Maximal Wall Thickness Research Articles

Can combined high-resolution vessel wall imaging and multiple post-labeling delay 3D pseudo-continuous arterial spin labeling differentiate moyamoya disease from atherosclerotic moyamoya syndrome?

PurposeTo investigate whether moyamoya disease (MMD) and atherosclerotic moyamoya syndrome (AS-MMS) differ in vascular morphology and perfusion characteristics using T1w-CUBE imaging and multiple post-labeling delay 3D pseudo-continuous arterial spin labeling imaging (MP 3D-PcASL), and to explore the potential of the combined techniques for accurate diagnosis of both diseases. MethodThis prospective study enrolled 51 patients with moyamoya vasculopathy, including 26 with MMD and 25 with AS-MMS. All patients underwent digital subtraction angiography (DSA)/magnetic resonance angiography (MRA), T1w-CUBE imaging, and MP 3D-PCASL examinations. Morphological parameters, including the outer diameter, maximum wall thickness, luminal stenosis morphology, degree of wall enhancement, number of collateral vessels, and perfusion parameters, such as cerebral blood flow (CBF) and arterial transit time (ATT), were measured. After univariate analysis between the two groups, logistic regression models based on the derived parameters of T1w-CUBE imaging, MP 3D-PCASL, and combined imaging were implemented, and receiver operating characteristic (ROC) curves were generated to compare the discriminatory power of the different imaging methods for the diagnosis of MMD. ResultsWith T1w-CUBE imaging, MMD showed a smaller outer diameter (2.76 ± 0.39 vs. 3.07 ± 0.49 mm) and maximum wall thickness (1.27 ± 0.19 vs. 1.49 ± 0.24 mm) than AS-MMS (both P < 0.05). Using MP 3D-pcASL, the resultant CBF (36.64 ± 14.28 vs. 28.77 ± 8.63 mL/100 g/min) was higher in MMD relative to AS-MMS, while an opposite pattern was shown for ATT (1.61 ± 0.09 vs. 1.72 ± 0.13 s; both P < 0.05). Robust diagnostic efficacies for disease differentiation, confirmed by high areas under the ROC curve (AUCs) (>0.808), were separately shown with T1w-CUBE and MP 3D-pcASL derived parameters. However, the combined multivariate logistic regression model showed optimaldiagnostic efficacy(AUC: 0.938; P < 0.05). ConclusionsCombined T1w-CUBE imaging and MP 3D-PCASL provides distinctive morphological and functional features to evaluate vessel walls and cerebral perfusion, and might help distinguish MMD from AS-MMS.

Bleb Morphology on Anterior-Segment Optical Coherence Tomography after XEN Gel Stent Implantation.

We investigated the internal morphology of filtration blebs after XEN gel stent implantation using anterior segment optical coherence tomography (AS-OCT) and identified factors related to intraocular pressure (IOP) postoperatively. Eighteen eyes of 18 patients who had undergone XEN gel stent implantation were analyzed. Blebs were imaged using Visante OCT (Carl Zeiss Meditec AG, Germany) at 6 months and 1 year after surgery and evaluated for quantitative parameters including bleb height, maximum height of internal cavity, maximum bleb wall thickness, and maximum bleb epithelial thickness. Subjects were classified into two groups according to the presence or absence of a definite internal cavity between the conjunctiva and sclera using AS-OCT imaging. Nine eyes (50%) were assigned to the internal cavity group and 9 (50%) to the uniform group. Postoperative IOP was significantly lower in the internal cavity group than in the uniform group both at 6 months and 1 year after surgery (p = 0.024 and p = 0.040). Postoperative IOP showed statistically significant negative correlations with bleb height and the height of the internal cavity (Spearman correlation coefficient r = -0.518, p = 0.028 and r = -0.453, p = 0.034, respectively). AS-OCT facilitates analysis of bleb morphology after XEN gel stent implantation. A larger height of the internal cavity of the bleb appeared to correlate with lower IOP after XEN implantation.

The role of echocardiography in management of patients with hypertrophic cardiomyopathy (review)

