Noninvasive Evaluation Research Articles

Comprehensive non-invasive evaluation of the functional status of patients with chronic heart failure

The emergence of new groups of medications used in the treatment of chronic heart failure (CHF) has made it possible to optimize treatment regimens, changing the clinical status and prognosis in this patient cohort. In this regard, the relevance of individual prognostic markers and risk assessment scales for heart failure (HF) is losing its value. The aim of our review is to summarize the currently available evidence on modern methods of evaluating the functional capabilities of the body and exercise tolerance in CHF patients on the background of systolic dysfunction before heart transplantation.

Unmixing-based cleaning methods evaluation for re-polychromated plasterwork

The cleaning of re-polychromated plaster is a rather challenging task for Conservators. The optimal choice of solvents and its application instruments may depend on the original polychromy (binder and pigment) that aims to be revealed and the overlay polychromy (binder and pigment) as well. We present a new image-processing based method that uses hyperspectral imaging to obtain a non-invasive quantitative evaluation of cleaning procedures. It is based on the application of unmixing techniques for this problem. The method computes three quality indices: efficiency, destructivity, and alteration, that are based on the residual amounts of overlay pigment, the detection of excessive abrasion in the sample and the change in color that the cleaning produces. It produces as well pixel-by-pixel concentration maps and presence maps for plaster and overlay pigment, and it can self-evaluate by computing the error map comparing the modelled spectral reflectance with the measured spectral reflectance from the samples.

Vectorial-based analysis of dual-tracer PET imaging: A proof of concept

BackgroundThe diagnosis of neurological diseases is complicated since they often share similar symptoms and occur in different severity levels. Imaging techniques such as PET molecular imaging are helpful for an early and accurate diagnosis and, staging allowing a noninvasive evaluation of the disease. The combination of two radioligands in the same patient could be valuable to achieve these diagnostic goals; nevertheless, the imaging data obtained with two radioligands is commonly interpreted independently. This novel approach to combine the PET data of two radiopharmaceuticals, separately acquired in the same subject, is to obtain new quantitative metrics. PET images of patients with Parkinson's disease (PD) and healthy controls (HC) were analyzed. Voxel-by-voxel uptake is compared by combining the imaging data. Dual-tracer PET imaging analysis was tested with [11C]DTBZ-[11C]Raclopride as proof of concept. ResultsThe new proposed metric based on a resultant vector is capable of efficiently discriminating healthy controls from PD patients (p < 0.0001) allowing the detection of slight changes in patients undergoing therapeutic approaches. Significant differences were found between HC and PD patients for the evaluated radiotracers. ConclusionsThe resultant vector appears to deliver useful information that could be helpful to evaluate PD patients under treatment and to improve differential diagnoses.

Role of magnetoencephalography in predicting the epileptogenic zone and post-operative seizure outcome - A retrospective study

PurposeStudy assessed the role of MSI in predicting the post-operative seizure outcome. MethodsThis retrospective study included patients who underwent MEG and epilepsy surgery and had a minimum 6 months of postoperative follow-up. Concordance of MEG cluster with post-surgical resection cavity was classified as follows Class I) Concordant and region-specific, Class II) Concordant and region non-specific, Class III) Concordant lateralization only and Class IV) Discordant lateralization. The relationship between MSI concordance and post-operative seizure outcome was assessed. ResultsA total of 183 patients (M: F = 109:74) were included. The mean age at onset of seizures: 8.0 ± 6.4 years. The dipoles were frequent in 123(67.2 %). The primary cluster orientation was regular in 59 (32.2 %) and mixed in 124 (67.8 %) patients. Concordance between MEG and resection cavity: Class I - 124 (67.8 %), class II- 30 (16.4 %), class III- 23 (12.6 %), and class IV- 6 (3.3 %). The post-surgically mean duration of follow-up was 19.52 ± 11.27 months. At 6-month follow-up period, 144 (78.7 %) patients had complete seizure freedom out of which 106 (73.6 %) had class I concordance. Concordance of MEG with resection cavity was associated with a good outcome at 6 months (p = 0.001), 1 year (p = 0.001), 2 years (p = 0.0005) and 5 years (p = 0.04). MEG cluster characteristics had no association with seizure outcome except the strength of the cluster and outcome at 3 years (p = 0.02) follow-up. ConclusionThe study supports that the complete resection of the MEG cluster had high chance of seizure-freedom and can be used as a complementary noninvasive presurgical evaluation tool.

