Training Patterns Research Articles

Sex Differences in Youth and Young Adult Sport Training Patterns, Specialization, and Return to Sport Durations.

Young female athletes may have higher rates of overuse injuries and sport specialization than male athletes. The association of sports specialization and return to sport (RTS) timeframe is also unknown. Specialized female athletes will have more intense, year-round training patterns, more overuse injuries, and longer RTS times than male athletes. Cohort study. Level 3. Injured athletes aged 10 to 23 years presenting to a sports medicine clinic reported their degree of sport specialization and training patterns. Skeletal maturity was estimated using the Khamis-Roche method. Injury type and RTS timeframes were categorized from electronic medical records. Chi-square tests and logistic regression analysis assessed associations between variables. A total of 485 athletes (40.2% female) were enrolled. Higher degrees of sport specialization were associated strongly with overuse injuries (P < 0.01). After adjusting for specialization, female athletes were more likely to sustain an overuse injury (adjusted odds ratio, 1.49; P = 0.04). Female athletes participated in fewer total physical activity hours per week (P < 0.01), fewer free play hours per week (P < 0.01), and participated in their main sport for more months of the year than their male counterparts (P = 0.02). Female athletes were more likely to be at a higher developmental stage than male athletes (P < 0.01). RTS timeframes were increased in athletes with serious overuse injury; however, no association was found between degree of specialization and RTS time regardless of sex. Female athletes are more likely to sustain overuse injuries with more organized, year-round, training and less free play compared with their male counterparts. Female sex may be an independent risk factor of overuse injury. Future strategies to mitigate these risks may include increased free play hours and limiting year-round training through seasonal rest.

Single-Scene SAR Image Data Augmentation Based on SBR and GAN for Target Recognition

High-performance neural networks for synthetic aperture radar (SAR) automatic target recognition (ATR) often encounter the challenge of data scarcity. The lack of sufficient labeled SAR image datasets leads to the consideration of using simulated data to supplement the dataset. On the one hand, electromagnetic computation simulations provide high amplitude accuracy but are inefficient for large-scale datasets due to their complex computations and physical models. On the other hand, ray tracing simulations offer high geometric accuracy and computational efficiency but struggle with low amplitude correctness, hindering accurate numerical feature extraction. Furthermore, the emergence of generative adversarial networks (GANs) provides a way to generate simulated datasets, trying to balance computational efficiency with image quality. Nevertheless, the simulated SAR images generated based on random noise lack constraints, and it is also difficult to generate images that exceed the parameter conditions of the real image’s training set. Hence, it is essential to integrate physics-based simulation techniques into GANs to enhance the generalization ability of the imaging parameters. In this paper, we present the SingleScene-SAR Simulator, an efficient framework for SAR image simulation that operates under limited real SAR data. This simulator integrates rasterized shooting and bouncing rays (SBR) with cycle GAN, effectively achieving both amplitude correctness and geometric accuracy. The simulated images are appropriate for augmenting datasets in target recognition networks. Firstly, the SingleScene-SAR Simulator employs a rasterized SBR algorithm to generate radar cross section (RCS) images of target models. Secondly, a specific training pattern for cycle GAN is established to translate noisy RCS images into simulated SAR images that closely resemble real ones. Finally, these simulated images are utilized for data augmentation. Experimental results based on the constructed dataset show that with only one scene SAR image containing 30 target chips, the SingleScene-SAR Simulator can efficiently produce simulated SAR images that exhibit high similarity in both spatial and statistical distributions compared with real images. By employing simulated SAR images for data augmentation, the accuracy of target recognition networks can be consistently and significantly enhanced.