The presented contains the discussion about the role of echocardiography in management of patients with hypertrophic cardiomyopathy (HCM). The article provides general information about the role of echocardiography in the diagnosis of the disease, clarification of the specific etiology of hypertrophy and differential diagnosis with secondary hypertrophy and phenocopies of HCMP. The features of right and left ventricular (LV) hypertrophy, determination of its predominant localization, phenotype, and conventionally used parameters for assessing myocardial hypertrophy, including the maximum LV wall thickness, LV myocardial mass and LV myocardial mass index, are discussed in detail. Knowledge of phenotypic variants helps to diagnose HCMP, to differentiated approach the management of patients and to choose the optimal treatment strategy. Special attention is paid to the assessment of the structure and function of the mitral valve (MV), the subvalvular apparatus and the phenomenon of systolic anterior motion of the MV responsible for the development of obstruction of the LV outflow tract. The previously existing opinion that cardiac abnormality in HCMP is limited only by hypertrophy of ventricular myocardium has recently undergone changes. Approximately 60% of patients with HCMP have at least one MV anomaly as a direct consequence of genetic mutations. The most common abnormalities that can be detected with echocardiography include elongation of the valvular leaflets and chords, prolapse of the valvular leaflets, hypertrophy, disposition and change in the number of papillary muscles. The importance and significance of assessing LV systolic and diastolic functions using echocardiography is emphasized. The role of transesophageal echocardiography in visualization of hypertrophy features of the MV structure and in the perioperative period during surgical correction of hypertrophied septum and valvular defects is also discussed.

Delamination mitigation in additively manufactured Al2O3 via enhanced thermal postprocessing

AbstractManufacturing thick (&gt;10 mm) alumina (Al2O3) parts through the ceramic additive manufacturing technique of digital light processing (DLP) is difficult due to the large amount of polymer that must be removed. Nearly 35–65 vol% of a fugitive UV‐curable polymer is used in commercial ceramic slurries in order to maintain shape through the DLP process. During the thermal debind, gases form and escape quickly due to pressure build‐up, leading to defects in the form of print layer delamination. Here, we analyze the polymer decomposition through thermogravimetric analysis in order to design a less aggressive thermal debind schedule through strategic thermal holds and decreased heating rates. The new schedule led to a 83% reduction in average delaminations per sample (from 6.9 delaminations per sample to 1.2 delaminations per sample) and up to a 100% increase in wall thickness (from nominally 10–20 mm). A complex, Al2O3 turbine rotor (with maximum wall thickness of 5 mm in the center hub section) of a JetCat P400 engine was fabricated to compare the new schedule to the manufacturer provided one. The improved thermal debind schedule produced a turbine rotor with no observable delamination defects.

Improved Diagnostic Criteria for Apical Hypertrophic Cardiomyopathy

BackgroundThere is no acceptable maximum wall thickness (MWT) threshold for diagnosing apical hypertrophic cardiomyopathy (ApHCM), with guidelines referring to ≥15 mm MWT for all hypertrophic cardiomyopathy subtypes. A normal myocardium naturally tapers apically; a fixed diagnostic threshold fails to account for this. Using cardiac magnetic resonance, “relative” ApHCM has been described with typical electrocardiographic features, loss of apical tapering, and cavity obliteration but also with MWT <15 mm. ObjectivesThe authors aimed to define normal apical wall thickness thresholds in healthy subjects and use these to accurately identify ApHCM. MethodsThe following healthy subjects were recruited: healthy UK Biobank imaging substudy subjects (n = 4,112) and an independent healthy volunteer group (n = 489). A clinically defined disease population of 104 ApHCM subjects was enrolled, with 72 overt (MWT ≥15 mm) and 32 relative (MWT <15 mm but typical electrocardiographic/imaging findings) ApHCM subjects. Cardiac magnetic resonance–derived MWT was measured in 16 segments using a published clinically validated machine learning algorithm. Segmental normal reference ranges were created and indexed (for age, sex, and body surface area), and diagnostic performance was assessed. ResultsIn healthy cohorts, there was no clinically significant age-related difference for apical wall thickness. There were sex-related differences, but these were not clinically significant after indexing to body surface area. Therefore, segmental reference ranges for apical hypertrophy required indexing to body surface area only (not age or sex). The upper limit of normal (the largest of the 4 apical segments measured) corresponded to a maximum apical MWT in healthy subjects of 5.2 to 5.6 mm/m2 with an accuracy of 0.94 (the unindexed equivalent being 11 mm). This threshold was categorized as abnormal in 99% (71/72) of overt ApHCM patients, 78% (25/32) of relative ApHCM patients, 3% (122/4,112) of UK Biobank subjects, and 3% (13/489) of healthy volunteers. ConclusionsPer-segment indexed apical wall thickness thresholds are highly accurate for detecting apical hypertrophy, providing confidence to the reader to diagnose ApHCM in those not reaching current internationally recognized criteria.

Association Between Bowel Wall Thickening and Long-Term Outcomes in Decompensated Liver Cirrhosis.