Staging liver fibrosis by a continuous-time random-walk diffusion model

PurposeNoninvasive assessment of liver fibrosis holds significant clinical importance. We aimed to evaluate the clinical potential of using a continuous-time random-walk diffusion model (CTRW) for staging liver fibrosis. MethodsThis prospective study included 52 patients suspected of liver disease and scheduled for liver biopsy. All patients underwent multi-b value diffusion-weighted imaging (DWI) using a 1.5 T MR scanner to derive the anomalous diffusion coefficient (D) and temporal (α) and spatial (β) diffusion heterogeneity indexes sourced from the CTRW. The mono-exponential DWI-derived apparent diffusion coefficient (ADC), transient elastography-derived liver stiffness measurement (LSM), aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) index were calculated. We assessed and compared the correlations of these parameters with fibrosis stages and their efficacy in staging liver fibrosis. ResultsSignificant correlations with fibrosis stages were found for APRI (r = 0.336), FIB-4 (r = 0.351), LSM (r = 0.523), D (r = −0.458), and ADC (r = −0.473). Significant differences were observed between APRI, LSM, D, and ADC of different fibrosis stages. The diagnostic performance of an index that combined D, α, β, ADC, and LSM was superior to that of ADC or LSM alone for fibrosis stage F ≥ 2 and better than the index that combined D, α, β for fibrosis stage F ≥ 4. ConclusionsAccurate liver fibrosis staging was achieved with a model that combined CTRW-derived parameters (D, α, and β), ADC, and LSM. The model could serve as a reliable tool for noninvasive fibrosis evaluation.

Assessment of Myocardial Work in sarcomere gene mutation carriers and overt hypertrophic cardiomyopathy

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is a common genetic heart disease defined by unexplained hypertrophy and often characterized by diastolic and systolic dysfunction. In recent studies, HCM patients were found to have impaired left ventricular (LV) myocardial work (MW), a more load-independent parameter compared to global longitudinal strain (GLS). MW was never studied in sarcomere mutation carriers. Aim To compare MW between sarcomere mutation carriers, healthy controls and overt HCM. Methods A single centre study with a case-control design. The study population comprised 3 groups: overt HCM patients with a likely pathogenic/pathogenic sarcomere gene variant (n=51), carriers (n=51) and age and sex matched (to the carriers) healthy controls (n=32). All participants (pts) underwent a transthoracic echocardiogram including myocardial deformation analysis to calculate global longitudinal strain (GLS) and MW. MW was calculated from same-day non-invasive blood pressure evaluation. Global work index (GWI), Global constructive work (GCW), Global work efficiency (GWE) and Global wasted work (GWW) were obtained. Results GWI (1695mmHg% vs 1869mmHg%, p=0.001) and GCW (1993mmHg% vs 2244mmHg%, p&amp;lt;0.001) were lower in sarcomere mutation carriers compared to controls. LVEF and GLS were similar between the two groups (p=0.233). HCM pts were older (p&amp;lt;0.001), less likely female (p=0.01) and had a higher prevalence of cardiovascular (Cv) comorbidities, including hypertension (p&amp;lt;0.001), compared with sarcomere gene mutation carriers. Global work index (GWI) (1209mmHg%vs1695mmHg%), global constructive work (1456mmHg% vs 1993mmHg%, p&amp;lt;0.001) and global work efficiency (GWE) (89% vs 95%, p&amp;lt;0.001) were significantly lower in overt HCM compared with sarcomere mutation carriers. GWW was higher (117mmHg% vs 95mmHg%, p=0.006) in overt HCM. Conclusion In this study, we show for the first time that MW indexes were significantly worse in sarcomere gene mutation carriers compared to controls. GLS and MW indexes were also significantly different between overt HCM and sarcomere gene mutation carriers. These data suggest that MW is more sensitive to early changes than GLS and could play a major role in the evaluation and follow-up of sarcomere mutation carriers.

Prevalence and implications of heart failure stages A-D in patients with chronic kidney disease

