Status Of PV Research Articles

Adding 3D electroanatomical mapping to cryoballoon pulmonary vein isolation improves pulmonary vein isolation durability at repeat ablation procedure

Abstract Objectives The addition of pre- and post-ablation electroanatomical mapping with the Achieve catheter and EnSite mapping system has shown to improve acute pulmonary vein isolation (PVI) rate of cryoballoon ablation (CBA). Recently, our group also demonstrated an improvement in 1-year outcome. Current study aimed to investigate the impact on PVI durability as seen during repeat ablation procedure. Methods 400 patients were compared in a propensity-matched analysis between CT- and Achieve catheter guided CBA (Control group; N=200) and Achieve catheter guided CBA with additional EnSite voltage maps performed pre- and post-CBA (Mapping group; N=200). Matching parameters were age, AF type and CHADS-VASc score. In patients undergoing repeat procedure, PV status was evaluated using CARTO mapping system. Results Baseline characteristics did not differ between both groups (Persistent AF: 47,5% vs. 46,5%, P=0,841; diagnosis-to-ablation time: 28,1±15,1 vs. 33,2±41,7months, P=0,107). The mapping group had a shorter follow-up time (25,6±7,2 vs. 50,3±3,3months, P<0,001). Repeat ablation was performed in 20 patients in the mapping group and 70 patients in the control group. At repeat, the proportion of patients with persistent complete PVI was higher in the mapping group (14/20(70.0%) vs 23/70(32,9%), P=0,030). Interestingly, less reconnections of the right inferior PV were seen in the mapping group (10,0% vs. 34,3%, P=0,035). There was no difference in reconnection rate of other PVs. Conclusions The addition of electro-anatomical EnSite mapping to the Achieve catheter improves PVI durability as seen during repeat ablation, mainly at the level of the right inferior PV. This finding might explain the improvement in 1-year outcome of this approach.

AB-452663-4 LEFT ATRIAL POSTERIOR WALL ABLATION USING PULSED FIELD ABLATION AS ADJUNCTIVE THERAPY DURING RE-DO PROCEDURES AFTER MULTIPLE FAILED PULMONARY VEIN ISOLATIONS USING THERMAL ENERGY

Pulmonary vein isolation (PVI) is the cornerstone for patients with atrial fibrillation (AF). Long-term efficacy is limited because of high PV reconnection rates. Ablation targets and strategies beyond PVI in re-do left atrial (LA) procedures have failed to improve outcome. Pulsed field ablation (PFA) has recently been introduced as a novel ablation technology. We report the first experience of re-do PVI with adjunctive LA posterior wall ablation (LAPWA) in patients with multiple failed LA procedures using thermal energy (RF /cryo). After high-density bipolar 3D voltage maps using a pentaspline diagnostic catheter, ablation was performed in conscious sedation using a steerable sheath and a pentaspline over-the-wire basket and flower PFA catheter. After re-do PVI (irrespective of PV status), the pentaspline catheter was visualized in the 3D mapping system. The posterior wall was ablated using the PFA catheter in the flower configuration (Figure). Projected catheter images overlapped approx. 30% between sites across the posterior wall. Per ablation site, 4 applications were administered. Post ablation, 3D voltage maps confirmed complete PVI and LAPWA. Bidirectional PVI was also documented using pacing. Procedural parameters, acute success, in-hospital safety and arrhythmia recurrence were assessed. Between Sept. 2021 and Nov. 2022, 17 patients were enrolled. Mean age was 68±8 years. Time since first AF diagnosis was 72±46 months. Mean number of previous LA procedures was 3±1. Acute PVI and LAPWA were 100% successful. Median procedural time was 160±62 min (including 47±10 min for pre and post mapping). LA dwell time of the PFA catheter was 46±19 min. Fluoroscopy time and dose area product were 24±09 min and 13±13 Gy.cm2. All patients tolerated this approach without procedural interruption. There were no acute or chronic complications. After a follow-up of 163±105 days, 12/17 (71%) patients were free of documented AF, atrial flutter or tachycardia. In patients with multiple failed LA ablations for AF, re-do PVI (irrespective of PV status) and LAPWA using PFA seems to be a safe and feasible approach with promising short-term results. Larger studies are needed to investigate long-term efficacy and safety in this patient group with otherwise very limited therapeutic options.

