Dilated Cardiomyopathy: Phosphorus 31 MR Spectroscopy at 7 T

Purpose: To test whether the increased signal-to-noise ratio of phosphorus 31 (31P) magnetic resonance (MR) spectroscopy at 7 T improves precision in cardiac metabolite quantification in patients with dilated cardiomyopathy (DCM) compared with that at 3 T. Materials and Methods: Ethical approval was obtained, and participants provided written informe consent. In a prospective study, 31P MR spectroscopy was performed at 3 T and 7 T in 25 patients with DCM. Ten healthy matched control subjects underwent 31P MR spectroscopy at 7 T. Paired Student t tests were performed to compare results between the 3-T and 7-T studies. Results: The phosphocreatine (PCr) signal-to-noise ratio increased 2.5 times at 7 T compared with that at 3 T. The PCr to adenosine triphosphate (ATP) concentration ratio (PCr/ATP) was similar at both field strengths (mean ± standard deviation, 1.48 ± 0.44 at 3 T vs 1.54 ± 0.39 at 7 T, P = .49), as expected. The Cramér-Rao lower bounds in PCr concentration (a measure of uncertainty in the measured ratio) were 45% lower at 7 T than at 3 T, reflecting the higher quality of 7-T 31P spectra. Patients with dilated cardioyopathy had a significantly lower PCr/ATP than did healthy control subjects at 7 T (1.54 ± 0.39 vs 1.95 ± 0.25, P = .005), which is consistent with previous findings. Conclusion: 7-T cardiac 31P MR spectroscopy is feasible in patients with DCM and gives higher signal-to-noise ratios and more precise quantification of the PCr/ATP than that at 3 T. PCr/ATP was significantly lower in patients with DCM than in control subjects at 7 T, which is consistent with previous findings at lower field strengths

Additional file 2: of Pathway to mental health recovery: a qualitative and quantitative study on the needs of Chinese psychiatric inpatients

Survey Questionnaire on Information and Participation needs. This survey questionnaire was developed basing on the item pool obtained on information provision and patient’s participation in the focus group discussion and was the assessment tool adopted in the second part of the study. (DOCX 19 kb

"Lone" Atrial Fibrillation Is Associated With Impaired Left Ventricular Energetics That Persist Despite Successful Catheter Ablation.

BACKGROUND: -"Lone" atrial fibrillation (AF) may reflect a subclinical cardiomyopathy that persists after sinus rhythm (SR) restoration, providing a substrate for AF recurrence. To test this hypothesis, we investigated the effect of restoring SR by catheter ablation on left ventricular (LV) function and energetics in patients with AF but no significant comorbidities. METHODS: -Fifty-three patients with symptomatic paroxysmal or persistent AF and without significant valvular disease, uncontrolled hypertension, coronary artery disease, uncontrolled thyroid disease, systemic inflammatory disease, or diabetes (i.e. "lone" AF) undergoing ablation and 25 matched controls in SR were investigated. Magnetic resonance imaging quantified LV ejection fraction (LVEF), peak systolic circumferential strain (PSCS), and left atrial volumes and function, while Phosphorus-31 MR spectroscopy evaluated ventricular energetics (ratio of phosphocreatine-to-adenosine triphosphate [PCr/ATP]). AF burden was determined pre- and post-ablation by 7-day Holter monitoring; intermittent ECG event monitoring was also undertaken after ablation to investigate for asymptomatic AF recurrence. RESULTS: -Before ablation, LV function and energetics were both significantly impaired in patients compared to controls (respectively: LVEF 61% [IQR 52-65%] versus 71% [IQR 69-73%], p<0.001; PSCS -15% [IQR -11 to -18%] versus -18% [-17 to -19%], p=0.002; PCr/ATP 1.81±0.35 versus 2.05±0.29, p=0.004). As expected, patients also had dilated and impaired left atria compared to controls (all p<0.001). Early after ablation (1 to 4 days), LVEF and PSCS improved in patients recovering SR from AF (respectively: LVEF +7.0±10%, p=0.005; PSCS -3.5±4.3%, p=0.001) but were unchanged in those in SR during both assessments (both p=ns). At 6-9 months post-ablation, AF burden reduced significantly (from 54% [IQR 1.5%-100%] to 0% [IQR 0%-0.1%], p<0.001). However, LVEF and PSCS did not improve further (both p=ns) and remained lower than in controls (p<0.001 and p=0.003, respectively). Similarly, there was no significant improvement in atrial function from pre-ablation (p=ns), and this also remained lower than in controls (p<0.001). PCr/ATP was unaffected by heart rhythm during assessment and AF burden before ablation (both p=ns). It was unchanged post-ablation (p=0.57), remaining lower than in controls irrespective of both recovery of SR and freedom from recurrent AF (p=0.006 and p=0.002, respectively). CONCLUSIONS: -"Lone" AF patients have impaired myocardial energetics and subtle LV dysfunction, which do not normalise after ablation. These findings suggest that AF may be the consequence (rather than the cause) of an occult cardiomyopathy, which persists despite a significant reduction in AF burden following ablation

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Background: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016