Abstract Background Heart failure (HF) is a frequent comorbidity among patients with chronic kidney disease (CKD). Echocardiography allows for simple, non-invasive evaluation of structural and functional heart disease that could potentially classify patients at high risk of HF. Purpose This study aimed to assess the prevalence of HF stages A-D defined by the AHA/ACC/HFSA in CKD patients, and to report the incidence rates of renal outcomes and mortality of these stages. Methods This is a prospective cohort study. Patients aged 30 to 75 years with estimated glomerular filtration rate (eGFR) stages G1 to G5 pre-dialysis were included. All participants were examined using a pre-defined echocardiographic protocol. HF stages B and C/D were defined based on ejection fraction, global longitudinal strain, TAPSE, left ventricular mass, left ventricular diameter, left atrial volume index, and valvular heart disease in accordance with the AHA/ACC/HFSA guidelines. The outcomes examined were (1) a composite of kidney transplantation and dialysis and (2) all-cause mortality. Results A total of 825 patients with CKD were included. Mean age was 58±13 years and 37% were female. The participants were categorized as follows: Stage A HF: 352 (42.7%); stage B HF: 295 (35.8%); and stage C/D HF: 122 (14.8%). In total, 56 participants did not fulfil the criteria of HF stage A, B, C, or D and were classified as HF stage 0. Figure 1 displays the prevalence of HF stages across CKD stages. Poorer eGFR (P for trend 0.001) and urine albumin/creatine ratio (P for trend 0.005) were both significantly associated with increasing HF stages in linear regression models (including age, sex, and systolic blood pressure). During a median follow-up of 4 years, 115 patients (13.9%) developed the composite renal outcome and 74 patients (9.0%) died. Incidence rate per 100 patient-years for the composite renal outcome according to HF-stages was 2.3 (95%CI: [0.95;5.5]) for stage 0, 3.3 (95%CI: [2.5;4.5]) for stage A, 3.8 (95%CI: [2.8;5.1]) for stage B, and 6.3 (95%CI: [4.3;9.3]) for stage C/D. The incidence rate did only significantly differ between stage C/D and stage 0 (p = 0.026), and HF stage C/D was the only stage associated with the composite renal outcome in univariable Cox regression (HR = 2.80 (95%CI: [1.07;7.31], p = 0.036)). Incidence rate of death (per 100 patient-years) by 0, A, B, and C/D HF-stages were 1.3 (95%CI: [0.43;4.2]), 1.0 (95%CI: [0.63;1.7]), 2.5 (95%CI: [1.7.;3.6]), and 7.3 (95%CI: [5.1;10]), respectively. Incidence of death was only significantly higher in stage C/D compared with stage 0 (p&amp;lt;0.001). Also, stage C/D was the only stage that was significantly associated with all-cause mortality in univariable Cox regression (HR = 5.47 (95%CI: [1.67;17.9], p = 0.005)). Conclusion Among patients with CKD, worse HF stages became more prevalent with worsening kidney function, and both incidence rates of the composite renal outcome and of death were higher in HF stage C/D.HF stages distributed on CKD stages

Assessment of left atrial fibrosis by 18F-FDG PET/CT in persistent atrial fibrillation : comparison to electroanatomical mapping and cMR late gadolinium enhancement

Abstract A wide body of evidence suggests that left atrial (LA) interstitial fibrosis is a key contributor to persistent atrial fibrillation (peAF) and that its extent is predictive of the success of catheter ablation (CA) for this condition. Late gadolinium enhanced magnetic resonance imaging (LGE-cMR) has become increasingly popular for non-invasive detection and quantification of atrial fibrosis prior to CA. However, it is limited by a high rate of suboptimal scans and by large variability of quantification of fibrosis. We recently described the ability to obtain high quality 18- fluorodeoxyglucose (FDG) positron emission tomography (PET) of the atria after acipimox administration, and hypothesize that, similar to the left ventricle (LV), atrial metabolic activity could be a marker of cellular viability, indicating the absence of atrial fibrosis. The objective of our study was to investigate the potential utility of 18FDG uptake in the LA as an indicator of atrial scar and a predictor of CA success in patients with peAF. To this end, we compared the LA 18FDG uptake to LA voltage mapping during electrophysiological studies (EP) and cMR-LGE as a reference standard. Method 33 nondiabetic patients with nonvalvular peAF hospitalized for a first CA in our center prospectively underwent 18FDG-PET/CT, and LGE-CMR prior to EP and CA procedures. FDG-PET, LGE-cMR and electoanatomical maps were segmented and corregistrated in 3D surface models based on anatomical information from the contrast enhanced cMR angiograms. For 18FDG-PET/CT, maximum intensity projection of standardized uptake values (SUVs) along the surface was calculated and abnormal low metabolism was identified using a threshold of four standard deviations below the average SUV value of the atrial blood. Electrical scarring on EP voltage maps was defined as bipolar measurements of &amp;lt; 0.3 mV in AF, while fibrosis by LGE-CMR was evaluated using several thresholds of 2-5 standard deviations above the average blood signal intensity and the average intensity of the enhancement around the mitral valve. All three parameters of scar were expressed in percentage of the total LA area. Results Atrial hypometabolism by FDG-PET correlated strongly with electrical scaring by low voltage area during EP study (p&amp;lt;0.001, R² = 0.573). Atrial wall mean SUV standardized by LV uptake was also associated with low voltage, also the association's strength was mild (p =0.012, R²=0.22). There was good spatial corregistration of areas of low FDG metabolism with low voltage areas during EP study (Figure 2). By contrast there was no association between PET and LGE-cMR and association between atrial LGE by cMR and atrial voltage for all used thresholds. Conclusion Low 18FDG uptake by PET/CT showed a good correlation with atrial electrical scaring, while LGE-CMR did not. Our data suggest that atrial FDG PET could therefore be a valuable technique for non-invasive evaluation of atrial fibrosis prior to CA.Low metabolism versus low voltageMetabolic and voltage maps

