Maximum Wall Research Articles

Electrocardiographic Findings in Genotype-Positive and Non-sarcomeric Children with Definite Hypertrophic Cardiomyopathy and Subclinical Variant Carriers.

In children with hypertrophic cardiomyopathy (HCM), the genotype-phenotype association of abnormal electrocardiographic (ECG) features in the backdrop of gene positivity has not been well described. This study aimed to describe the abnormal ECG findings in children with HCM harboring who have genetic variants and determine the association with major adverse cardiac events (MACE). We retrospectively analyzed 81 variants-positive, phenotype-positive (V+P+), 66 variant-positive, phenotype-negative (V+P-), and 85 non-sarcomeric subjects. We analyzed ECG findings and clinical outcomes in the three groups of subjects. Repolarization abnormalities (ST and T wave changes) and pathologic Q waves were the most common abnormalities in variant and non-sarcomeric subjects. The V+P+ group showed higher occurrence of ST segment changes and T wave abnormalities compared to V+P- group. Independent predictors of MACE included ST segment changes (OR 3.54, CI 1.20-10.47, p = 0.022). T wave changes alone did not predict outcome (OR 2.13, CI 0.75-6.07, p = 0.157), but combined repolarization abnormalities (ST+T changes) were strong predictors of MACE (OR 5.84, CI 1.43-23.7, p = 0.014) than ST segment changes alone. Maximal wall z score by echocardiography was a predictor of MACE (OR 1.21, CI 1.07-1.37, p = 0.002). Despite the presence of significant myocardial hypertrophy (z score > 4.7), voltage criteria for LVH were much less predictive. In the non-sarcomeric group, RVH was significantly associated with MACE (OR 3.85, CI 1.08-13.73, p = 0.038). These abnormal ECG findings described on the platform of known genetic status and known myocardial hypertrophy may add incremental value to the diagnosis and surveillance of disease progression in children with HCM. Select ECG findings, particularly repolarization abnormalities, may serve as predictors of MACE in children.

Finite Element Analysis of Fluid–Structure Interaction in a Model of an L-Type Mg Alloy Stent-Stenosed Coronary Artery System

The coronary stent deployment and subsequent service process is a complex geometric/physical nonlinear and fluid–structure coupling system. Analyzing the distribution of stress–strain on the stent is of great significance in studying the deformation and failure behavior. A coupled system dynamics model comprising stenotic coronary artery vessels and L-type Mg alloy stents was established by applying the polynomial hyperelastic constitutive theory. The nonlinear, significant deformation behavior of the stent was systematically studied. The stress–strain distribution of the coupling system during stent deployment was analyzed. The simulation results show that the edges of the supporting body fixed without a bridge are the weakest zone. The stress changes on the inside of the wave of the supporting body are very large, and the residual stress accumulated in this area is the highest. The peak stress of the plaque and the arterial wall was lower than the damage threshold. The velocity of the blood between the wave crest of the supporting body is large and the streamline distribution is concentrated. In addition, the inner surface pressure on the stent is evenly distributed along its axial dimension. The maximum arterial wall shear stress always appears on the inside of the wave crest of the supporting body fixed with a bridge, and, as such, the largest obstacle to the blood flow is in this zone.

The Involvement of ALPK3 in Hypertrophic Cardiomyopathy in East Asia.

ObjectiveALPK3 is associated with a recessive form of pediatric cardiomyopathy accompanied by musculoskeletal and craniofacial abnormalities. Heterozygous truncating variants in this gene (ALPK3tv) have recently been confirmed as a cause of autosomal dominant hypertrophic cardiomyopathy (HCM). Whether ALPK3 is also implicated in HCM in East Asia and the effect of missense variants in ALPK3 on HCM remains unresolved.MethodsWe compared the frequency of rare deleterious variants in ALPK3 in a study cohort comprised of 793 HCM cases of East Asian descent to that in the controls subset of Genome Aggregation Database (gnomAD). Gene burden test was used to assess this association. The involvement of these variants in HCM was further validated by independent cohort. The clinical characteristics and prognoses of these carriers were compared with sarcomere-positive and negative patients.ResultsRare deleterious variants in ALPK3 were significantly enriched in HCM compared with gnomAD controls (truncating: 4/793 vs. 4/4523, P = 0.02; missense: 25/793 vs. 46/4523, P = 2.56e-5). Replication in an independent cohort provided more supporting evidence. Further comparisons revealed that ALPK3 carriers displayed more severe hypertrophy in interventricular septum (IVS) and apex, as well as greater maximal left ventricular wall thickness, relative to sarcomere negatives.ConclusionHeterozygous rare variants in ALPK3, both missense and truncating variants, are associated with HCM in East Asians.