Strain As An Indicator For Stress Fractures In Racehorses

Abstract The horse racing industry, despite its financial significance, grapples with significant welfare issues, particularly stress fractures in racehorses. Third metacarpal (MC3) bone fractures, constituting about one-third of all limb fractures, severely impact horse health and performance. The frequent occurrence of condylar fractures in the MC3, often resulting in bone comminution, poses high risks-sometimes necessitating euthanasia, and complicates the management and recovery processes for the rest. Comprehensive methods for quantitatively determining fracture risks in horses are lacking, with strain measurements on the MC3 during racing conditions showing promise as an indicator of high loads and potential fracture risks. This study investigated the mechanical properties of MC3 under high compressive loads. Six MC3 bones from euthanized horses were instrumented with strain gauge rosettes at four key locations: Lateral Condyle (CondL), Medial Condyle (CondM), Dorsal DistoLateral (DisL) and Dorsal DistoMedial (DisM). Each bone underwent a pre-loading phase and five cycles of 12kN sinusoidal loading to replicate galloping forces. Strain patterns were observed before and after introducing an artificial slot in the lateral condylar groove to simulate a fatigue crack. A strong correlation was found between load and minimum principal strain in both intact and fatigue crack-induced (FCI) bones, with R-squared values over 0.99. Post-FCI, 83% of bones exhibited an increase in the minimum principal strain-load response slope, indicating uniform changes in material behavior. Additionally, a rise in post-FCI y-intercept values across MC3 locations indicated higher initial strain and possible changes in bone properties.

Electrocardiographic strain and relationship with LV remodelling and clinical outcomes in patients with aortic stenosis undergoing transcatheter aortic valve implantation.

Left ventricular (LV) remodelling and fibrosis is known to occur in patients with aortic stenosis (AS) and is linked to post-intervention outcomes. These myocardial changes may be detected upon the routine 12-lead electrocardiogram by the presence of a LV strain pattern (LVS-ECG). Although LVS-ECG has been related to excessive cardiovascular morbidity and mortality in multiple patient populations, there is currently a dearth of data upon its impact in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of the current study was to investigate the prevalence, predictors and prognostic value of LVS-ECG. Between 2012 and 2019, 640 consecutive patients underwent TAVI at Haukeland University Hospital, Bergen. Of these, 600 patients with severe AS were included in the TAVI-NOR study. Patients with known bundle branch block (n=85) or permanent pacing (n=25) were excluded, leaving 490 patients (mean age 81±6years, 52% females) eligible for the analyses. LVS-ECG was defined as down-sloping, convex ST-segment depression with asymmetric T-wave inversion in V5 or V6. LVS-ECG was present in 25.7% patients. Higher levels of NT-proBNP (OR 1.96; 95% CI:1.08-3.55, p=0.028), LVEF<50% (OR 3.14; 95% CI:1.61-6.13, p=0.001), increase in LV mass index per SD (32g/m2) (OR 1.37; 95 CI:1.06-1.76, p=0.014), and the presence of LV hypertrophy on ECG (OR 3.23; 95% CI:1.97-5.32, p<0.001) were independent predictors of LVS-ECG in the multivariable-adjusted analysis. Although all-cause mortality was significantly higher in patients with LVS-ECG compared to those without (54.8% vs 44.2%, p=0.041), the presence of LVS-ECG did not predict all-cause mortality during a median follow-up of 64±24 months (HR 1.05; 95% CI:0.79-1.39, p=0.742). Patients with LVEF <50% and concomitant LVS-ECG had a worse prognosis than those with LVEF >50% and no LVS-ECG (p<0.001). LVS-ECG may represent a simple marker of structural and functional LV remodelling that signals a propensity to excess mortality during long-term follow-up after TAVI, as it is strongly associated with other prognosticators such as reduced LVEF and increased levels of NT-proBNP.

Empowering primary care physicians in child and adolescent psychiatry: a needs assessment on collaborative care in Dubai.