Artificial intelligence analysis applied to facial features for prediction of high-risk coronary atherosclerosis at cardiac CT: the LOMBROSO Trial

Abstract Background Cardiac computed tomography (CT) has recently emerged as an accurate tool for non-invasive evaluation of coronary artery disease (CAD) and coronary atheroscelrosis itself. Nowadays no validated tools are available to predict the presence of high risk atherosclerosis, probably due to the multifactorial pathogenesis of atherosclerosis. Facial features may express both genetic and environmental factors that could be associated to high risk atherosclerosis. Aim of the present study was to verify whether deep learning models applied to facial features may accurately predict the presence of high risk coronary atherosclerosis at cardiac CT. Methods We enrolled a consecutive cohort of 100 patients who underwent clinical indicated cardiac CT for suspected, CAD. Before CT, 10 facial photos were taken from every patients from random fronts views. All cardiac CT were analysed for the presence of non-calcified plaque volume (defined as &amp;lt;150 HU at CT); the non-calcified plaque volume was quantified on a per-patient basis in mm3. We built a deep learning model, exploiting the transfer learning technique; briefly, we implemented an ‘xception’ architecture, joining a pre-trained convolutional part with a specific combination of dense layers, in which an output layer follows a hidden layer with 512 neurons and a dropout layer with a dropout rate=0.2. The batch size, the number of epochs and the learning rate were 16, 20, and 0.0001, respectively. A training set composed of 198 face images was fed into the model, while 80 face images served as test set for the prediction of the presence of elevated volume of non-calcified plaque from patients facial features. Results We present the final results from the first 100 patients enrolled (69 male and 31 female, with mean age of 62±10 years old). In 30 patients cardiac CT resulted completely normal, while in 70 subjects the presence of coronary atherosclerosis was demonstrated. On the test set, we obtained for deep learning facial analysis an AUC equal to 0.79, 1, 0.94, 0.89 for the prediction of presence of high risk plaque, elevated low density plaque volume and elevated non-calcific plaque volume. These AUC data were significatively higher when compared to SCORE2 capability to predict the presence of high risk plaque features, low density plaque volume and non-calcific plaque volume (AUC equal to 0.65, 0.64, 0.66, respectively) among all 100 patients enrolled. Conclusions Prediction of the presence of high risk atherosclerosis from deep learning models applied to facial features appeared to be feasible and promising. Of note, significatively high AUC were demonstrated for deep learning facial analysis when compared to SCORE2. Our results may provide a useful tool for appropriate identification of patients that may merit to underwent cardiac CT, even if asymptomatic, for early identification of high risk atherosclerosis.

Cigarette smoking abolishes the mediterranean diet benefit on exercise capacity, coronary physiology and target organ damage in hypertensive males with erectile dysfunction

Abstract Background Erectile dysfunction (ED) often coexists impairing quality of life in the hypertensive aging male population. The Mediterranean diet (Med-diet) benefits cardiovascular health. Coronary flow reserve (CFR) displays the ability of the coronary circulation to increase flow. Central vascular stiffness and microalbuminuria (UMALb) represent hypertension-related target organ damage (TOD). Purpose To investigate cigarette smoking adverse effects on the Med-diet benefit in exercise capacity, coronary physiology and TOD in hypertensive males with ED. Methods We enrolled 290 hypertensive ED males (mean age: 57 yo) with no history of diabetes mellitus or overt cardiovascular disease. 121 (42%) were current cigarette smokers. Intensity of smoking referred in packs/year. All underwent a treadmill stress test (Bruce protocol), exercise capacity was validated as metabolic equivalents (METs). We measured the CFR of the LAD artery (2D echo) by performing an adenosine protocol (max dose 140μg/Kg/min over 6 min). PW Doppler measurements were achieved at the middle/distal LAD (color Doppler flow mapping). CFR was validated as ratio between peak diastolic flow velocity following drug infusion and rest. Ratios ≥ 2 indicate macro and microvascular coronary integrity. Participants were screened for the presence of UMALb (urinary albumin loss 30 – 300 mg /24 h urine volume collection). Finally a non-invasive evaluation of the carotid – femoral pulse wave velocity (PWV), estimation of central pressures and augmentation index (AIx) a parameter of wave reflection amplification were performed (Sphygmocor device). ED severity and the Med-diet adherence were assessed by the SHIM-5 (range:0-25) and the Med-diet (range:0-55) scores. Higher values indicate a better erectile ability and Med-diet compliance respectively. Results In bivariate analysis the Med-diet score was positively associated with METs, CFR and the SHIM-5 score and negatively with PWV, AIx and UMALb (p&amp;lt; 0,05). CFR, METs and the SHIM-5 score were also positively related (p&amp;lt; 0,03). In linear regression analysis the Med-diet relation remained significant after correction for age, BMI, LDL, total cholesterol and systolic blood pressure. However introducing cigarette smoking as a cofounder abolished the above relations. Packs/year were positively related to AIx, UMALb and negatively to the SHIM-5 score (p&amp;lt; 0,05). We also divided our population according to the mean Med-diet score (27) in high and low Med-diet groups .The high score group had higher METs and SHIM-5 score and lower PWV. Smokers had higher AIx and lower SHIM-5 score (pictures). Conclusion Cigarette smoking influences microvascular physiology and peripheral wave reflection and so abolishes Med-diet benefit on exercise capacity, coronary physiology, target organ damage and erectile ability in hypertensive males with ED. It is of vital importance consult this population avoiding smoking to restore cardiovascular health and quality of life.

