Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus

Purpose: To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). Methods and Materials: 147 diabetic (mean age: 65 ± 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 ± 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. Results: Diabetics showed a higher number of diseased segments (4.1 ± 4.2 vs. 2.1 ± 3.0; p 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS ≤ 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS ≤ 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. Conclusions: Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics

Recurrent syncope on effort due to concealed constrictive pericarditis.

A 69-year-old male patient was admitted for two syncopal episodes on effort associated with dyspnoea and jugular constrain. Clinically, he was found to have mild bilateral pleural effusion, jugular vein distension, and marked peripheral oedema. Echocardiographic examination showed a leftward interventricular septum during peak inspiration owing to the increasing right ventricle pressure (Figure 1A) and a dilation (27 mm) and absent collapse of the inferior vena cava and hepatic veins (Figure 1B). Ventriculography does not reveal calcifications of the pericardium (Figure 1C). At the invasive haemodynamic evaluation, simultaneous right and left catheterization showed the square root sign of LV diastolic pressure trackings and equalization of LV and RV diastolic plateau pressure tracking. Magnetic resonance images (coronal T1-weighted FSE sequence image; Harmony, Siemens, Erlangen, Germany) showed the thickened pericardium (>5 mm) with irregular margins (white arrows) (Figure 1D). After administration of contrast media, the late acquisitions revealed diffuse and homogeneous hyperintense pericardium (white arrows) (Figure 1E and F; a, left ventricle; b, right ventricle). An endomyocardial biopsy was performed and excluded associated restrictive myocardial diseases. A diagnosis of constrictive pericarditis was put forward and the patient underwent pericardiectomy. Surgical pathology examination of the resected pericardium revealed, at gross examination, a diffuse severe fibrous thickening (Figure 2A). At histology, multiple foci of chronic inflammation (lymphocytes and plasma cells) are detected associated only with mild calcification (Figure 2B, haematoxylin\u2013eosin 740; and Figure 2C, B-lymphocytes CD20; Figure 2D, T-lymphocytes CD3; Figure 2E, macrophages CD68; Figure 2F, plasma cells CD79a; Figure 2G, cytotoxic T-lymphocytes CD8, all magnification 7160). Initially, the constrictive pericarditis was concealed because of the coexistence of equivocal clinical symptoms. Because of sleeping troubles, a diagnosis of mild constrictive pulmonary disease together with obstructive sleep apnoea syndrome was put forward. An electroencephalogram was performed suggesting focal epilepsy and valproic acid therapy was undertaken. The patient was discharged home 7 days after surgery. Nowadays, he is able to practice a light mountain-bike activity

Expression of the mu opioid receptor and effects of the opioid antagonist Naloxone on in vitro maturation of oocytes recovered from anestrous bitches

The mu-opioid receptor (MOR) is expressed in bovine, human, equine and canine oocytes, and in seasonal breeders, it is expressed with higher intensity during the anoestrous phase. Supplementation of in vitro maturation (IVM) medium with opioid agents, agonists or antagonists, was shown to affect oocyte maturation in several species such as rat, bovine and equine. This study reports the effects of supplementing IVM medium with naloxone (Nx), an opioid antagonist, on nuclear and cytoplasmic maturation rate of oocytes recovered from anoestrous bitches. Cytoplasmic maturation was examined in terms of mitochondrial (mt) distribution. In order to confirm the receptor-mediated action of Nx, in oocytes of anoestrous bitches, MOR expression was analyzed by Western blot. Cumulus-oocyte complexes, recovered from the ovaries of bitches in anoestrous, were cultured in vitro and Nx was added at the concentrations of 1 x 10(-6), 1 x 10(-8) and 1 x 10(-10) M. The rate of oocytes resuming meiosis after culture in presence of 1 x 10(-6,) M Nx (29%) was significantly higher than that of oocytes of control group (12%; p < 0.05). However, treatment with Nx did not affect mt distribution pattern. In denuded oocytes and in corresponding cumulus cells, a doublet of 65 and 50 kDa was observed. We conclude that, in oocytes of anoestrous bitches, MOR is expressed and Nx significantly improves nuclear maturation rate. Further studies should be performed to elucidate the expression of other opioid receptors, such as delta and kappa, and possible interactive effects of their antagonists on canine oocyte maturation

Performance of a machine-learning algorithm for fully automatic LGE scar quantification in the large multi-national derivate registry

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): J. Schwitter receives research support by “ Bayer Schweiz AG “. C.N.C. received grant by Siemens. Gianluca Pontone received institutional fees by General Electric, Bracco, Heartflow, Medtronic, and Bayer. U.J.S received grand by Astellas, Bayer, General Electric. This work was supported by Italian Ministry of Health, Rome, Italy (RC 2017 R659/17-CCM698). This work was supported by Gyrotools, Zurich, Switzerland. Background  Late Gadolinium enhancement (LGE) scar quantification is generally recognized as an accurate and reproducible technique, but it is observer-dependent and time consuming. Machine learning (ML) potentially offers to solve this problem.  Purpose  to develop and validate a ML-algorithm to allow for scar quantification thereby fully avoiding observer variability, and to apply this algorithm to the prospective international multicentre Derivate cohort. Method  The Derivate Registry collected heart failure patients with LV ejection fraction &amp;lt;50% in 20 European and US centres. In the post-myocardial infarction patients (n = 689) quality of the LGE short-axis breath-hold images was determined (good, acceptable, sufficient, borderline, poor, excluded) and ground truth (GT) was produced (endo-epicardial contours, 2 remote reference regions, artefact elimination) to determine mass of non-infarcted myocardium and of dense (≥5SD above mean-remote) and non-dense scar (&amp;gt;2SD to &amp;lt;5SD above mean-remote). Data were divided into the learning (total n = 573; training: n = 289; testing: n = 284) and validation set (n = 116). A Ternaus-network (loss function = average of dice and binary-cross-entropy) produced 4 outputs (initial prediction, test time augmentation (TTA), threshold-based prediction (TB), and TTA + TB) representing normal myocardium, non-dense, and dense scar (Figure 1).Outputs were evaluated by dice metrics, Bland-Altman, and correlations.  Results  In the validation and test data sets, both not used for training, the dense scar GT was 20.8 ± 9.6% and 21.9 ± 13.3% of LV mass, respectively. The TTA-network yielded the best results with small biases vs GT (-2.2 ± 6.1%, p &amp;lt; 0.02; -1.7 ± 6.0%, p &amp;lt; 0.003, respectively) and 95%CI vs GT in the range of inter-human comparisons, i.e. TTA yielded SD of the differences vs GT in the validation and test data of 6.1 and 6.0 percentage points (%p), respectively (Fig 2), which was comparable to the 7.7%p for the inter-observer comparison (n = 40). For non-dense scar, TTA performance was similar with small biases (-1.9 ± 8.6%, p &amp;lt; 0.0005, -1.4 ± 8.2%, p &amp;lt; 0.0001, in the validation and test sets, respectively, GT 39.2 ± 13.8% and 42.1 ± 14.2%) and acceptable 95%CI with SD of the differences of 8.6 and 8.2%p for TTA vs GT, respectively, and 9.3%p for inter-observer.  Conclusions  In the large Derivate cohort from 20 centres, performance of the presented ML-algorithm to quantify dense and non-dense scar fully automatically is comparable to that of experienced humans with small bias and acceptable 95%-CI. Such a tool could facilitate scar quantification in clinical routine as it eliminates human observer variability and can handle large data sets. </jats:sec