Application Value of Gastroenterography Combined With CT in the Evaluation of Short-Term Efficacy and Prognosis in Patients With Esophageal Cancer Radiotherapy.

PurposeTo observe the application value of gastroenterography combined with CT in the evaluation of short-term efficacy and prognosis in patients with esophageal cancer radiotherapy.MethodsFrom January 2013 to December 2020, the clinical data of 207 patients with esophageal cancer treated by radiotherapy in our hospital were collected retrospectively. All patients received gastroenterography and CT examination before and after radiotherapy, and the patients were followed-up for 1 year, and the evaluation value of their short-term efficacy and prognosis was observed.ResultsAfter radiotherapy, the length diameter, short diameter, and volume of the lymph node were lower than those before radiotherapy (p < 0.05), but the maximum tube wall thickness had no significant difference (p > 0.05). The length diameter, short diameter, and volume of the lymph node, and the maximum tube wall thickness in the good efficacy group and the good prognosis group were lower, and the objective response rate in the good prognosis group was higher (p < 0.05). The area under the curve (AUC) of the length diameter, short diameter, and volume of the lymph node to evaluate the short-term efficacy of patients with esophageal cancer was 0.738, 0.705, and 0.748, respectively, and the AUC to evaluate the prognosis of patients with esophageal cancer was 0.751, 0.776, and 0.791, respectively.ConclusionGastroenterography combined with CT has a good application value in the evaluation of short-term efficacy and prognosis in patients with esophageal cancer radiotherapy.

Average, and Maximum Ureteral Wall Thickness are Predictor Factor for Ureteroscopy Outcomes?

Objective: The aim of our study is to investigate the effect of average and maximum ureteral wall thicknesses measured by computed tomography before the operation on ureteroscopy results.Materials and Methods: This prospective study was conducted with 103 patients who underwent ureteroscopy for ureteral stones between July and December 2021. The maximum ureteral wall thickness in the region of the ureteral stone and the average of the ureteral wall thicknesses measured from the 3-6-9-12 lines were calculated by non-contrast computed tomography. The operation time, residual stone, double j insertion status, and intraoperative complication status were examined according to the average ureteral wall thickness and maximum wall thickness.Results: Of the 103 patients included in the study, 77 were male, and 26 were female. The mean age of the patients was 43.83±15.11 years. The mean stone length was 10.76±3.84 mm. The average ureteral wall thickness was 3.81±1.24 mm, while the maximum ureteral wall thickness was 4.9±1.8 mm. It was found that as the maximum, and average ureteral wall thickness increased, the operation time, residual stone, double insertion rate, and post-ureteroscopic lesion scale grade increased (p&amp;lt;0.05).Conclusion: Maximum and average ureteral wall thicknesses are predictive factors for ureteroscopy results.

Performance Enhancement of Double-Layer Microchannel Heat Sink by Employing Dimples and Protrusions on Channel Sidewalls

High-temperature gradient causes thermal stress and is indirectly responsible for other demerits in nonstacked microchannels. High-temperature gradient is overcome by employing double layers in the heat sink. Utilization of dimple and protrusion in such double-layered sink to enhance overall performance is done in the present numerical study. Before placement of dimples and protrusions on sidewalls of the sink, optimum width and depth of channel have been assessed. Microsinks with the protruded-dimpled bottom layer and microsinks with protruded-dimpled layers are investigated. The parameters such as maximum bottom wall temperature difference (ΔTb), Nusselt number ratio (Nu/Nuo), and thermal performance factor (η) have been evaluated. The impact of aligned and staggered arrangements of dimple and protrusion is also compared. Deionized water as a coolant for the range of Reynolds number of 89–924 is examined. It has been realized that aligned models offer higher heat transfer coefficient, maximum Nu, and minimum ΔTb, but in terms of overall performance, staggered sinks are superior. The heat sink with both layers protruded and dimpled, showing Nu/Nuo and η of 1.36 and 1.32, respectively, is observed as one of the optimum sinks which offers an excellent lowest ΔTb of 1.48 K.