Reduced right ventricular outflow tract strain at cardiac magnetic resonance correlates with low-voltage areas at unipolar electroanatomic mapping in patients with brugada syndrome

Abstract Background Brugada Syndrome (BrS) was initially described as a channelopathy without underlying structural substrate, but pathological and electroanatomic abnormalities of the right ventricular outflow tract (RVOT), are increasingly recognized, suggesting a possible role of electroanatomic mapping (EAM) in risk stratification of these patients. New echocardiographic and cardiac magnetic resonance (CMR) tools are able to identify subtle structural and functional myocardial abnormalities associated with an increased arrhythmic risk. Purpose We aimed to assess the presence of structural and functional abnormalities of RVOT by CMR-derived RV and RVOT feature tracking in BrS patients. We also sought to evaluate the relationship between RVOT functional abnormalities and the presence and extension of RVOT abnormal voltage areas at EAM. Methods we retrospectively enrolled BrS patients submitted to CMR comprehensive of RVOT sequences and bipolar and unipolar endocardial EAM. Abnormal voltage areas were defined by the presence of signal amplitude &amp;lt;4mV at unipolar mapping and signal amplitude &amp;lt;1.5mV at bipolar mapping. We included a control group of 15 healthy volunteers submitted to CMR including RVOT sequences. Results We studied 16 patients, 12/16 males, mean age 42±9 years. In all cases CMR showed normal left and right ventricular ejection fraction (LVEF 57±4%, RVEF 56±6%). RVOT peak strain values were significantly impaired in BrS patients compared to controls (-17.9±8.6% vs -26.4±9.5%, p=0.011), while RV-GLS did not differ between the two groups (-22.2±4.0% vs 24.6±2.5%, p=0.061). EAM showed the presence of pathological voltages at both unipolar and bipolar mapping in 12 patients, abnormal unipolar and normal bipolar maps in 1 case and both unipolar and bipolar normal maps in 3 patients. Median extent of abnormal voltage areas was 5.3 cm2 [IQ 1-4 = 0.6-9.3 cm2] at unipolar and 4.1 cm2 [IQ 1-4 = 0.7-7.5 cm2] at bipolar map. RVOT peak strain showed a significant correlation with abnormal voltage areas at unipolar EAM (r=0.546, r2=0.525, p=0.029). Patients with both unipolar and bipolar normal maps (n=3) had normal RVOT strain values compared to controls (-25.7±3.9 vs -26.4±9.5%, p=0.90). Conclusions In patients with BrS, RVOT peak strain is significantly reduced compared to controls and is associated with abnormal voltage areas at endocardial unipolar EAM. Noninvasive evaluation of BrS patients with CMR-derived RVOT feature tracking may help to identify patients requiring invasive evaluation with EAM. Prospective studies evaluating the prognostic role of RVOT strain and EAM in BrS patients are needed.