Current status of PV in China and its future forecast

Current status and the progress of PV in China are introduced with detailed data, covering PV manufacturing, market development, cost reduction and technology innovation. Fast growing of PV industry in China is due to series of incentive policies provided by the Chinese government, which are provided in this paper as well. To slow down the speed of PV development, the 5.31 new policy is issued on May 31, 2018 by the Chinese government as a milestone. The affections of the new policy and future PV market are analyzed. The target of energy transition of China and the role of PV are provided. PV will have more broad space in development when it comes to grid parity in the future.

Current status of solar PV and the possibility of agrivoltaic in dry areas

Current status of solar PV and the possibility of agrivoltaic in dry areas

P1652Limited correlation of calculated plasma volume status with invasive right heart pressures in patients with heart failure

Abstract Background Estimated plasma volume (ePV) can be calculated from haematocrit and body weight, and has been shown to correlate with PV measured using 125Iodine labelled human serum albumin. Comparing a patient's ePV to ideal PV (iPV), an estimate of a patient's relative congestion, called PV status (PVS), is possible. Higher PVS is associated with increased mortality in patients with heart failure (HF), and has been proposed as a simple, cheap, and non-invasive way of assessing congestion. Purpose Whether PVS is associated with invasively measured markers of congestion is unknown. We calculated PVS in patients with HF who had right heart catheterisation (RHC), and assessed any correlation between PVS and invasive measures of congestion. Methods We calculated PVS in consecutive patients who had RHC performed as part of transplant assessment. iPV was calculated as: iPV = c × weight (kg) where c=39 in males and c=40 in females. ePV was calculated using subjects' haematocrit and weight as follows: ePV = (1 − haematocrit) × [a + (b × weight in kg)], where haematocrit is a fraction, a=1530 in males and a=864 in females, and b=41 in males and b=47.9 in females. PVS was calculated as: PVS = PVS = (ePV − iPV) /iPV × 100%. Correlation between PVS and invasive wedge pressure, mean right atrial (RA) pressure, and NTproBNP were made using Pearson correlation. Results PV indices and RHC data were available for 61 patients, 43 (71%) were male. Median age was 55 [IQR 48, 58] years. 20 (33%), 24 (39%), and 15 (25%) were NYHA association class II, III, and IV respectively. The median NTproBNP was 1390 [IQR 512, 3612] pg/ml and median ejection fraction was 29 [IQR 20, 35] %. The median PVS was −5.9% (IQR −12.5, −1.6]. Median wedge and mean-RA pressures were 14 [7, 21] and 4 [1, 8] mmHg, respectively. Correlation between mean RA pressure and PVS is shown in the figure. There was no correlation between PVS and mean RA pressure (r=0.12, p=0.34) or wedge pressure (r=0.01, p=0.92). There was a weak correlation between NTproBNP and PVS (r=0.31, p=0.01) Correlation mean RA pressure and PVS Conclusion PVS did not correlate with the invasive measures of congestion, mean RA and wedge pressure, but was weakly correlated with NTproBNP. Although there were limited number of patients in this study, we question the conclusion that PVS is a marker of congestion, and whether it can be used clinically for this purpose.

P786Plasma volume status is associated with the change in nutritional status during hospitalization in acute decompensated heart failure patients with preserved left ventricular ejection fraction