Bowel wall thickening is commonly observed in liver cirrhosis, but few studies have explored its impact on the long-term outcomes of patients with cirrhosis. Overall, 118 patients with decompensated cirrhosis were retrospectively enrolled, in whom maximum wall thickness of small bowel, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum could be measured in computed tomography (CT) images. X-tile software was employed to determine the best cut-off values of each segment of bowel wall thickness for predicting the risk of further decompensation and death. Cumulative rates of further decompensation and death were calculated by Nelson-Aalen cumulative risk curve analyses. Predictors of further decompensation and death were evaluated by competing risk analyses. Sub-distribution hazard ratios (sHRs) were calculated. Cumulative rates of further decompensation were significantly higher in patients with wall thickness of ascending colon ≥ 11.7mm (P=0.014), transverse colon ≥ 3.2mm (P=0.043), descending colon≥9.8mm (P=0.035), and rectum ≥ 7.2mm (P=0.045), but not those with wall thickness of small bowel ≥ 8.5mm (P=0.312) or sigmoid colon≥7.1mm (P=0.237). Wall thickness of ascending colon≥11.7mm (sHR=1.70, P=0.030), transverse colon ≥ 3.2mm (sHR=2.15, P=0.038), and rectum≥7.2mm (sHR=2.38, P=0.045) were independent predictors of further decompensation, but not wall thickness of small bowel≥8.5mm (sHR=1.19, P=0.490), descending colon ≥ 9.8mm (sHR=1.53, P=0.093) or sigmoid colon≥7.1mm (sHR=0.63, P=0.076). Small bowel, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum wall thickness were not significantly associated with death. Colorectal wall thickening, but not small bowel wall, may be considered for the prediction of further decompensation in cirrhosis.

Prognostic Implications of the Extent of Cardiac Damage in Patients With Fabry Disease

BackgroundThere is limited evidence on the risk stratification of cardiovascular outcomes in patients with Fabry disease (FD). ObjectivesThis study sought to classify FD patients into disease stages, based on the extent of the cardiac damage evaluated by echocardiography, and to assess their prognostic impact in a multicenter cohort. MethodsPatients with FD from 5 Italian referral centers were categorized into 4 stages: stage 0, no cardiac involvement; stage 1, left ventricular (LV) hypertrophy (LV maximal wall thickness >12 mm); stage 2, left atrium (LA) enlargement (LA volume index >34 mL/m2); stage 3, ventricular impairment (LV ejection fraction <50% or E/eʹ ≥15 or TAPSE <17 mm). The study endpoint was the composite of all-cause death, hospitalization for heart failure, new-onset atrial fibrillation, major bradyarrhythmias or tachyarrhythmias, and ischemic stroke. ResultsA total of 314 patients were included. Among them, 174 (56%) were classified as stage 0, 41 (13%) as stage 1, 57 (18%) as stage 2 and 42 (13%) as stage 3. A progressive increase in the composite event rate at 8 years was observed with worsening stages of cardiac damage (log-rank P < 0.001). On multivariable Cox regression analysis, the staging was independently associated with the risk of cardiovascular events (HR: 2.086 per 1-stage increase; 95% CI: 1.487-2.927; P < 0.001). Notably, cardiac staging demonstrated a stronger and additive prognostic value, as compared with the degree of LV hypertrophy. ConclusionsIn FD patients, a novel staging classification of cardiac damage, evaluated by echocardiography, is strongly associated with cardiovascular outcomes and may be helpful to refine risk stratification.

Clinical significance of abdominal computed tomography and colonoscopy in the evaluation of phlebosclerotic colitis.

Clinical manifestations of phlebosclerotic colitis (PC) exhibit significant variability, necessitating diverse treatment strategies depending on disease severity. However, there is limited research exploring the relationship between imaging findings and disease severity. Hence, this retrospective study aimed to analyze the correlation between computed tomography (CT) findings, colonoscopic features, and disease severity. This study compared the abdominal CT characteristics, colonoscopy findings, and treatment modalities of 45 PC patients. CT images were assessed for the severity of mesenteric venous calcification, maximum colonic wall thickness, number of involved colonic segments, and presence of pericolic inflammation. Colonoscopic images were assessed for dark purple discoloration mucosa, erosive and ulcerative lesions, mucosal edema, luminal narrowing, and the number of involved colonic segments. In addition, patients were categorized into three groups: the observation (n = 15), medical treatment (n = 19), and operation (n = 11) groups. In CT images, a significant difference in pericolic inflammation (p = 0.039) was observed among groups. Further, significant differences in dark purple discoloration mucosa (p = 0.033), erosive or ulcerative lesions (p < 0.001), mucosal edema (p < 0.001), luminal narrowing (p = 0.012), and the number of involved colonic segments (p = 0.001) were observed in colonoscopy. Moreover, we found positive correlations between CT and colonoscopy features. In conclusion, CT manifestations and colonoscopy findings exhibited correlation with disease severity in PC. When limited to one diagnostic tool, observations from that tool can infer potential manifestations of the alternative tool.