Abstract WMP69: Features Of Calcified Carotid Atherosclerosis Are Associated With Stroke In Patients With Embolic Stroke Of Undetermined Source

Introduction: We examined qualitative features of calcified plaque in patients with embolic stroke of undetermined source (ESUS). Methods: A retrospective cohort of anterior circulation acute ischemic stroke patients with CTA neck and meeting criteria for ESUS was identified. A segmentation software measured carotid bifurcation calcified plaque volumes. A neuroradiologist manually measured maximum carotid wall and calcified wall thickness (WT), maximum craniocaudal calcified plaque length, degree of circumferential involvement (none, punctate, 90°, 180°, 270°, 360°) and assessed for intimal, transmural, and adventitial calcifications. Descriptive statistics included medians and interquartile ranges. Differences between ipsilateral (carotid ipsi ) and contralateral (carotid contra ) carotid arteries to stroke side were tested using Wilcoxon Signed-Rank, McNemar, and marginal homogeneity tests. Results: Ninety-four subjects met criteria for ESUS. Mean age was 65 years and 55% were women. Carotid ipsi had a significantly higher volume of calcified plaque [Vol ipsi =39.1 (12.4, 86.7) vs Vol contra =25.9 (4.9, 71.7), p=0.05] and maximum calcified WT [CalcWT ipsi= 1.4 (0, 2.6) vs CalcWT contra =0 (0, 2.1), p=0.03] than carotid contra . There were no significant differences in the maximum craniocaudal calcified plaque length (p=0.09) or degree of circumferential calcified plaque involvement (p=0.35) between carotid ipsi and carotid contra . Intimal (p=0.03) but not transmural (p=0.14) or adventitial (p=0.12) calcifications were significantly more frequent in carotid ipsi than carotid contra . A subgroup analysis (n=48) including either carotid artery measuring ≥3mm in maximum WT showed intimal calcifications remained significantly associated with stroke side (p=0.02; Figure). Conclusion: Higher calcified plaque volumes, calcified wall thickness and intimal calcifications may be associated with ischemic stroke in patients with ESUS.

Hypertrophic Cardiomyopathy, Sudden Death and Implantable Defibrillators

Implantable cardiac defibrillators (ICD) are greatly efficient in eliminating arrhythmias in patients withhigh-risk hypertrophic cardiomyopathy, showing that this equipment has a contribution in the prevention and treatment of unexpected death. When patients have risk marker, unexpected death in one or more first-degree relations with maximal left ventricle wall thickness 30 mm of current and unexplained syncopal episode, ICD installation is considered appropriate. If one has a dangerously fast heartbeat that prevents heart from pumping enough blood to the rest of body ventricular fibrillationor ventricular tachycardia, or if the patient is at high risk of suffering such a heart rhythm problem (arrhythmia), usually due to a weak heart muscle, the patient can survive using ICD.

Abstract 13438: Obesity is Uncommon in Patients With Transthyretin Cardiac Amyloidosis

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome that includes distinct subtypes with different pathophysiologies, genetics, and treatment. Distinguishing HFpEF due to transthyretin cardiac amyloidosis (ATTR-CA) is critical given its specific treatable pathophysiology. Obesity is a common driver of HFpEF, but it has been noted clinically that low body mass index (BMI) is a common finding in ATTR-CA. Methods: A single center, retrospective study of patients undergoing 99mTc-pyrophosphate (PYP) scans from 2010-2019 was analyzed for BMI association with ATTR-CA and the Val122Ile variant. BMI differences were prospectively evaluated in the ongoing multicenter Screening for Cardiac Amyloidosis Using Nuclear Imaging for Minority Populations (SCAN-MP) study. The association of BMI with ATTR-CA/Val122Ile was compared by Wilcoxon rank sum analysis and combined with age, sex, and maximum LV wall thickness in a multivariable logistic regression in both the retrospective and SCAN-MP cohorts. Results: In the retrospective analysis, BMI (in kg/m 2 ) among those with ATTR-CA/Val122Ile (n=198, 40%) was lower (25.8, IQR 23.4-28.9) than in other patients (27.1, IQR 23.9-32.0) (p&lt;0.001). In multivariable logistic regression, BMI &lt; 30 (OR 2.60, 95% CI 1.49-4.54), remained independently associated with ATTR-CA/Val122Ile. In the first 221 patients enrolled in SCAN-MP, 18 (8%) had ATTR-CA (n=11) or were carriers of the Val122Ile variant (n=7) with negative PYP scans. Among those subjects, BMI was significantly lower (25.6 [IQR 24.3-28.3]) than in other patients (32.6 [27.9-38.1]) (p&lt;0.001). BMI did not differ between ATTR-CA patients (27.5 [25.3-28.9]) and Val122Ile allele carriers with negative 99mTc-pyrophosphate scans (25.3 [24.3-28.2]). When combined with age, sex, and maximum LV wall thickness, BMI&lt;30 (OR 11.8 [CI 2.47-56.14]) and maximum LV wall thickness (OR 1.38/mm [95% CI 1.10-1.74]) were associated with ATTR-CA/Val122Ile. Conclusions: Lower BMI is associated with a diagnosis of ATTR-CA/Val122Ile in heart failure with increased LV wall thickness and may be useful in selecting patients benefiting from evaluation for ATTR-CA.