Child and adolescent psychiatric disorders pose significant public health concerns necessitating prompt intervention. Primary care physicians (PCPs) play a critical role as initial points of contact, facilitating early detection, management, and referral of these conditions. In Dubai, integrating mental health services into primary care faces unique challenges, highlighting the need for systemic reforms and enhanced PCP training. This study investigated perceptions, barriers, and systemic challenges encountered by PCPs in managing child and adolescent psychiatric conditions in Dubai's primary care setting. It also assessed family physicians' involvement and preparedness in this domain. Using a mixed-methods approach, we conducted a survey among family physicians in Dubai Health facilities and analyzed patient data from family medicine clinics. The survey evaluated formal training, preparedness, encounter frequency, and referral patterns for psychiatric care in young patients. Qualitative insights from open-ended survey questions provided additional understanding of specific challenges. Findings revealed significant gaps in formal training, with only 33.3% of respondents trained in child and adolescent psychiatry during medical education, and 21.1% participating in Continuing Medical Education (CME). A majority (54.4%) of PCPs felt unprepared to manage psychiatric care in young patients. Patient data analysis showed a predominance of male patients (59.9%) and identified Autism Spectrum Disorder (43.1%) as the most common condition, emphasizing the reliance on specialized care through a high referral rate (63.1%). Major barriers included time constraints, limited psychiatric knowledge, resistance to mental health services, systemic and structural issues, communication challenges, and resource shortages. Enhanced training and systemic reforms are urgently needed to integrate mental health services effectively into Dubai's primary care. Implementing structured collaborative care models, fostering interdisciplinary collaboration, and addressing systemic barriers are crucial for improving child and adolescent psychiatric condition management. These initiatives promise better patient outcomes and more efficient healthcare resource utilization.

Ultrahigh-Density Polar Vortex Lattice in Square-Shaped Moiré Bilayers of Lead Chalcogenides.

Nanoscale exotic polar topological structures, such as vortices and skyrmions, hold promise for next-generation electronic devices, yet their spontaneous formation in 2D van der Waals (vdW) materials remains quite challenging. Herein, we demonstrate from first-principles that ultrahigh-density polar vortices emerge in the square moiré bilayer formed by twisting two layers of centrosymmetric PbS with the D4h point group. The emerged ferroelectricity arises from the inherent complex strain associated with the twisted structures, and the resulting electron polarization is much greater than that obtained in sliding ferroelectricity. Notably, the engineered strain patterns are characterized by peculiar inhomogeneous in-plane fields with a checkerboard distribution of uniaxial tension. This nanoscale nonuniform strain produces an ultrahigh-density vortex polarization lattice. The results from our study not only reveals a new mechanism for electric polarization and polar topologies in moiré bilayers but also provides opportunities for designing 2D ultrahigh-density electric devices.

Training in the Use of Myoelectric Prostheses Through the Combined Application of Immersive Virtual Reality, Cross-education, and Mirror Therapy

ABSTRACT Introduction During the rehabilitation process (RHB) of the patient with traumatic upper-limb amputation, the use of immersive virtual reality (IVR) facilitates the incorporation of the prosthesis into the body schema. This reinforces and enhances sensorimotor and cognitive stimulation to improve motor learning and motor patterns, while normalizing global gestures. Objectives The aims of this study were to implement retraining of gestural acquisition and prosthetic control in patients with upper-limb injuries and amputations through IVR, and to then incorporate this in the normalization of functional patterns in activities of daily living (ADLs) with the work of “cross-education” as well as the therapy of observation of actions—mirror therapy to enhance the joint effect of the approach with IVR. Methods Standard sessions were established for transradial and transhumeral trauma patients with upper-limb amputation and traumatic injuries within the rehabilitation treatment. During the sessions, games and virtual environment were used. The software ran in desktop mode using a “Leap Motion” or for immersive versions of 3D glasses (Oculus Rift S). Results The application of IVR in combination with conventional treatment obtained significant benefits for functionality. These included learning correct motor execution as well as motivational and emotional state with distal traumatic injuries and upper-limb amputations with or without myoelectric prosthesis, obtaining 5.6 on average on the GROC (global rating of change) scale. Conclusions Immersive virtual reality shows benefit for the normalization of motor learning of functional patterns in DLA and on the emotional, motivational level of the patient. Clinical Relevance The integrated combination of cross-education, mirror therapy, and immersive virtual reality may represent greater acquisition of motor patterns in the prosthetic training of patients with upper-limb amputation.

Numerical modeling and analysis of neck injury induced by parachute opening shock.