Repurposing the β3-Adrenergic Receptor Agonist Mirabegron in Patients With Structural Cardiac Disease

Left ventricular (LV) hypertrophy contributes to the onset and progression of heart failure (HF), particularly for patients with pre-HF (stage B) for whom no treatment has yet proven effective to prevent transition to overt HF (stage C). The β3-adrenergic receptors (β3ARs) may represent a new target, as their activation attenuates LV remodeling. To determine whether activation of β3ARs by repurposing a β3AR agonist, mirabegron, is safe and effective in preventing progression of LV hypertrophy and diastolic dysfunction among patients with pre- or mild HF. The Beta3-LVH prospective, triple-blind, placebo-controlled phase 2b randomized clinical trial enrolled patients between September 12, 2016, and February 26, 2021, with a follow-up of 12 months. The trial was conducted at 10 academic hospitals in 8 countries across Europe (Germany, Poland, France, Belgium, Italy, Portugal, Greece, and the UK). Patients aged 18 years or older with or without HF symptoms (maximum New York Heart Association class II) were screened for the presence of LV hypertrophy (increased LV mass index [LVMI] of ≥95 g/m2 for women or ≥115 g/m2 for men) or maximum wall thickness of 13 mm or greater using echocardiography. Data analysis was performed in August 2022. Participants were randomly assigned (1:1) to mirabegron (50 mg/d) or placebo, stratified by the presence of atrial fibrillation and/or type 2 diabetes, for 12 months. The primary end points were LVMI determined using cardiac magnetic resonance imaging and LV diastolic function (early diastolic tissue Doppler velocity [E/e'] ratio assessed using Doppler echocardiography) at 12 months. Patients with at least 1 valid measurement of either primary end point were included in the primary analysis. Safety was assessed for all patients who received at least 1 dose of study medication. Of the 380 patients screened, 296 were enrolled in the trial. There were 147 patients randomized to mirabegron (116 men [79%]; mean [SD] age, 64.0 [10.2] years) and 149 to placebo (112 men [75%]; mean [SD] age, 62.2 [10.9] years). All patients were included in the primary intention-to-treat analysis. At 12 months, the baseline and covariate-adjusted differences between groups included a 1.3-g/m2 increase in LVMI (95% CI, -0.15 to 2.74; P = .08) and a -0.15 decrease in E/e' (95% CI, -0.69 to 0.4; P = .60). A total of 213 adverse events (AEs) occurred in 82 mirabegron-treated patients (including 31 serious AEs in 19 patients) and 215 AEs occurred in 88 placebo-treated patients (including 30 serious AEs in 22 patients). No deaths occurred during the trial. In this study, mirabegron therapy had a neutral effect on LV mass or diastolic function over 12 months among patients who had structural heart disease with no or mild HF symptoms. ClinicalTrials.gov Identifier: NCT02599480.

Study on the Law of Blank and Material Properties on the Free Bending of Pipes

To explore the impact of various material parameters on the three-dimensional free bending behavior of metal pipes and enhance the quality of such bending processes, this study focused on TP2 copper pipes with dimensions Φ12mm×1mm. Under uniform conditions of process parameters, free bending equipment, and key component characteristics, pipes with varying wall thicknesses and materials were investigated. The evaluation criteria were based on the maximum wall thickness thinning rate and maximum ellipticity of the pipes. The investigation aimed to understand how alterations in different material parameters affect bending radius, propulsive force, and wall thickness of the pipes. The results revealed that smaller bending radii correlate with more pronounced influences of wall thickness on pipe curvature. Additionally, an increase in wall thickness led to a decrease in pipe forming quality. The bending radius of the pipe was determined by multiple parameters, including the material's elastic modulus, yield strength, pipe hardening index, and strength coefficient. The maximum ellipticity of the pipe was found to be associated with material strength, while the alteration of pipe wall thickness was influenced by the hardening index, denoted as 'n'.

Towards ROXAS AI: Deep learning for faster and more accurate conifer cell analysis

