventricular hypertrophy (LVH) or hypertrophic obstructive cardiomyopathy (HOCM). However, FD is easily overlooked by physicians due to the heterogeneity of clinical manifestations. Therefore, an expert consensus meeting was held to establish a screening algorithm for FD in patients with CKD. Method The first meeting was held in Taiwan in August 2022. The screening criteria for FD with respect to age, sex, family history, cardiac involvement and signs and symptoms were discussed. The findings of meeting and the consensus opinion of the expert group were summarized. Results The screening algorithm was shown in Figure 1. It is recommended to screen for FD regardless of age. Screening for FD is recommended for CKD patients with family history of FD, stroke at young age (&amp;lt;55 years) or typical signs and symptoms including angiokeratoma, hypohidrosis, neuropathic pain, heat/cold and exercise intolerance, hearing loss and cornea verticillata. If CKD patients have one of the cardiac symptoms including dyspnea, palpitation and chest pain, it is recommended to check the cardiac-related red flags including LVH and HOCM using echocardiogram, short PQ interval, atrioventricular block and prolonged QRS interval using electrocardiogram, and low native T1 and posterolateral late gadolinium enhancement using magnetic resonance imaging. If cardiac-related red flags are present, screening for FD is recommended. Screening can also be performed in patients with CKD who do not have any typical symptoms but have a high suspicion of FD. In males, screening can be performed by measuring α-galactosidase A enzyme activity. If the enzyme activity is reduced or absent, assessment of globotriaosylsphingosine (lyso-Gb3) levels in plasma and genetic analysis are recommended. In female, assessment of lyso-Gb3 levels in plasma and genetic analysis are recommended. Conclusion FD is an underrecognized and not so rare disease. Physicians should maintain a skeptical attitude in clinical practice in order to make diagnosis in time and help patients and their entire families avoid life-threatening diseases at a young age. There are still more issues to be addressed, including whether to inform patients of the screening results, how to interact and communicate with patients, etc.

Comparison of Methemoglobin, Deoxyhemoglobin, and Ferrous Nitrosyl Hemoglobin as Potential MRI Contrast Agents.

Gadolinium-based contrast agents (GBCAs) are in widespread use to enhance magnetic resonance imaging for evaluating vascular pathology. However, safety concerns and limitations regarding the use of GBCAs has led to an increased interest in alternative contrast agents. Previously, methemoglobin (metHb) and oxygen-free hemoglobin (HHb) have been shown to increase the T1-weighted signal intensity of blood, which is associated with a decrease in the T1 parameter and an enhanced contrast of the image. Thus, a lower T1 value compared to the baseline value is favorable for imaging. However, it is unknown as to whether metHb or HHb would be a stronger and more appropriate contrast agent and to what extent the T1-weighted signal is affected by concentration. This study evaluated T1-weighted images of blood samples over a range of metHb and HHb concentrations, as well as ferrous nitrosyl hemoglobin (HbIINO) concentrations. Comparison of T1 values from a baseline value of ~ 1500ms showed that metHb is the strongest contrast agent (T1 ~ 950ms at 20% metHb) and that HHb is a relatively weak contrast agent (T1 ~ 1450ms at 20% HHb). This study showed for the first time that HbIINO can provide a contrast effect, although not as strong as metHb but stronger than HHb (T1 estimated as 1250ms at 20% HbIINO). With metHb providing a viable contrast between 10 and 20%, metHb has the potential to be a safe and effective contrast agent since it can be naturally converted back to hemoglobin.

0423 The Role of Fear of Sleep in Cognitive Behavioral Therapy for Insomnia and Cognitive Processing Therapy

Abstract Introduction Fear of sleep (FoS) is linked to symptoms of PTSD. Additionally, cognitive behavioral therapy for insomnia (CBTi) can reduce FoS. Utilizing data from a randomized controlled trial of CBTi followed by Cognitive Processing Therapy for PTSD (CPT), this secondary data analysis sought to examine the relationship between FoS and PTSD symptoms, and how FoS is impacted by CBTi, in individuals exposed to interpersonal violence with PTSD. Additionally, we sought to extend the literature by examining whether FoS predicts the effect of subsequent CPT on PTSD severity or if CPT further reduces FoS. Methods A sample of 83 participants were randomly assigned to either receive sequential delivery of four weekly sessions of CBTi, which included modules to address FoS, followed by 12 weekly sessions of CPT (Group 1: CBTi+CPT) or receive four weekly phone check-ins (CTRL) followed by CPT (Group 2: CTRL+CPT). Participants were assessed at baseline (T1), after CBTi/CTRL (T2), and after CPT (T3). Relevant measures included the Fear of Sleep Inventory (FoSI) and Clinician Administered PTSD Scale (CAPS). Analyses included correlations, mean differences tests, and regression-based analyses. Results At T1 FoSI and CAPS were positively correlated (r = 0.47, p &amp;lt; 0.001). At T2 a significant reduction in FoSI scores was observed after CBTi/CTRL for Group 1 (t = 4.81, p &amp;lt; 0.001), but not Group 2, and a significant difference in FoSI scores between Group 1 and Group 2, all while controlling for baseline differences (F (1, 80) = 3.99, p &amp;lt; 0.05). Lastly, for the entire sample lower T2 FoSI scores predicted lower T3 CAPS scores (B = 0.42, p &amp;lt; 0.01) and FoS was not further reduced following CPT. Conclusion Results replicate previous work by demonstrating a positive relationship between FoS and PTSD severity. Additionally, FoSI was significantly reduced after CBTi. Lastly, lower levels of FoS predicted reduced PTSD symptoms following CPT, although CPT was not associated with significant reductions in FoS. Results highlight that CBTi that explicitly addresses FoS may reduce FoS, and findings also suggest that effectively reducing FoS prior to PTSD treatment may improve treatment outcomes. Support (if any) NIH/NINR R01 NR013909; VA Center of Excellence for Suicide Prevention

Aggressive behavior and the socialization and regulation of anger in early adolescent friendships

This research explored the relations among aggressive behavior, friend socialization of anger, and adaptive anger regulation within early adolescent friendships. Participants were 202 adolescents (52.50% girls; Mage = 12.68 years) who participated in 101 same-gender close friend dyads at an initial assessment (T1) and a second assessment two years later (T2). At T1, adolescents reported on their aggression, adaptive anger regulation, and on their friends’ socialization responses to anger at T1, and at T2 their own adaptive anger regulation. ActorPartner Interdependence Modeling (APIM) evaluated relations among aggression, anger socialization, and anger regulation. Adolescents’ T1 aggressive behavior was associated with lower supportive and greater unsupportive anger socialization within friendships, and with their lower T2 adaptive anger regulation. In turn, supportive anger socialization was associated with greater adaptive T2 anger regulation and unsupportive anger socialization with lower T2 adaptive anger regulation. Mediational analyses indicated that T1 aggressive behavior predicted lower T2 anger regulation indirectly through T1 greater unsupportive anger socialization. Results highlight how aggressive behavior may hinder healthy anger socialization processes within friendships and demonstrate the importance of friend emotion socialization as a venue in which adolescents may (or may not) learn adaptive ways of managing anger arousal.