Neck injuries from parachute opening shock (POS) are a concern in skydiving and military operations. This study employs finite element modeling to simulate POS scenarios and assess cervical spine injury risks. Validated against various conditions, including whiplash, the model replicates head/neck kinematics and soft tissue responses. POS simulations capture body/head motions during parachute deployment, indicating minimal risk of severe neck injuries (Abbreviated Injury Score/AIS ≥ 2) and low risk of soft tissue tears. Vertebral stress analysis during a rougher jump highlights high stress at C5/C6 lamina, indicating fracture risk. Comparative analysis with rear impact scenarios reveals distinct strain patterns, with rear impacts showing higher ligament strain, consistent with higher soft tissue damage risk. Though POS simulations exhibit lower strain values, they emphasize similar neck deformation patterns. The model's capability to accurately simulate head and neck movements during parachute openings provides critical validation for its use in assessing injury risks. The study's findings underline the importance of considering specific loading conditions in injury assessments and contribute to refining safety standards for skydiving and military operations. By highlighting the differences in injury mechanisms between POS and rear impacts, this research offers valuable insights into tailored injury mitigation strategies. The results not only enhance our understanding of neck injury mechanisms but also inform the development of protective gear and safety protocols, ultimately aiding in injury prevention for skydivers and military personnel.

A study on sleep posture analysis using fibre bragg grating arrays based mattress

Prolonged sleeping postures or unusual postures can lead to the development of various ailments such as subacromial impingement syndrome, sleep paralysis in the elderly, nocturnal gastroesophageal reflux, sore development, etc Fibre Bragg Gratings (a variety of optical sensors) have gained huge popularity due to their small size, higher sensitivity and responsivity, and encapsulation flexibilities. However, in the present study, FBG Arrays (two FBGs with 10 mm space between them) are employed as they are advantageous in terms of data collection, mitigating sensor location effects, and multiplexing features. In this work, Liquid silicone encapsulated FBG arrays are placed in the head (E), shoulder (C, D), and lower half body (A, B) region for analyzing the strain patterns generated by different sleeping postures namely, Supine (P1), Left Fetus (P2), Right Fetus (P3), and Over stomach (P4). These strain patterns were analyzed in two ways, combined (averaging the data from each FBG of the array) and Individual (data from each FBG was analyzed separately). Both analyses suggested that the FBGs in the arrays responded swiftly to the strain changes that occurred due to changes in sleeping postures. 3D histograms were utilized to track the strain changes and analyze different sleeping postures. A discussion regarding closely related postures and long hour monitoring has also been included. Arrays in the lower half (A, B) and shoulder (C, D) regions proved to be pivotal in discriminating body postures. The average standard deviation of strain for the different arrays was in the range of 0.1 to 0.19 suggesting the reliable and appreciable strain-handling capabilities of the Liquid silicone encapsulated arrays.

Structural disorder facilitates future memory decisions.

It is well known that perception and cognition are systematically biased towards the recent past. That is, a decision about the current state of a perceptual feature (e.g. orientation) can be predicted based on a recent state of the same feature. Such serial dependencies have been demonstrated across perception, memory and cognition, and have been jointly attributed to an adaptive mechanism meant to promote stability in a constantly changing environment. Here, we argue that this adaptive mechanism prioritizes past information on the most basic structural level, such that the strength of the attractive bias is modulated by the amount of structural coherence in stimuli. We presented visual patterns of varied structural disorder (randomness) prior to a recognition memory decision that required discriminating between trained and novel visual patterns. Both highly generic geometrical shapes and completely random patterns failed to elicit an effect on decisional response times. By contrast, we found recognition memory decisions to be significantly faster in trials where the irrelevant probe pattern was 'optimally' random. This result suggests that decision-making is influenced by the past's informational worth. More importantly, it suggests an optimal amount of uncertainty to facilitate future decisions.