Quantitative wood anatomy (QWA) has proven to be a powerful method for extracting relevant environmental information from tree-rings. Although classical image-analysis tools such as ROXAS have greatly improved and facilitated measurements of anatomical features, producing QWA datasets remains challenging and time-consuming. In recent years, deep learning techniques have drastically improved the performance of most computer vision tasks. We, therefore, investigate three different deep learning models (U-Net, Mask-RCNN, Panoptic Deeplab) to improve the main bottleneck, cell detection. Therefore, we create a Conifer Lumen Segmentation (CoLuS) dataset for training and evaluation. It consists of manual outlines of each cell lumen from anatomical images of several conifer species that cover a wide range of sample qualities. We furthermore apply our deep learning model to a previously published high-quality QWA chronology from Northern Finland to compare the warm-season (AMJJAS) temperature reconstruction skill of our deep learning method with that of the current ROXAS implementation, which is based on classical image analysis. Based on our evaluation dataset we show improvements of 7.6% and 8.1% for our best performing deep learning model (U-Net) for the computer vision metrics mean Intersection over Union (mIoU) and Panoptic Quality (PQ) compared to automatic ROXAS segmentation, in addition to being much faster. Furthermore, U-Net reduces the percentage error compared to automatic ROXAS analysis - which tends to systematically underestimate lumen area - by 57.8% for lumen area, 63.2% for average cell wall thickness, and 54.1% for cell count. In addition, we show higher performance for the U-Net compared to the Mask-RCNN previously used for tree cell segmentation. These improvements are independent of sample quality. For the Northern Finland QWA chronology, our U-Net model matches or outperforms ROXAS with and without manual post-processing, showing a common signal (Rbar) of 0.72 and a AMJJAS temperature correlation of 0.81 for maximum radial cell wall thickness. A clear improvement is especially visible for the anatomical latewood density, likely due to the better detection of small cell lumina. Our results demonstrate the potential of deep learning for higher-quality segmentation with lower manual post-processing time, saving weeks to months of tedious work without compromising data quality. We thus plan to implement deep learning in a future version of ROXAS.

Assessment of papillary muscle free strain in hypertrophic cardiomyopathy and hypertension-induced left ventricular hypertrophy.

We aimed to evaluate and compare papillary muscle free strain in hypertrophic cardiomyopathy (HCMP) and hypertensive (HT) patients. Global longitudinal strain (GLS), and longitudinal myocardial strain of the anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were obtained in 46 HCMP and 50 HT patients. Interventricular septum (IVS)/posterior wall (PW) thickness ratio, left ventricular mass index (LVMI), left atrial anteroposterior diameter (LAAP) and mitral E/E' were found to be increased in patients with HCMP compared to HT patients. Left ventricular cavity dimensions were smaller in HCMP patients. GLS of HCMP and HT patients were - 14.52 ± 3.01 and -16.85 ± 1.36%, respectively (p < 0.001). Likewise, ALPM and PMPM free strain values were significantly reduced in HCMP patients over HT patients [-14.00% (-22 to -11%) and -15.5% (-24.02 to -10.16%) vs -23.00% (-24.99 to -19.01%) and -22.30% (-26.48 to -15.95%) (p = 0.016 and p = 0.010)], respectively. ALPM free strain showed a statistically significant correlation with GLS, maximal wall thickness, IVS thickness and LVMI. PMPM free strain showed a significant correlation with GLS, IVS thickness and LAAP. The GLS value of - 13.05 had a sensitivity of 61.9% and a specificity of 97.4% for predicting HCMP. ALPM and PMPM free strain values of -15.31 and -17.17% had 63 and 76.9% sensitivity and 85.7 and 76.9% specificity for prediction of HCMP. Besides other echocardiographic variables, which were investigated in earlier studies, papillary muscle free strain also could be used in HCMP to distinguish HCMP- from HT-associated hypertrophy.

Association between left atrial myopathy and sarcomere mutation in patients with hypertrophic cardiomyopathy: insights into left atrial strain by MRI feature tracking.

Left atrial (LA) myopathy, characterized by LA enlargement and mechanical dysfunction, is associated with worse prognosis in hypertrophic cardiomyopathy (HCM) while the impact of sarcomere mutation on LA myopathy remains unclear. We aimed to assess the association between LA myopathy and sarcomere mutation and to explore the incremental utility of LA strain in mutation prediction. A total of 105 consecutive HCM patients (mean age 47.8 ± 11.9years, 71% male) who underwent HCM-related gene screening and cardiac MRI were retrospectively enrolled. LA volume, ejection fraction and strain indices in reservoir, conduit, and booster-pump phases were investigated respectively. Fifty mutation-positive patients showed higher LA maximal volume index (59.4 ± 28.2 vs 43.8 ± 18.1mL/m2, p = 0.001), lower reservoir (21.3 ± 7.9 vs 26.2 ± 6.6%, p < 0.001), and booster-pump strain (12.1 ± 5.4 vs 17.1 ± 5.0%, p < 0.001) but similar conduit strain (9.2 ± 4.5 vs 9.1 ± 4.5%, p = 0.909) compared with mutation-negative patients. In multivariate logistic regression, LA booster-pump strain was associated with sarcomere mutation (odds ratio = 0.86, 95% confidence interval: 0.77-0.96, p = 0.010) independent of maximal wall thickness, late gadolinium enhancement, and LA volume. Furthermore, LA booster-pump strain showed incremental value for mutation prediction added to Mayo II score (AUC 0.798 vs 0.709, p = 0.024). In HCM, mutation-positive patients suffered worse LA enlargement and worse reservoir and booster-pump functions. LA booster-pump strain was a strong factor for sarcomere mutation prediction added to Mayo II score. The independent association between sarcomere mutation and left atrial mechanical dysfunction provide new insights into the pathogenesis of atrial myopathy and is helpful to understand the adverse prognosis regarding atrial fibrillation and stroke in mutation-positive patients. • In patients with hypertrophic cardiomyopathy, left atrial (LA) reservoir and booster-pump function, but not conduit function, were significantly impaired in mutation-positive patients compared with mutation-negative patients. • LA booster-pump strain measured by MRI-derived feature tracking is feasible to predict sarcomere mutation with high incremental value added to Mayo II score.