Abstract 17504: Revisiting the Etiology of a Non-Ischemic Cardiomyopathy

Introduction: In the era of REVIVED-BCIS2 and ISCHEMIA clinical trials, the role of routine invasive coronary angiography for treatment of coronary artery disease (CAD) in the setting of left ventricular dysfunction has come into question. While the majority of heart failure (HF) patients undergo some form of non-invasive ischemic evaluation, there are a wide range of opinions on which testing modality is the most appropriate. Case: This is a 53 year-old man with a history of HTN, HLD, and presumed non-ischemic cardiomyopathy and LVEF of 15-20%, first diagnosed in 2009. He had a family hx of heart disease in several distant relatives, thus the etiology was presumed familial. In 2022, he had NYHA class II symptoms and a routine echo showed a LVEF of 25% with anteroseptal hypokinesis. Given these findings, a coronary CTA was obtained. This demonstrated infarct in the LAD territory and a proximal left main to mid-LAD aneurysm measuring up to 7 mm with a partially calcified shell and peripheral thrombus, consistent with prior Kawasaki’s disease (KD). He was initiated on a DOAC to prevent further embolic events and aspirin. He is now undergoing serial monitoring of the aneurysm size, thrombus burden, and functional testing to monitor for ischemia. Discussion: Non-invasive anatomic testing to evaluate for CAD in HF patients can provide useful information over a functional assessment. KD is a rare disease with an estimated incidence rate of ≈25 per 100,000 children less than 5 years of age. KD can lead to coronary artery aneurysms, which often contain thrombi, and subacute/chronic myocarditis. The affected arteries can become stenotic over time or even occlude, leading to ischemic injury later in life. Early recognition of this rare disease is important to initiate appropriate treatment and prevent thromboembolic complications. Conclusion: KD is a rare cause of adult cardiomyopathy. Anatomic testing was essential to appropriately diagnose and treat this patient’s cardiomyopathy.

Multimodal Ophthalmic Imaging in Spinocerebellar Ataxia Type 7.

The aim of this case series and narrative literature review is to highlight the importance of multimodal imaging in the ophthalmological examination of patients with spinocerebellar ataxia type 7 and provide a summary of the most relevant imaging techniques. Three patients with SCA7 were included in this case series. A literature review revealed twenty-one publications regarding ocular manifestations of SCA7, and the most relevant aspects are summarized. The role of different imaging techniques in the follow-up of SCA7 patients is analyzed, including color vision testing, corneal endothelial topography, color fundus photography (CFP) and autofluorescence, near infrared reflectance imaging, spectral domain optical coherence tomography (SDOCT), visual field examination, and electrophysiological tests. SDOCT provides a rapid and non-invasive imaging evaluation of disease progression over time. Additional examination including NIR imaging can provide further information on photoreceptor alteration and subtle disruption of the RPE, which are not evident with CFP at an early stage. Electrophysiological tests provide essential results on the state of cone and rod dystrophy, which could be paramount in guiding future genetic therapies. Multimodal imaging is a valuable addition to comprehensive ophthalmological examination in the diagnosis and management of patients with SCA7.

Wall Properties of Elastic and Muscular Arteries in Children and Adolescents at Increased Cardiovascular Risk.

Pulse wave velocity (PWV) assessment represents a simple method to estimate arterial distensibility. At present, carotid-femoral PWV (cf-PWV) is considered the gold standard method in the non-invasive evaluation of the elastic properties of the aorta. On the other hand, the mechanical properties of muscular arteries can be evaluated on the axillo-brachial-radia axis by estimating the carotid-radial PWV (cr-PWV). While a number of studies have addressed these issues in adults, limited information is available on the respective features of cf-PWV and cr-PWV and on their modulating factors in children and adolescents at increased cardiovascular risk. The mechanical properties of the predominantly elastic (aorta) and muscular (axillo-brachial-radial axis) arteries were evaluated in a pediatric population characterized by either elevated blood pressure (BP) or excess body weight, and the main factors affecting cf-PWV and cr-PWV values in these individuals were investigated. 443 children and adolescents (median age 11.5 years, 43.3% females) were enrolled; 25% had BP values >90th percentile and 81% were excess weight. The cf-PWV values were significantly lower than the cr-PWV values: median (Q1-Q3) = 4.8 m/s (4.3-5.5) and 5.8 m/s (5.0-6.5), respectively (p < 0.001). The pubertal development (p < 0.03), systolic BP and diastolic BP z-scores (p = 0.002), heart rate (p < 0.001), and waist-to-height ratio (p < 0.005) were significantly associated with cf-PWV values. No significant association was found between BMI z-score and cf-PWV. Predictors of high cf-PWV (>95th percentile) were the heart rate (OR 1.07, 95%CI 1.04-1.10, p < 0.001) and waist-to-height ratio (OR 1.06, 95%CI 1.0-1.13, p = 0.04). The variables significantly related with cr-PWV values were diastolic BP z-score (p = 0.001), heart rate (p < 0.01), and HOMA index (p < 0.02). No significant association was found between the cr-PWV and BMI z-score or waist-to-height ratio. Systolic and diastolic BP values and central obesity are associated with aortic stiffness in a population of children and adolescents at increased cardiovascular risk. In contrast, diastolic BP, heart rate, and levels of insulin resistance appear to be related to distensibility of the upper limb vascular district.