Transcriptional evidence of HPA axis dysregulation in adolescent females: Unique contributions of chronic early-life stressor exposure and maternal depression history

BackgroundDepression risk increases dramatically for adolescent females following the pubertal transition. Although chronic early-life stressor exposure and a maternal history of depression are established risk factors for depression onset in this population, we know little about the biological mechanisms underlying these associations. MethodTo investigate, we examined how chronic early-life stressor exposure and maternal depression history were associated with stress-related gene expression patterns, using a high-risk family design in 48 psychiatrically healthy adolescent females, 20 of whom had a mother with a lifetime history of depression. Lifetime chronic stressor exposure was assessed using the STRAIN and gene expression patterns were estimated using transcriptional profiling of whole blood. ResultsConsistent with hypotheses, we found that adolescent females with greater chronic stressor exposure had higher NR3C1 expression levels compared to those with less chronic stressor exposure. Additionally, youth with a depressed mother had lower levels of FKBP5 expression compared to those without a depressed mother. Levels of FKBP5 expression, in turn, interacted with chronic stressor exposure to predict NR3C1 expression. Specifically, for those with low chronic stressor exposure, levels of FKBP5 and NR3C1 expression were strongly interrelated, whereas for those with high chronic stressor exposure, NR3C1 expression was high regardless of levels of FKBP5 expression. LimitationsThis study was correlational, the sample size was limited, and additional research is needed to elucidate the underlying mechanisms and predict who subsequently develops depression. ConclusionsNotwithstanding these limitations, these data indicate that having low FKBP5 expression, alongside high NR3C1 expression, may be a potential preclinical marker of depression risk in adolescent females that warrants additional investigation.

ISTA Award 2023: Toward functional reconstruction of the pre-diseased state in total knee arthroplasty.

The surgical target for optimal implant positioning in robotic-assisted total knee arthroplasty remains the subject of ongoing discussion. One of the proposed targets is to recreate the knee's functional behaviour as per its pre-diseased state. The aim of this study was to optimize implant positioning, starting from mechanical alignment (MA), toward restoring the pre-diseased status, including ligament strain and kinematic patterns, in a patient population. We used an active appearance model-based approach to segment the preoperative CT of 21 osteoarthritic patients, which identified the osteophyte-free surfaces and estimated cartilage from the segmented bones; these geometries were used to construct patient-specific musculoskeletal models of the pre-diseased knee. Subsequently, implantations were simulated using the MA method, and a previously developed optimization technique was employed to find the optimal implant position that minimized the root mean square deviation between pre-diseased and postoperative ligament strains and kinematics. There were evident biomechanical differences between the simulated patient models, but also trends that appeared reproducible at the population level. Optimizing the implant position significantly reduced the maximum observed strain root mean square deviations within the cohort from 36.5% to below 5.3% for all but the anterolateral ligament; and concomitantly reduced the kinematic deviations from 3.8 mm (SD 1.7) and 4.7° (SD 1.9°) with MA to 2.7 mm (SD 1.4) and 3.7° (SD 1.9°) relative to the pre-diseased state. To achieve this, the femoral component consistently required translational adjustments in the anterior, lateral, and proximal directions, while the tibial component required a more posterior slope and varus rotation in most cases. These findings confirm that MA-induced biomechanical alterations relative to the pre-diseased state can be reduced by optimizing the implant position, and may have implications to further advance pre-planning in robotic-assisted surgery in order to restore pre-diseased knee function.

Overlapping Strain Patterns in Patients With Cardiac Amyloidosis and End‐Stage Renal Disease

Overlapping Strain Patterns in Patients With Cardiac Amyloidosis and End‐Stage Renal Disease

A Customized Distribution of the Coefficient of Friction of the Porous Coating in the Short Femoral Stem Reduces Stress Shielding

Stress shielding and aseptic loosening have been identified as adverse effects of short-stem total hip arthroplasty resulting in hardware failure. However, there is a gap in research regarding the impact of stress shielding in customized porous coatings. The purpose of this study was to optimize the distribution of the coefficients of friction in the porous coating of a metaphyseal femoral stem to minimize stress shielding. Static structural analysis of an implanted short, tapered-wedge stem with a titanium porous coating was performed with the use of Analysis System Mechanical Software under axial loading. To limit computational time, we randomly sampled only 500 of the possible combinations of coefficients of friction. Results indicate that the coefficient of friction in the distal lateral porous coating significantly affected the mid-distal medial femoral surface and lateral femoral surface. The resultant increased proximal strains resulted from an increased coefficient of friction in lateral porous coating and a reduction in the coefficient of friction in medial mid-distal coating. These findings suggest that a customized porous coating distribution may produce strain patterns that are biomechanically closer to intact bone, thereby reducing stress shielding in short femoral stems.