Association of duration and intensity of exercise with phenotypic expression in hypertrophic cardiomyopathy

ObjectivesThere is limited data regarding the impact of exercise on phenotypic expression in hypertrophic cardiomyopathy (HCM). We aimed to investigate whether such an association exists in a cohort of genotype-positive HCM patients. MethodsIn this cross-sectional study of genotype-positive HCM families, we used structured questionnaires to obtain data regarding intensity and duration of exercise of participants starting at the age of 10, as well as data regarding exercise recommendations and their impact on quality of life (QOL). The association of cumulative metabolic-equivalent hours of exercise at different ages with different measures of phenotypic expression (maximal wall thickness, left atrial diameter, extent of late gadolinium enhancement) was analyzed. ResultsThe study included 109 patients from 55 families, including 43 male (39%) and 90 (83%) phenotype-positive. No association was identified between exercise duration or intensity with any of the phenotypic markers with the exception of greater cumulative exercise associated with younger age at presentation. Similar results were obtained when analysis was limited to exercise until the age of 20, until the age of 30 or only after 30.Among phenotype-positive patients, 89% recalled receiving recommendations regarding exercise restriction, 29% noted reduction in exercise level following such recommendations and 25% noted this having a significant impact on their QOL. ConclusionWe found no association between exercise intensity or duration and phenotypic expression in genotype-positive HCM patients. These findings are important for physician-patient discussions and support the recent trend towards more permissive exercise restrictions in HCM.

Role of Multidetector Computed Tomography in Differentiation of Benign and Malignant Cavitary Lung Lesions With a Histopathological Correlation: A Retrospective Cross-Sectional Study.

Introduction Cavitary lung disease has a wide range of differential diagnoses, which include both benign and malignant lesions. Imaging differentiation of benign from malignant cavitary lesions has always been a challenge due to overlapping imaging findings. The present study describes the most accurate multidetector computed tomography (MDCT) findings that could help in differentiating benign from malignant conditions in correlation with the histopathological reports. Methods This retrospective study was carried out on diagnosed cases of cavitary lung lesions on MDCTfrom January 2022 to February 2023. We evaluated the number of cavitary lung lesions, their location with respect to lung segment/lobe, the maximum diameter of the largest lesion, the maximum wall thickness of the largest cavity, and additional findings associated with these lesions. Measurements of the maximum wall thickness were plotted on a graph. Statistical analysis was done, and a receiver operating characteristic curve (ROC) was calculated to find the accurate cut-off wall thickness for malignant and non-malignant lesions.These findings were then correlated with the histopathological report. Results A review of the MDCT scans of 47 patients was done; 30 (63.8%) of those were male with a mean age of 47.93±14.68 (SD) years while 17 (36.2%) were female with a mean age of 52.53 ±18.38 (SD) years. Out of 47 patients, 27 (57.4%) had benign lesions and 20 (42.5%) had malignant lesions. Significant differences (p<0.05) were found between benign and malignant lesions while comparing the averages of maximum wall thickness (8.1 mm and 14.5 mm, respectively) and the irregular inner margin of the largest cavitary lesions. The presence of consolidation and centrilobular nodules correlated significantly (p<0.05) with the benign nature of cavitary lung lesions. The maximum cut-off wall thickness was <6 mm and >17 mm for the differentiation of benign from malignant lung lesions, respectively. Conclusions The maximum wall thickness and irregular inner margin of cavitary lung lesions was a good indicator for the differentiation of benign and malignant etiologies on MDCTwhile consolidation and centrilobular nodules favoured the benign etiology more.