Clinical characterisation of hypertrophic cardiomyopathy caused by MYH7 gene variants in children

Abstract Background Variants in the cardiac Beta Myosin Heavy chain 7 gene (MYH7) are a common cause of hypertrophic cardiomyopathy (HCM) in adults, but their role in paediatric-onset HCM has not been systematically characterised. This study aims to describe the presentation, clinical characteristics and outcomes of childhood HCM secondary to disease-causing MYH7 variants. Methods Retrospective, longitudinal, data from 70 individuals meeting diagnostic criteria for HCM under the age of 18 years with disease-causing MYH7 variants from a single specialist centre (1991–2019) were collected. A Major Adverse Cardiac Event was defined as sudden cardiac death (SCD), heart failure-related death, cardiac transplantation, haemodynamically-compromising sustained ventricular arrhythmia or appropriate implantable cardioverter defibrillator (ICD) therapy. Results Median age at diagnosis was 9.2 years (IQR 4.2–13.3 years); 47 patients (67.1%) were less than 12 years and 7 (10.0%) were under the age of 1 at diagnosis. Twenty-two patients (31.4%) were probands. MYH7 variants were missense (n=67) or truncating (n=1). Reason for presentation were: family screening (n=45, 64.3%); cardiac symptoms (n=12, 17.1%); incidental finding (n=11, 15.7%); and out of hospital cardiac arrest (n=2, 2.9%). At baseline, mean maximum left ventricular wall thickness (MLVWT) z-score was 9.6 (±5.8), 11 patients (15.7%) had resting left ventricular outflow tract obstruction (left ventricular outflow tract gradient ≥30mmHg). Baseline phenotype did not significantly differ between probands and non-probands (MLVWT Z score 11.9 (±4.5) vs 8.5 (±6.1), p-value 0.0675). Over a median follow up of 3.6 years (IQR 1.8–7.9 years), 10 patients (14.3%) underwent a left ventricular septal myectomy at a median age 6.4 years (IQR 3.4–12.1 years) and 27 (38.6%) had an implantable cardioverter defibrillator (ICD) for primary (n=24, 34.3%) or secondary (n=3, 4.3%) prevention. Three patients (4.3%) died (SCD, n=1; heart-failure related, n=1; non-cardiac, n=1) and 3 (4.3%) underwent cardiac transplantation. Ten patients (14.3%) experienced a MACE. Patients who experienced a MACE were more likely to be probands [n= 6 (60.0%) vs n=16 (26.7%); p=0.036] but did not differ in terms of baseline phenotype (p=0.134). Conclusion MYH7 variants can cause infantile and childhood-onset disease, which is associated with significant early cardiac morbidity and mortality. Adverse outcomes were more common in those presenting as probands. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medical Research Council, Great Ormond Street Hospital charity.

Clinical characteristics and natural history of pre-adolescent non-syndromic hypertrophic cardiomyopathy

Abstract Background The clinical presentation and natural history of pre-adolescent sarcomeric hypertrophic cardiomyopathy (HCM) has not been systematically characterised. The aim of this study was to describe the clinical characteristics and outcomes of a large, international, multicentre cohort of children diagnosed with non-syndromic HCM below the age of 12. Methods Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children meeting diagnostic criteria for HCM below 12 years of age (pre-adolescent) were collected and compared with 568 diagnosed aged 12–16 years. Patients with syndromic and metabolic HCM were excluded. Results Of 639 (male n=417, 65.3%) children with pre-adolescent HCM, 339 (53.1%) had a family history of HCM and 57 (8.9%) a family history of sudden cardiac death (SCD). At the time of baseline assessment; 132 (20.7%) had heart failure symptoms and 39 (6.1%) reported unexplained syncope. Median maximal left ventricular wall thickness on echocardiogram was 13.6mm (IQR 10–19) with a corresponding median z-score of 8.7 (5.3–14.4). 145 (22.7%) had left ventricular outflow tract obstruction (LVOTO) (maximal LVOT gradient≥30mmHg) and 35 (5.5%) had severe LVOTO (gradient≥90mmHg). Over a median follow up 5.6 years (IQR 2.3–10), 10.5% underwent a myectomy and 23.2% implantable cardiac defibrillator (ICD) implantation for primary (81.8%) or secondary (14.2%) prevention. 42 (6.7%) patients died [SCD 4.9%, heart failure death 0.8%, other 1%] and 21 (3.3%) underwent cardiac transplantation. 69 (10.8%) patients had an arrhythmic event (SCD n=31, resuscitated cardiac arrest n=17, appropriate ICD therapy n=14, sustained VT with haemodynamic compromise n=7). Compared to those presenting after 12 years, those under 12 were less likely to have a family history of SCD (8.9% vs 13%, p:0.047) or report unexplained syncope (6.1% vs 12.3%, p&amp;lt;0.00). The degree of hypertrophy did not differ but a higher proportion of pre-adolescent patients had LVOTO (22.7% vs 14.4%, p&amp;lt;0.00). A higher proportion of pre-adolescent underwent a myectomy (10.5% vs 7.2%, p:0.045) but a lower proportion received a primary prevention ICD (18.9% vs 30.1%, p:0.041). The overall proportion of patients reaching the mortality or arrhythmic end-points did not differ, but SCD and resuscitated cardiac arrest events were more frequent in pre-adolescent patients (4.9% vs 3.9% and 2.7 vs 1.6% respectively). Conclusion Pre-adolescent HCM is associated with a high symptom burden and variable cardiac phenotype, comparable to those presenting later in childhood. Despite baseline similarities and equal overall survival, younger patients were less likely to receive a primary prevention ICD despite being more likely to experience a SCD or resuscitated cardiac arrest. This study suggests that younger patients should not be considered a distinct entity for risk stratification and that similar management strategies to older HCM patients should be employed. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): BHF (British Heart Foudnation) MRC (Medical Research Council)