FBG and BOTDA Based Monitoring of Mine Pressure Under Remaining Coal Pillars Using Physical Modeling.

Strong mine pressure often emerges when the working face of the lower coal seam in a closely spaced coal seam system passes through the remaining coal pillar in the overlying goaf. This study investigates the law of overburden movement and the manifestation of mine pressure during mining under the remaining coal pillar. A physical model measuring 2.5 × 0.2 × 1.503 m is constructed. Fiber Bragg grating sensing technology (FBG) and Brillouin optical time domain analysis technology (BOTDA) are employed in the physical model experiment to monitor the internal strain of the overlying rock as the working face advances. This study determines the laws of overlying rock fracture and working face pressure while mining coal seams beneath the remaining coal pillar. It analyzes the relationship between the pressure at the working face and the strain characteristics of the horizontally distributed optical fiber. A fiber grating characterization method is established for the stress evolution law of overlying rock while passing the remaining coal pillar. The experimental results indicated that the fracture angle of overlying rock gradually decreases during the mining stage through and after the coal pillar. In the mining stage through the coal pillar, the cycle pressure step distance of the working face is reduced by 33.3% compared to the stage after mining through the coal pillar. Initially, the strain pattern of the horizontal optical fiber is unimodal when pressure is first applied to the working face, and it transitions from unimodal to bimodal during periodic pressure. The peak value of fiber Bragg grating compressive strain and the range of influence of advanced support pressure are 3.6 times and 4.8 times, respectively, before passing through the remaining coal pillar. Finally, the accuracy of the FBG characterization method is verified by comparing it to the monitoring curve of the coal seam floor pressure sensor. The research results contribute to applying fiber optic sensing technology in mining physical model experiments.

Left fascicular pacing is not inferior to left bundle branch pacing in preserving ventricular mechanical synchrony and cardiac function

Abstract Background Left bundle branch pacing (LBBP) has emerged as a more physiological alternative to right ventricular pacing.However, capturing the pre-divisional LBB is not easy to accomplish. This study investigates if left fascicular pacing(LFP), defined as the capture of one of the LBB fascicles, could achieve comparable left ventricular (LV) mechanical synchronicity and cardiac function compared to LBBP. Methods Thirty-one patients with pacing indication for bradycardia were retrospectively collected: LBBP was successfully performed in 13 patients and 18 achieved LFP. All patients underwent echocardiography before and after implantation and at one-year follow-up. Left ventricular (LV) volumes, ejection fraction (EF) and global longitudinal strain (GLS) were measured. The lateral-septal (LW-SW) work difference was used as a measure of mechanical dyssynchrony. Septal flash, apical rocking and septal strain patterns were also assessed. Results Although LW-SW work difference were significantly higher in the LBBP groups than that in the LFP group at baseline(272±269 mmHg*% vs 25±279mmHg*%,p=0.02), a similar increase in LW-SW work difference was observed during follow-up(199±342 mmHg*% vs 371±384mmHg*%,p=0.21). In addition, both LFP and LBBP induced septal flash or apical rocking in some patients, and resulted in subtle changes in strain patterns, which were not significantly different between groups. At one year follow-up, LV ejection fraction (EF) remained almost unchanged in both LBBP and LFP patients(ΔLVEF: 1.1+3.1% vs -0.3±4.8%,p=0.35) , and global longitudinal strain (GLS) was slightly and equally decreased in LFP compared to LBBP (ΔLVGLS: -1.6±2.3% vs -1.2±2.7%,p=0.69). Conclusion LFP and LBBP did not differ in mechanical dyssynchrony or LV remodelling.

Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in patients with severe aortic stenosis

Abstract Introduction There is a lack of data regarding the performance of current electrocardiographic (EKG) criteria for left ventricular hypertrophy (LVH) in patients with severe aortic stenosis (AS). Purpose To test the performance of the current EKG scores to diagnosis LVH in AS patients, and also to compare the performance of a new proposed score. Methods The present study evaluated 80 patients with severe AS that underwent cardiac magnetic resonance to diagnose LVH, defined as left ventricular indexed mass of 95 g/m² for female and 115 g/m² for male patients. The EKG criteria used for left ventricular hypertrophy were Sokolow-Lyon criteria, Romhilt-Estes point score system, Cornell voltage criteria and Peguero-Lo Presti criteria. Results Among the 80 patients included in analysis, 58.7% were male and the mean age was 64±8 years. There was a high prevalence of comorbidities, highlighting diabetes (32.5%), hypertension (67.5%), atrial fibrillation (5.0%) and coronary artery disease (11.3%). Regarding echocardiogram, the median left ventricle ejection fraction was 64 (56-68)% and the median indexed aortic valve area was 0.43 (0.35-0.49) cm²/m². Cardiac magnetic resonance analysis demonstrated a mean left ventricle mass of 168±55g, and the LVH incidence was 26.3%. Regarding EKG, Strain pattern was found in 49.1% of the patients, Cornell voltage criteria was positive in 51.3%, Sokolow-Lyon criteria in 51.3%, Romhilt-Estes point score system in 42.5% and Peguero-Lo Presti criteria in 61.3%. Discriminative capacity of electrocardiographic criteria for LVH is shown in Figure 1. Peguero-Lo Presti score had the best diagnostic accuracy in the overall population and in male sex (AUC 0.776), while Cornell voltage criteria had the best diagnostic accuracy in female patients (AUC 0.776). Based on linear regression model, the proposed score was created to predict LVH at cardiac magnetic resonance: 48 + (1.3 x Deepest S wave) + (0.5 x S wave in V1 or V2 plus R wave in V5). The proposed score cutoff value of 90.5 mm had a sensitivity of 0.765 and specificity of 0.707 (for male sex: 0.769 and 0.655, respectively; for female sex: 0.750 and 0.759, respectively). Compared to the scores described in the literature, the proposed score had the best area AUC for the overall population (Figure 1), for female and male patients (AUC 0.796, 0.819 and 0.780, respectively). Conclusion In patients with severe AS, the proposed score had the best diagnostic accuracy compared to the scores described in the literature for LVH identification, followed by Peguero-Lo Presti score, even when analyzed based on gender. Besides, the proposed score had also acceptable sensitivity and specificity for LVH detection.AUC of electrocardiographic scores.

Interplay between strain pattern-based classification of dyssynchrony and myocardial scar in CRT patients

Abstract Introduction Echocardiography-derived septal strain patterns are valuable for predicting volumetric reverse remodelling and survival in patients undergoing cardiac resynchronization therapy (CRT). Nevertheless, presence of myocardial scarring in the left ventricle (LV) is known to attenuate CRT treatment response. Purpose This study aims to investigate the interplay between septal strain patterns and myocardial scarring in CRT candidates, and how they link to outcome after CRT. Methods In this prospective multicentre study, CRT candidates from five European institutions underwent pre-implantation assessments using speckle-tracking strain analysis on echocardiography and cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE). Dyssynchrony was graded through analysis of septal strain curves, categorizing patients into five distinct patterns, denoted as strain Stage-0 through strain Stage-4 (Fig. A). LGE of the LV wall was quantitatively assessed using CMR (as a percentage). The study endpoints were volumetric reverse remodelling (volume responder = more than 15% decrease LV end-systolic volume) after one year, and all-time all-cause mortality. Results A total of 267 patients, with a mean age of 66±11 years (69% males, 90% left bundle branch block [LBBB]) presented with an average LV ejection fraction (EF) of 30±7%. With each stepwise increase in strain stage, global LV scarring decreased (p&amp;lt;0.01; Fig. B) and the proportion of volume responders increased (all p&amp;lt;0.0001; Fig. C). ROC curves demonstrated that the predictive power of strain stages for CRT volumetric response was not significantly improved when scarring percentage was added (AUC 0.78 [95% CI: 0.69-0.83] vs. 0.81 [95% CI: 0.71-0.90]; p&amp;gt;0.05; Fig. D). In a multivariate cox regression model – including clinical characteristics that were significantly related to survival in univariate analysis – a patients’ strain stage was the only significant predictor of survival, also outperforming scar burden as determinant of outcome (HR 0.68; p=0.041; Fig. E). Conclusions Septal strain patterns show a strong association with the extent of reverse remodelling and outcome in CRT-treated patients. An inverse relationship is observed between pre-implant strain stages and the extent of myocardial scarring. However, scar burden did not provide incremental predictive value over the strain stages. Strain-pattern-based dyssynchrony assessment is a meaningful predictive marker which integrates information on myocardial dysfunction due to dyssynchrony as well as scar burden.