Associations between electrocardiographic findings and echocardiographic profiles in patients with hypertrophic cardiomyopathy

BackgroundThe relationships between electrocardiography (ECG) findings and echocardiographic profiles in patients with hypertrophic cardiomyopathy (HCM) are not fully understood. MethodsOne hundred forty patients (mean age: 62.9 ± 15.3 years, 96 men) with HCM were studied. We assessed the associations between ECG findings and echocardiographic findings including maximum left ventricular wall thickness, HCM subtypes and distribution of left ventricular hypertrophy (LVH): the LV was divided into basal, mid, and apical segments by dividing it into thirds along the long axis. ResultsIn ECG, LVH by voltage criteria, abnormal Q wave, negative T wave, and giant negative T wave (GNT) were observed in 74 (53 %), 30 (21 %), 132 (94 %), and 25 (18 %) of the patients, respectively. In two groups with and without an LVH pattern according to voltage criteria in ECG, there were no significant differences in maximum LV wall thickness, subtype of HCM, and distribution of LVH. Regarding an abnormal Q wave, the proportion of patients with LVH in the basal segment was significantly higher in patients with an abnormal Q wave than in patients without an abnormal Q wave (87 % vs 61 %, p = 0.008). An abnormal Q wave was not observed in patients with LVH confined to the apex. Patients with a GNT included patients with LVH located at only the apex (apical HCM), LVH from the mid segment to apex, and LVH from the base to apex. No GNT was found in patients with hypertrophy located in the upper region from the base to mid segment of the LV. ConclusionsIn patients with HCM, there was no significant correlation between the presence of LVH by voltage criteria in ECG and echocardiographic findings. An abnormal Q wave was associated with disproportionate hypertrophy of the basal wall and a GNT reflected the presence of LVH in the apical segment.

Delayed-release rapamycin halts progression of left ventricular hypertrophy in subclinical feline hypertrophic cardiomyopathy: results of the RAPACAT trial.

Feline hypertrophic cardiomyopathy (HCM) remains a disease with little therapeutic advancement. Rapamycin modulates the mTOR pathway, preventing and reversing cardiac hypertrophy in rodent disease models. Its use in human renal allograft patients is associated with reduced cardiac wall thickness. We sought to evaluate the effects of once-weekly delayed-release (DR) rapamycin over 6 months on echocardiographic, biochemical, and biomarker responses in cats with subclinical, nonobstructive HCM. 43 client-owned cats with subclinical HCM. Cats enrolled in this double-blinded, multicentered, randomized, and placebo-controlled clinical trial were allocated to low- or high-dose DR rapamycin or placebo. Cats underwent physical examination, quality-of-life assessment, blood pressure, hematology, biochemistry, total T4, urinalysis, N-terminal pro-B-type natriuretic peptide, and cardiac troponin I at baseline and days 60, 120, and 180. Fructosamine was analyzed at screening and day 180. Echocardiograms were performed at all time points excluding day 120. Outcome variables were compared using a repeated measures ANCOVA. No demographic, echocardiographic, or clinicopathologic values were significantly different between study groups at baseline, confirming successful randomization. At day 180, the primary study outcome variable, maximum LV myocardial wall thickness at any location, was significantly lower in the low-dose DR rapamycin group compared to placebo (P = .01). Oral DR rapamycin was well tolerated with no significant differences in adverse events between groups. Results demonstrate that DR rapamycin was well tolerated and may prevent or delay progressive LV hypertrophy in cats with subclinical HCM. Additional studies are warranted to confirm and further characterize these results.

Outcomes of primary ureteroscopic lithotripsy: The role of maximum ureteral wall thickness at the site of stone impaction.

To verify if the maximum thickness of the ureteral wall at the stone site (m-UWT) can affect the outcomes of primary retrograde ureteroscopic lithotripsy (P-URSL) within a single-center dataset. We retrospectively reviewed data on 354 consecutive URSL performed from January 2020 to May 2022 at "Fondazione Poliambulanza" in Brescia (Italy). We included patients older than 18 years who underwent URSL for a single ureteral stone with a maximum diameter ranging from 5 to 10 mm. Patients with anatomical abnormalities, a positive preoperative urinary culture, or without a NCCT performed during the acute event were excluded. Patients were treated in an emergency setting (P-URSL within 48 h from the diagnosis of acute ureteral colic) or in a delayed one (D-URSL after a period of maximum 90 days of ureteral double-j stenting). For the resulting 139 patients we recorded demographic, clinical and stone-related features and perioperative data. We processed these data by univariate and multivariate analysis, and with a logistic regression analysis. Of the 139 included procedures, 63 were P-URSL and 76 D-URSL. At the univariate analysis we found that stone diameter (OR 0.845, p = 0.017), stone volume (OR 0.023, p = 0.001), stone density (OR 0.998, p = 0.000) and m-UWT (OR 0.499, p = 0.013) are predictors of P-URSL. Stone density (OR 0.998, p = 0.002) is an independent predictor of P-URSL at the multivariate analysis. At a logistic regression analysis, a distal ureteric position (OR 0.189, p = 0.014), stone diameter (OR 1.289, p = 0.006), and m-UWT (OR 2.297, p = 0.02) were found to be statistically significant predictors of incomplete stone clearance in patients undergoing P-URSL. m-UWT is the only predictor of short-term postoperative adverse events in patients undergoing P-URSL (OR 3.386, p < 0.001). From a descriptive analysis, it emerged that an increased m-UWT (>2 mm) significantly correlates to an endoscopic finding of ureteritis' signs and to an increase in operative time, hospital stay and post-procedural stenting time. A m-UWT greater than 2 mm also correlates with a lower stone free rate (SFR) and with a significant increase in both short and long-term postoperative complications. Our study confirmed a connection between m-UWT and poor endoscopic findings, as well as a direct correlation with the main morphometric parameters of the stone and finally with the outcomes of P-URSL itself. Further studies are necessary to validate our results, so that m-UWT might be routinely considered a useful tool in the decision-making process for P-URSL.