Automated Lung Disease Detection and Classification Using Quantum Glowworm Swarm Optimizer with Quasi Recurrent Neural Network on Chest X-Ray Images

Lung diseases or otherwise called respiratory diseases are airborne diseases that affect the lungs and the other tissues of the lungs. Tuberculosis, Coronavirus Disease 2019 (COVID-19), and Pneumonia are a few instances of lung diseases. If the lung disease is diagnosed and treated in the initial stage, the chances of recovery rate and long-term survival rates can be increased. Usually, lung disease is identified by Chest X-Ray (CXR) image examination, skin test, sputum sample test, Computed Tomography (CT) scan examination, and blood test. Because of its non-invasive and convenient evaluation for overall outcomes of the chest situation, Lung disease can be detected by specialized radiologists on CXR images. In recent times, Deep Learning (DL) applies to medical images for disease detection and has proved an effective technique for detecting disease. The recent advancement of DL supports the detection and classification of lung diseases in medicinal imaging. This article presents an Automated Lung Disease Detection Using Quantum Glowworm Swarm Optimization with Quasi Recurrent Neural Network (QGSO-QRNN) model on CXR imaging. The presented QGSO-QRNN technique focuses on the identification of lung diseases using DL concepts. To accomplish this, the presented QGSO-QRNN technique initially performs image pre-processing by the use of the Gaussian Filtering (GF) technique. Besides, the Faster SqueezeNet approach is exploited for feature vector generation. Finally, the QRNN model is applied for precise classification of lung diseases with the QGSO technique as a hyperparameter optimizer. The investigational assessment of the QGSO-QRNN technique is examined by employing standard medical datasets and the outputs display the promising performance of the QGSO-QRNN technique over other existing techniques by means of diverse measures.

Localized focal cortical dysplasia type II: seizure freedom with lesionectomy guided by MRI and FDG-PET.

The authors perform thorough, noninvasive presurgical evaluations for intractable epilepsy at their center and avoid unnecessary intracranial EEG when possible. The purpose of this study was to clarify the appropriateness of their lesion-oriented surgical strategy for localized focal cortical dysplasia (FCD) type II. Fifty-one patients with pathologically proven localized FCD type II who were followed for at least 1 year after surgery were included. Patients with FCD type II with lobar or multilobar distribution were excluded. The results of presurgical evaluations, including thin-slice 3-T MRI, FDG-PET, and ictal SPECT, as well as surgical procedures and postoperative seizure and functional outcomes, were examined retrospectively. MRI was positive in 46 (90%) of 51 patients, and FDG-PET revealed localized hypo- or hypermetabolism in 47 (92%) of 51 patients. Ictal SPECT revealed concordant hyperperfusion in 37 of 42 patients examined. Intracranial EEG was used in only 13 patients (25%), including 5 with negative MRI results and 4 with subtle MRI findings. Of the 15 patients with FCD in the vicinity of eloquent (sensorimotor and language) areas, intracranial EEG was used in 4. Lesionectomy was performed in all 51 patients. Intraoperative electrocorticography (ECoG) was performed in 8 patients, but the findings were not used to tailor the extent of resection. Postoperative seizure outcomes were Engel class I in 47 patients (92%) and Ia in 45 (88%). In the 15 patients with FCD in the vicinity of eloquent areas, 13 (87%) achieved a class I outcome. Predictive factors for favorable seizure outcome were complete resection of the MRI lesion (p = 0.006) and frontal lobe surgery (p = 0.012). Postoperative neurological deficits were noted in only 4 (27%) of 15 patients with FCD in the vicinity of eloquent areas. All 5 MRI-negative patients achieved an Engel class I outcome. In most of the patients with localized FCD type II, MRI and/or FDG-PET detected the localized abnormality. Lesionectomy without intracranial EEG led to seizure freedom in most cases. Even when lesions were in the vicinity of eloquent areas, seizure and functional outcomes were favorable. Intraoperative ECoG may thus be unnecessary. Complete resection of the lesion is essential for favorable seizure outcome in MRI-positive patients. In MRI-negative patients, surgery with intracranial EEG guided by FDG-PET provided seizure-free outcomes.