Orthostatic hypotension in hereditary ATTR Val30Met amyloidosis: predictors and associated clinical features

Abstract Introduction The prevalence of orthostatic hypotension (OH) in patients with mutated transthyretin (TTR) amyloidosis (mATTR) is 40–60%. According to previous studies, OH is frequent and an early feature in patients with Val30Met mutation (the most prevalent form of mATTR). Aim To characterize TTR Val30Met patients with OH and to identify clinical characteristics associated with OH development. Methods Retrospective study of consecutive Val30Met TTR patients with suspected cardiac involvement observed at our cardiology clinic during 2019. Two groups were defined: group 1: patients without OH; group 2: patients with OH. Data was obtained by chart review. Statistically significant predictors of OH were found using logistic regression. Results We included a total of 248 patients (group 1 – 173; group 2 – 75). Group 1 patients were 52% male, median age 45 [interquartile range (IQR) 39–55] and median age at onset 34 (IQR 29,75–46,25) years. Left ventricle hypertrophy [LVH, defined as maximal LV wall thickness (LVT) ≥12 mm] occurred in 26,5%, with median maximal LVT 10 mm (IQR 9–12); 49,7% had conduction disturbances, 30,6% gastrointestinal (GI), 17,3% genitourinary (GU) manifestations and 5% were in Coutinho staging ≥2/3. Group 2 had 56% male, median age of 49 years at evaluation (IQR 42–65) and 35 years at onset (IQR 30–59). LVH was present in 42,9%, with median maximal LVT 11 mm (IQR 10–14); 74,7% had conduction disturbances, 56% GI and 42,7% GU manifestations and 21% were in Coutinho staging ≥2/3. In univariate analysis, higher age (p=0,005), presence of LVH (p=0,009), conduction disturbances (p&amp;lt;0,001), GU manifestations (p&amp;lt;0,001) and higher Coutinho staging (p&amp;lt;0,001) were all associated with the presence of OH, while age at onset was not (p=0,648). In multivariate analysis, only Coutinho staging [odds ratio (OR) 2.609; 95% confidence interval (95% CI) 1.344–5.065] and GU manifestations (OR 3,151; 95% CI 1,595–6,225) were found to be significant predictors of OH. Conclusion Our study suggests that OH is more associated with GU manifestations and Neurologic staging, than with amyloid cardiomyopathy or age, suggesting a predominant neurogenic component. The prevalence of OH in our sample of Val30Met patients was lower than previously described. Funding Acknowledgement Type of funding sources: None.

Exercise training inhibits left ventricular collagen upregulation in mice with hypertrophic cardiomyopathy