Ultrasound Enhancing Agents with Transthoracic Echocardiography for Maximal Wall Thickness in Hypertrophic Cardiomyopathy

ObjectivesTo determine whether ultrasound enhancing agent (UEA) changes maximal wall thickness (WT) in hypertrophic cardiomyopathy (HCM), and if it improves correlation with magnetic resonance imaging (MRI). Patients and MethodsA total of 107 patients with HCM were prospectively enrolled at a single tertiary referral center between July 10, 2014, and August 31, 2017, and underwent transthoracic echocardiography (TTE) with and without UEA and MRI. Maximal WT measurements were compared, and variability among the 3 modalities was evaluated using a simple linear regression analysis and paired t tests and Bland-Altman plots. Interobserver variability for each technique was assessed. ResultsMost (63%) of cardiac imagers found UEA helpful in determining maximal WT by TTE, with 49% reporting change in WT. Of 52 patients where UEA changed WT measurement, 32 (62%) reported an increase and 20 (38%) reported a decrease in WT. The UEA did not alter the median discrepancy in WT between MRI and TTE. However, where UEA increased reported WT, the difference between MRI and TTE improved in 79% of cases (P=.001) from 2.0-0.5mm. In those with scar on MRI, UEA improved agreement of WT between TTE and MRI compared with that of TTE without UEA (79% vs 39%; P=.011). Interclass correlation coefficient for WT for TTE without UEA, with UEA, and MRI was 0.84; (95% CI, 0.61-0.92), 0.88; (95%CI, 0.82-0.92), and 0.97; (95%CI, 0.96-0.98), respectively. ConclusionAlthough use of UEA did not eliminate differences in WT discrepancy between modalities, the addition of UEA to TTE aided in WT determination and improved correlation with MRI in those with greater WT and in all patients with myocardial scars.

Development and validation of machine learning algorithms to predict posthypertensive origin in left ventricular hypertrophy

BackgroundLeft ventricular hypertrophy is often associated with hypertension, which is not necessarily the cause of hypertrophy. Non-hypertension-related aetiologies often have a strong impact on patient management, and therefore require a thorough and careful workup. When considering all left ventricular hypertrophies, even the mild ones, the number of patients who need a workup increases drastically. This raises the need for a tool to evaluate the pretest probability of the origin of left ventricular hypertrophy. AimTo predict the hypertensive origin of left ventricular hypertrophy using machine learning on first-line clinical, laboratory and echocardiographic variables. MethodsWe used a retrospective single-centre population of 591 patients with left ventricular hypertrophy, starting at 12mm maximal left ventricular wall thickness. After splitting data in a training and testing set, we trained three different algorithms: decision tree; random forest; and support vector machine. Model performances were validated on the testing set. ResultsAll models exhibited good areas under receiver operating characteristic curves: 0.82 (95% confidence interval: 0.77–0.88) for the decision tree; 0.90 (95% confidence interval 0.85–0.94) for the random forest; and 0.90 (95% confidence interval: 0.85–0.94) for the support vector machine. After threshold selection, the last model had the best balance between its specificity of 0.96 (95% confidence interval: 0.91–0.99) and its sensitivity of 0.31 (95% confidence interval: 0.17–0.44). All algorithms relied on similar most influential predictor variables. Online calculators were developed and made publicly available. ConclusionsMachine learning models were able to determine the hypertensive origin of left ventricular hypertrophy with good performances. Implementation in clinical practice could reduce the number of aetiological workups needed in patients presenting with left ventricular hypertrophy.