Cardiac amyloidosis Echo-Score for patients with severe aortic stenosis. The AMY-TAVI trial

Abstract Background and Purpose A longitudinal strain pattern characterized by apical sparing (RELAPS&amp;gt;1) has been identified as indicative of cardiac amyloidosis (CA). We conducted an analysis to assess its diagnostic accuracy in individuals with severe aortic stenosis (AS) and explored novel echocardiographic variables for predictive value. Methods All patients diagnosed with AS who underwent transcatheter aortic valve implantation (TAVI) were prospectively enrolled. 2D-Speckle-tracking echocardiography was utilized to assess myocardial deformation parameters. Subsequent to TAVI, screening for CA was conducted through 99mTc-DPD scintigraphy and protein electrophoresis. Results A total of 324 patients were included (mean age 81.5 ± 5.8 years, 51% women). Among them, 38 individuals (11.7%) exhibited cardiac uptake in scintigraphy: 14 patients (4.3%) with grade 1, 13(4%) grade 2, and 11(3.4%) grade 3. RELAPS&amp;gt;1 was more prevalent in patients with AS-CA (74%vs.44%,p=0.006). We propose an echocardiographic prediction model (GRAM score) for CA in the context of AS that is more sensitive and specific than RELAPS &amp;gt;1 alone. This model incorporates the left ventricular mass index, maximum transvalvular aortic pressure gradient, RELAPS&amp;gt;1, and age (AUC: 0.85, 95% CI: 0.77–0.93). Conclusions While RELAPS &amp;gt;1 is more commonly observed in individuals with AS-CA, it is noteworthy that this pattern can also manifest in nearly half of AS patients without CA, diminishing its utility as a standalone screening tool. In light of this, our study puts forth a more sensitive and specific prediction score for identifying CA in patients with severe AS.GRAM score for predicting AS-CA

Strain and Deformation Analysis Using 3D Geological Finite Element Modeling with Comparison to Extensometer and Tiltmeter Observations

This study verifies the practicality of using finite element analysis for strain and deformation analysis in regions with sparse GNSS stations. A digital 3D terrain model is constructed using DEM data, and regional rock mass properties are integrated to simulate geological structures, resulting in the development of a 3D geological finite element model (FEM) using the ANSYS Workbench module. Gravity load and thermal constraints are applied to derive directional strain and deformation solutions, and the model results are compared to actual strain and tilt measurements from the Jiujiang Seismic Station (JSS). The results show that temperature variations significantly affect strain and deformation, particularly due to the elevation difference between the mountain base and summit. Higher temperatures increase thermal strain, causing tensile effects, while lower temperatures reduce thermal strain, leading to compressive effects. Strain and deformation patterns are strongly influenced by geological structures, gravity, and topography, with valleys experiencing tensile strain and ridges undergoing compression. The deformation trend indicates a southwestward movement across the study area. A comparison of FEM results with ten years of strain and tiltmeter data from JSS reveals a strong correlation between the model predictions and actual measurements, with correlation coefficients of 0.6 and 0.75 for strain in the NS and EW directions, and 0.8 and 0.9 for deformation in the NS and EW directions, respectively. These findings confirm that the 3D geological FEM is applicable for regional strain and deformation analysis, providing a feasible alternative in areas with limited GNSS monitoring. This method provides valuable insights into crustal deformation in regions with sparse strain and deformation measurement data.