Acute global longitudinal strain evaluation in patients with subacute to chronic chest pain: A pilot, observational study

BackgroundGlobal longitudinal strain (GLS) imaging is a multifaceted modality that has been utilized in various fields of clinical cardiology in the recent past; however, its implementation for the assessment of ischemia has been limited. ObjectivesThis study aimed to document the functional changes in GLS secondary to acute myocardial ischemia in patients with chronic chest pain. MethodsIn this unblinded, single-center, investigator-initiated, prospective pilot study, the functional changes in GLS at baseline, during, and immediately following coronary percutaneous intervention were monitored in 10 ambulatory patients who underwent elective catheterization. The exclusion criteria included a low ejection fraction, or a history of chemoradiation, myopathy, and congenital heart disease. ResultsThe average GLS at baseline, during the balloon intervention (BI), and 1–2 min after BI was −15.4 % ± 3.3 %, −10.2 % ± 3.6 %, and −16.1 % ± 4.2 %, respectively. The average GLS decreased significantly by 5.1 % (95 % CI, −7.9 % to −2.3; P = 0.0013) from baseline to BI, increased by 6.3 % (95 % CI, 3.7 % to 8.9 %; P < 0.001) from BI to immediately post-BI, and increased by 0.7 % from baseline to post-BI (95 % CI, −0.4 % to 2.7 %; P = 0.161). ConclusionPatients undergoing BI showed a significant decrease in the average GLS within 1–2 min of BI, with GLS returning to baseline subsequently, clearly demonstrating the efficacy of the modality and the clinical significance of data obtained. These functional changes replicate cardiac perfusion to the segments supplied by respective vessels and its effect with reperfusion or ballooning. The slight increase in GLS from baseline to post-intervention was not statistically significant, which could be attributed to the confounding factors. Analyzing our data, we can safely conclude that GLS is potentially a sensitive, temporal, and quantitative tool for identifying patients with acute ischemia with its limitations and need for further perfection of this modality. Therefore, GLS assessments on 2D echo can be used for risk stratification of patients with subacute to chronic chest pain concerning for ischemia in addition to EKG, troponins and other data obtained by non-invasive testing and evaluation.

Prognostic significance of the wall to lumen ratio of retinal arterioles evaluated by adaptive optics

ObjectiveMicrovascular structural alterations may be considered an important form of hypertension-mediated organ damage. An increased media-to-lumen ratio of subcutaneous small arteries evaluated with locally invasive techniques (micromyography) predicts the development of cardiovascular (CV) events. However, it is not known whether retinal arteriole structural alterations evaluated with a noninvasive approach (Adaptive Optics) may have a prognostic significance. Design and methodsTwo-hundred and thirty-seven subjects (mean age 58.7 ± 16.1 years, age range 13–89 years; 116 males) were included in the study: 65 normotensive subjects (27.4 %) and 172 patients with essential hypertension or primary aldosteronism (72.6 %). All subjects underwent a non-invasive evaluation of retinal arteriolar wall-to-lumen ratio (WLR) by Adaptive Optics. Subjects were re-evaluated after an average follow-up time of 4.55 years in order to assess the occurrence of clinical events (non CV and/or CV death or events). ResultsFifty-four events occurred in the study population:26 were cardio-cerebrovascular events (ischemic or hemorragic stroke, atrial fibrillation, heart failure, coronary artery disease, peripheral artery disease, cardiac valvular disease) while the remaining were deaths for any cause, or neoplastic diseases. Subjects with events were older and had a WLR of retinal arterioles significantly greater than those without events. The event-free survival was significantly worse in those with a baseline WLR above the median value of the population (0.28) according to Kaplan-Mayer survival curves and multivariate analysis (Cox's proportional hazard model). The evidence was confirmed after restricting the analysis to CV events. ConclusionsStructural alterations of retinal arterioles evaluated by Adaptive Optics may predict total and CV events.

Navigating the Diagnostic Maze: Unraveling the Non-invasive Evaluation of Bladder Outlet Obstruction in Men—a Comprehensive Systematic Review

Navigating the Diagnostic Maze: Unraveling the Non-invasive Evaluation of Bladder Outlet Obstruction in Men—a Comprehensive Systematic Review

Association between Corneal Higher-Order Aberrations Evaluated with a Videokeratographer and Corneal Surface Abnormalities in Dry Eye.

Analysis of higher-order aberrations (HOAs) is one reported method for evaluating dry eye disease (DED)-related loss of visual function. Tear film (TF) instability and corneal epithelial damage (CED) are both reportedly responsible for HOAs in DED, although, to the best of our knowledge, there are no reported methods that allow concurrent evaluation of their effects. In this study, we used a videokeratographer (VK) to continuously measure HOAs in DED after eye opening and investigated factors of ocular surface abnormalities that determine HOAs. This study involved 96 DED cases that underwent DED symptom assessment with a questionnaire and examination of tear volume, TF abnormalities (i.e., TF lipid-layer interference grades and spreading grades, and non-invasive breakup time and fluorescein breakup time), and CED, and their correlation with HOAs evaluated via VK. The results show that HOAs at 1 or 2 s after eye opening can reflect TF instability and CED within the central 4-millimeter-diameter area of the optical zone in DED eyes concurrently. This finding may be useful for the rapid and non-invasive detection and evaluation of degraded visual function in DED cases with a variety of clinical features.