Abstract Background Hypertrophic cardiomyopathy (HCM) is estimated to affect 1:500, and is characterised by otherwise unexplained left ventricular (LV) hypertrophy, cardiomyocyte disarray, fibrosis, diastolic dysfunction, and ventricular arrhythmias. Historically, patients with HCM have been discouraged from participation in high intensity sports and exercise. However, the 2020 Sports Cardiology Guidelines recommend that patients with HCM should receive advice about exercise training (ET) based on individual risk assessment. To learn more about the effects of ET in HCM, we exposed mice carrying an HCM-causative sarcomere mutation (Myh6R403Q/+ (R403Q) mice) to high intensity interval training. Purpose To investigate the effect of exercise training on hypertrophic cardiomyopathy in mice. Methods R403Q mice were stratified to treadmill exercise (n=11) or sedentary behaviour (n=11). After 3 weeks, we induced HCM by giving CsA in the feed for 3 weeks, while the ET or sedentary behaviour continued for a total of 6 weeks. Each bout of treadmill running consisted of a 10-minute warm up, followed by 5 intervals of 8 minutes at high intensity (90% of VO2 max speed at week 0) and 2 minutes at medium intensity (60% of VO2 max speed at week 0). Every third day of the ET protocol we increased the high and medium intensity running speeds by 0.6 and 0.4 m/min, respectively. We performed echocardiography after 0, 3, and 6 weeks of the 6-week protocol. After completion of the protocol, we recorded lung and whole heart weight, and harvested LVs for molecular analyses. Results Confirming the expected HCM phenotype, R403Q mice that received CsA (R403Q SED+CsA) had a 1.3-fold increase in whole heart weight (p&amp;lt;0.0001), 1.5-fold increase in lung weight (p&amp;lt;0.001), and 2.4-fold increase in maximal left ventricular posterior wall (LVPW) thickness measured by echocardiography (p&amp;lt;0.0001) compared to sedentary wild type littermates given CsA (WT SED+CsA). Heart weight, lung weight, and maximum LVPW thickness were also increased 1.5- (p&amp;lt;0.0001), 1.6- (p&amp;lt;0.0001), and 2.0-(p&amp;lt;0.0001) fold, respectively, compared to R403Q not given CsA (R403Q SED-CsA). R403Q ET+CsA mice increased their running distance before exhaustion 2.0-fold compared to baseline (p=0.010), and ran 1.6-fold longer than R403Q SED+CsA (p=0.020). In R403Q ET+CsA mice, LV mRNA expression of Col1a2 was 51% (p=0.021), and Col3a1 49% (p=0.013) of R403Q SED+CsA expression levels. Compared to R403Q SED+CsA mice, exercise training did not affect heart weight, maximum LV posterior wall thickness or lung weight in R403Q ET+CsA mice. Conclusion Treadmill ET inhibited upregulation of LV collagen expression in mice with HCM, but did not affect hypertrophy. This could indicate that ET during early development of HCM attenuates development of fibrosis. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority (Helse Sør-Øst RHF) and KG Jebsen Cardiac Research Center

Congenital cystic adenomatoid malformation associated with right aortic arch with mirror image branching and absence of left pulmonary artery in an adult

BackgroundCongenital cystic adenomatoid malformation is an uncommon developmental anomaly that is diagnosed prenatally or during early childhood and is rare to present in adulthood. Type 2 congenital cystic adenomatoid malformation is often associated with other anomalies such as congenital cardiac anomalies. We present a case of type 2 congenital cystic adenomatoid malformation in an adult male associated with absence of left pulmonary artery and right aortic arch with mirror image branching. To our knowledge, this is the first case report with the combination of all three anomalies.Case presentationA 33-year-old male presented to the Department of Pulmonary Medicine with high-grade fever, chills and rigor, breathlessness, and productive cough for a duration of one week. He had multiple similar self-limiting episodes in the past which did not require hospitalization. The plain radiograph showed right aortic arch and a small left hilum. CT thorax showed multiple cystic lesions of size 0.5–2.0 cm in the apico-posterior segment of the left upper lobe; anterior, posterior, and lateral segments of the left lower lobe; and the apical segment of the right upper lobe with a maximal cyst wall thickness of 2 mm. Volume of left lung was reduced with trans-thoracic herniation of the medial segment of the right middle lobe; bronchiectatic changes were seen in the apical, anterior, and posterior segments of the right upper lobe; and fibrotic strands were seen in the apical segment of the right lower lobe and the apico-posterior segment of the right upper lobe. Mediastinal window showed right-sided aortic arch with mirror image branching. The pulmonary trunk was seen to continue as the right pulmonary artery with absent left pulmonary artery.ConclusionsThough congenital cystic adenomatoid malformation is a disease of infancy and childhood, it should also be considered in adults presenting with recurrent lower respiratory tract infections and/or pneumothorax. Radiologists must be aware of the types of congenital cystic adenomatous malformation (CCAM) and their associations, as type 2 CCAM has a high association with congenital cardiac disease. Proximal interruption of pulmonary artery should be considered if the pulmonary trunk continues as either right or left pulmonary artery.

Role of CT colonography in differentiating sigmoid cancer from chronic diverticular disease.