Abstract Introduction Plasma volume (PV) expansion has an essential role in heart failure (HF). PV can be estimated by a simple formula using hematocrit and body weight, and PV status (PVS) provides prognostic information in patients (pts) with chronic HF. Nutritional status (NS) based on the prognostic nutritional index (PNI) and NS change during hospitalization have been shown to predict prognosis in pts admitted with acute decompensated HF (ADHF). Purpose We sought to assess the hypothesis that PVS is associated with NS change during hospitalization in pts with HF with preserved LVEF (HFpEF) who are admitted with ADHF. Methods We prospectively studied 411 pts who were admitted for ADHF with LVEF ≥50% and survived to discharge. Body weight measurement and venous blood sampling were performed on admission and at discharge. PVS was defined as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The pts were divided into 3 groups by PNI: normal (>38), moderate malnutrition (35–38), and severe malnutrition (<35). During admission, pts who remained in the moderate or severe malnutrition group or whose NS worsened were defined as no improvement in NS. Follow-up data was obtained in 203 cases. They were followed for up to 18 months, and the incidence of all-cause death was evaluated. Results On admission, PVS in the moderate (n=71, 13.3±13.9%) or severe malnutrition group (n=69, 14.8±10.8%) was significantly higher than in the normal PNI group (n=271, 5.4±10.8%, p<0.001). During hospitalization, 123 pts had no NS improvement. Admission PVS was significantly higher in pts with no NS improvement than in pts with improved NS (13.9±11.2% vs 5.9±12.8%, p<0.0001). In multivariate logistic regression analysis, admission PVS was independently associated with no NS improvement during hospitalization (OR 1.06, 95% CI 1.03–1.08, p<0.0001). Receiver operating characteristics curve analysis revealed that the optimal cut-off value of admission PVS for predicting no NS improvement was 9.4% (sensitivity: 72%, specificity: 63%). The area under the curve for predicting no NS improvement using admission PVS was significantly greater than for other independent factors (Figure 1A). During the follow-up period (median 12.4 months), 68 of 203 patients had all-cause death. Kaplan-Meier analysis showed that the patients with no NS improvement had a significantly higher risk of all-cause death (Figure 1B). Figure 1 Conclusions In this multicenter study, admission PVS was shown to be associated with poor improvement in NS during hospitalization in HFpEF pts admitted for ADHF. Acknowledgement/Funding Roche diagnostics, FUJIFILM Toyama Chemical

P795Long-term prognostic value of the combination of plasma volume status and pulmonary-systemic pressure ratio in patients admitted with acute decompensated heart failure

Abstract Background Plasma volume (PV) expansion plays an essential role in heart failure and PV status provides prognostic information in patients (pts) with acute decompensated heart failure (ADHF). On the other hand, concomitant presence of pulmonary hypertension in heart failure is associated with increased adverse events and may be related to interventricular uncoupling and impaired cardiac efficiency. It has recently been shown that an increased mean pulmonary artery pressure to mean systemic arterial pressure ratio (MPS ratio), a marker of interventricular coupling and efficiency, is associated with worse clinical outcomes in patients with advanced heart failure. However, there is no information available on the long-term prognostic value of the combination of PV status and MPS ratio in pts admitted for ADHF. Methods We studied 248 pts admitted for ADHF, who underwent right heart catheterization at the admission and were discharged with survival. PV status and MPS ratio were obtained at the admission. PV status was calculated as the following: Actual PV = (1 − hematocrit) x [a + (b x body weight)] (a=1530 in males and a=864 in females, b=41 in males and b=47.9 in females), Ideal PV = c x body weight (c=39 in males and c=40 in females), and PV status = [(actual PV − ideal PV)/ideal PV] x 100(%). The study endpoint was cardiovascular death (CVD). Results During a mean follow-up period of 5.2±4.4 yrs, 62 pts had CVD. PV status (10.0±16.2 vs 5.0±15.3%, p=0.03) and MPS ratio (0.408±0.114 vs 0.347±0.102, p=0.0001) were significantly greater in patients with than without CVD. At multivariate Cox regression analysis, PV status and MPS ratio were significantly associated with CVD, independently of prior heart failure hospitalization, eGFR, and serum sodium level and anemia. Patients with greater PV status (> median value = 4.6%) and MPS ratio (> median value = 0.346) had a significantly higher CVD risk than those with either and none of them (44% vs 22% vs 14%, p<0.0001, respectively). Conclusions The combination of PV status and MPS ratio might be useful for stratifying patients at risk for CVD in patients with ADHF.