To evaluate the accuracy of computed tomography colonography (CTC) in differentiating chronic diverticular disease from colorectal cancer (CRC), using morphological and textural parameters. We included 95 consecutive patients with histologically proven chronic diverticular disease (n = 53) or CRC (n = 42) who underwent CTC. One radiologist, unaware of histological findings, evaluated CTC studies for the presence of potential discriminators including: maximum thickness, involved segment length, shouldering phenomenon, growth pattern, diverticula, fascia thickening, fat tissue edema, loco-regional lymph nodes, mucosal pattern. Another radiologist performed volumetric texture analysis on the involved segment. Several qualitative imaging parameters resulted to significantly correlated with colorectal cancer, including absence of diverticula in the affected segment, straightened growth pattern and shouldering phenomenon. A maximum wall thickness/involved segment length ratio < 0.1 had 98% specificity and 47% sensitivity in identifying diverticular disease. Regarding first-order texture analysis parameters, kurtosis resulted to be significantly different between the two groups. Absence of diverticula, straightened growth pattern and shouldering phenomenon are significantly associated with CRC (71-91% sensitivity; 82-91%).

Mechanical Behavior of the Reinforced Retaining Wall under Vehicle Load

This study primarily aims to explore the mechanical behavior and influence factors of the reinforced retaining wall subject to vehicle loads. Mohr–Coulomb model was adopted to simulate and analyze the structural characteristics of the reinforced retaining wall by the finite element method. Its mechanical behavior was investigated in accordance with relevant theories. The results showed that the vertical and horizontal maximum displacement of the reinforced retaining wall occurs at the wall surface of the retaining wall, the maximum internal soil pressure appears at the middle and lower part of the retaining wall, and the maximum tensile strain of the tension bar acts on the wall rupture surface. As impacted by static vehicle load, the largest settlement is located at the parking position, and the maximum horizontal displacement and wall stability will vary with the vehicle position. Moreover, the closer the vehicle to the reinforcement is, the greater the lateral Earth pressure will be imposed on the upper part of the reinforcement body. With the variation of the vehicle position, the tension stress of the geogrid will vary noticeably.

CT imaging findings of anti-PD-1 inhibitor-related enterocolitis.

Immune checkpoint inhibitors promote the antitumor activity of T cells; however, there is a risk of side effects. The aim of this study was to characterize the computed tomography (CT) findings of one such side effect, anti-programmed cell death-1 antibody-related enterocolitis (αPD-1-EC). This single-institution retrospective study included 21 patients with αPD-1-EC who underwent CT between January 2015 and April 2020. Two board-certified radiologists independently evaluated the CT findings, including the pattern of intestinal wall enhancement, maximum bowel wall thickness, maximum appendiceal diameter, and involvement of enterocolitis in each intestinal segment. Symptoms and their severity were also investigated. Pancolitis and skip lesions involving both the rectosigmoid colon and the cecum were found in 9 patients each (42.9%). The rectum was the most frequently involved lesion (18/21, 85.7%), and appendiceal involvement was found in 11 patients (52.4%). The most frequent wall enhancement pattern was the gray pattern (i.e., mild homogeneous enhancement of the thickened bowel wall). The mean maximum diameter of the involved appendix was 9.6 ± 4.5 mm (range 4.5-18 mm). Frequent symptoms included diarrhea (21/21), fever (8/21), and abdominal pain (7/21). Other concomitant immune-related adverse events were found in 6 patients. Pancolitis, skip lesions, and appendiceal involvement were frequent in patients with αPD-1-EC. When combining these characteristic findings with other clinical findings, such as low-grade diarrhea, other concomitant immune-related adverse events, and anti-PD-1 therapy administration, CT may be a useful diagnostic tool for αPD-1-EC.

Tissue characteristics of the athlete"s heart: differentiation of physiological and pathological hypertrophy using parametric T1 and T2 mapping