Solar Photovoltaic Grid Parity: A Review of Issues, Challenges and Status of Different PV Markets

This paper presents a review on the solar PV grid parity in the global market by analyzing all the factors having an influence on the grid parity, methodology so far adapted to investigate the grid parity and the status of PV markets of different countries. The analysis indicates that solar resources, evolution in PV module cost, progression in electricity prices, environmental cost and grid extension cost are the major factors that affect the grid parity and these factors vary time to time and market to market. Cost reduction of PV modules in global markets has followed the Swanson prediction enabling it to compete for the conventional electricity market. Germany had been leading the PV market but owing to the change in policy and decrease in incentives, its annual PV installation has been decreased since 2013. China introduced incentives based renewable policy that abruptly increased the PV installations in 2011 and now China is leading the solar PV market. Study of different PV markets revealed that PV grid parity dynamically occurs in various segments of power sectors like residential, industrial and commercial sectors at different times. This paper will be supportive for the investors to understand PV market and its constraints, for the solar policymakers to comprehend various policy incentives that would help the solar PV penetration into the current electricity market.

The Path to Perovskite on Silicon PV

Henry J. Snaith is Professor of Physics in the Clarendon Laboratory at the University of Oxford and Fellow of the Royal Society. He has pioneered the field of perovskite solar cells and published more than 300 papers. He is the founder and Chief Scientist Officer of Oxford Photovoltaics, which holds the largest perovskite patent portfolio worldwide and focuses on developing and commercialising perovskite PV technology. In this interview, he discusses the present status and future prospects of perovskite PV. The interview is available at https://youtu.be/sbe9Z5oEs5o.

A Study of Wordhood in Complex Predicates

This paper is based on the two aspects of PV V compositions: the language's status as lexical compositions and the lexical units which often function as morphologically complex predicates but consist of syntactically independent words. With Ackerman (1997, 2003), PVs in Serbo-Croation(Algonquian) and Hungarian(Ugric), which parallel many of the phenomena cited by Craig and Hale(1988), are syntactically independent words. PV V compositions in the languages are lexical units and are sometimes complex morphological units. So, Conditions on (in)separability are morphological and independent of the lexical status of PV V compositions and the PVs are neither clitics nor bound morphemes.

PV status: Research, Solar cell Production and Market Implementation of Photovoltaics

Already a multibillion dollar market, solar PV looks set to play a continuing role in the world energy mix of the future, but there is clearly significant further potential for the uptake of the technology. Arnulf Jaeger Waldau from the European Commission reports on recent findings from a study assessing the global status of Solar PV.

Is coronary thermodilution as accurate as doppler velocity for measuring coronary flow reserve?

Background: Thermodilution coronary flow reserve (CFRthermo) IS a new technique for measuring coronary flow reserve (CFR) using a coronary pressure wire and based on the ability of the pressure transducer to also measure temperature changes. CFRthermois defined as the mean transit time of room temperature saline injected down the LAD at rest divided by the mean transit time at maximal hyperemla. Methods: In an open-chest pig model, CFRthermoin the left anterior descending (LAD) artery was measured and compared to flow reserve from a Doppler wire (CFR doppler), and an external flow probe placed around the LAD (CFRfkxv). In 6 pigs, CFR was measured by all 3 means in the normal LAD and after creation of an epicardial LAD stenosis. In order to determine the added effect of microvascular disease, measurements of flow reserve were also performed after disruption of the coronary microcirculation using embolized microspheres. lntracoronary papaverine (20 mg) was used to induce hyperemia. Methodr and Results: Twenty-three patients (age 52 * 8 years) were studied. A total of 129 PVs were assessed with AcuNav (Acuson) and 80 PVs with 9MHz (Boston Sci) ICE. After RF ablation, peak Doppler velocity at PV ostium increased from 52 * 17 to 74 t 24 cm/s and gradient increased from 1.2 * 0.7 to 2.4 c 1.4’ mmHg, *p < 0.01. Ablation also resulted I” an acute decrease in PV cross-sectional area (CSA) from 3.1 f 1.8 to 1.9 * 1 .I’ err?, increase in wall thickness from 0.7 f 0.2 to 1.6 f 0.7’ mm and loss of its normal motility throughout the cardiac cycle: %change decreased from 27 * 14% to 20 * 8%’ (Fig), ‘p < 0.01. Unablated PVs remained unchanged. Conclusion: RF ablation resulted in acute increases in PV flow velocity and wall thickness and decreases in CSA and motility, although no significant pulmonary stenosis was ’ observed. ICE provides.useful information about PV status in RF catheter ablation.