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Fund of Hungary Background Intensive physical exercise leads to structural and functional cardiac adaptation termed athlete’s heart. Cardiac magnetic resonance (CMR) has an important role in the differentiation of physiological adaptation and pathological conditions. Beside the precise measurement of the ventricular volumes, mass, and function, it provides tissue specific information. Recently, native T1 mapping technique has been applied as a non-contrast method to detect myocardial fibrosis. Previous studies suggested that native T1 mapping can identify myocardial pathology before other CMR imaging techniques. T2 mapping values are elevated in case of myocardial edema. Purpose The aim of our study was to investigate the differences in CMR characteristics especially the native T1 and T2 mapping values of highly trained healthy athletes, healthy controls and patients with hypertrophic cardiomyopathy (HCM). Methods A total of 43 healthy athletes (water polo, swimming, football, 22 ± 8 training hours/week), 27 non-athlete healthy control and 25 HCM patients were involved in the study. Our inclusion criteria were: age &amp;gt;18 years, in the athlete group &amp;gt;7 training hours per week . We evaluated the left ventricular (LV) end-systolic, end-diastolic (EDVi) and stroke volume (SVi) index, mass index (LVMi), ejection fraction (EF) and maximal end-diastolic wall thickness (EDWT). In a basal short axis slice the native T1 and T2 mapping values were evaluated. Results Athletes had significantly higher LV volumes compared to the control and HCM group (LVEDVi 114 ± 13 vs. 86 ± 11; 84 ± 15 ml/m2, LVSVi 64 ± 7 vs. 51 ± 7; 54 ± 10 ml/m2, respectively, p &amp;lt; 0.0001). HCM patients had the highest LVMi (72 ± 14 g/m2) and EDWT (18 ± 4 mm) compared to athletes and controls, athletes had higher LVMi (60 ± 11 vs. 42 ± 8 g/m2) and EDWT (10 ± 2 vs. 8 ± 1 mm) compared to the controls (p &amp;lt; 0.001). The native T1 mapping values differed significantly in the three groups, athletes had the lowest, HCM patients had the highest T1 values (athletes: 956 ± 19 ms, controls: 971 ± 20 ms, HCM patients: 993 ± 39 ms; p &amp;lt; 0.0001). There was no difference in the T2 mapping values between athletes and controls (44 ± 2 vs. 43 ± 2 ms), HCM patients had higher T2 values (45 ± 2 ms) compared to the other two groups (p &amp;lt; 0.01). Conclusion Intensive and regular training may lead to tissue specific changes of the myocardium. T1 and T2 mapping are potentially useful tools for differentiating between athlete"s heart and patients with hypertrophic cardiomyopathy. Abstract Figure. T1 mapping in HCM and athlete

Experimental and Numerical Investigation of the Effect of Bypass Injection on Wall Temperature Distribution of a Single-Phase Mini/Micro-Channel

Temperature uniformity is an important factor in the thermal management of electronic devices. The present study investigates the effect of bypass injection on the wall temperature distribution of a single-phase mini/micro-channel using water as the coolant. Experimental studies were conducted on an 18 mm thick copper substrate heated by a cartridge heater, with the bypass inlet located midway between the channel inlet and outlet. After validating the numerical results with the experimental data, simulations were carried out on a 1 mm thin copper and silicon substrates with uniform and non-uniform heat flux conditions on the back of the substrate, for two different locations of bypass injection. Results for the thin copper and silicon substrates with uniform heat flux condition indicate that the bypass injection helps in reducing the difference between the maximum and minimum local wall temperatures by up to 60% and 76% for silicon and copper substrates, respectively. The reduction is higher for the bypass injection located midway between the channel inlet and outlet compared to the injection located at one-fourth of the channel length from the inlet. Bypass injection is found to be beneficial for the non-uniform (step change) heat flux condition, with the higher heat flux over the second half of the channel length. The experimental and numerical results for the thick copper substrate show a near-uniform wall temperature distribution even without bypass injection.

Rupture Risk Assessment of Cervical Spinal Manipulations on Carotid Atherosclerotic Plaque by a 3D Fluid-Structure Interaction Model.

Method The FSI model, based on MRI data of an atherosclerosis patient, was used to simulate the deformations of the plaque and lumen during the process of two kinds of typical cSMT (the high-speed, low-amplitude spinal manipulation and the cervical rotatory manipulation). The biomechanical parameters were recorded, such as the highest wall shear stress (WSS), the maximum plaque wall stress (PWS), the wall tensile stress (Von mises stress, VWTS), and the strain. Result The max_WSS was 33.77 kPa in the most extensive deformation. The highest WSS region on the plaque surface was also the highest PWS region. The max_PWS in a 12% stretch was 55.11 kPa, which was lower than the rupture threshold. The max_VWTS of the cap in 12% stretch which approached the fracture stress level was 116.75 kPa. Moreover, the vessel's max_VWTS values in 10% and 12% stretch were 554.21 and 855.19 kPa. They were higher than the fracture threshold, which might cause media fracture. Meanwhile, the 7% stretched strain was 0.29, closed to the smallest experimental green strains at rupture. Conclusion The carotid arteries' higher stretch generated the higher stress level of the plaque. Cervical rotatory manipulation might cause plaque at a high risk of rupture in deformation after 12% stretch and more. Lower deformation of the plaque and artery caused by the high-speed, low-amplitude spinal manipulation might be safer.