Special Issue: State of the Art of Cardiac Multimodality Imaging

Imagen cardiaca multimodalImatge cardíaca multimodalCardiac multimodality imagin

Qualidade das informações contábeis, governança corporativa e desempenho financeiro: uma análise comparativa de empresas brasileiras e francesas

The Quality of Accounting Information and Corporate Governance influence the perception of investors about publicly traded companies. In view of this, this research explores the relationships among Quality of Accounting Information, Corporate Governance and Financial Performance of Brazilian and French companies. Thus, to demonstrate the existence of relationships among Quality of Accounting Information and Financial Performance of companies, governance structures and Financial Performance, and Quality of Accounting Information, governance structures and also Financial Performance of companies, a quantitative study of correlation among these dimensions was carried out. The relationships between quality and performance were statistically significant and have been proved. On the other hand, the relationships between governance and performance were strong, in view of the correlations found. Among the Financial Performance indicators, it is noteworthy that the profitability indicators are correlated with quality and governance more frequently than those of profitability. The result proved the initial assumptions about the existence of such relationships and showed that the French market reflected more evolution than the Brazilian market, that is, the relationships between Corporate Governance and Financial Performance were more evident in the case of French companies.A Qualidade das Informações Contábeis e a Governança Corporativa exercem influência sobre a percepção de investidores acerca das empresas de capital aberto. Diante disso, esta pesquisa explora as relações entre a Qualidade das Informações Contábeis, Governança Corporativa e Desempenho Financeiro de empresas brasileiras e francesas. Assim, para demonstrar a existência de relações entre Qualidade das Informações Contábeis e Desempenho Financeiro das empresas, estruturas de governança e Desempenho Financeiro, e Qualidade das Informações Contábeis, estruturas de governança e, ainda, o Desempenho Financeiro das empresas realizou-se um estudo quantitativo de correlação entre essas dimensões. As relações entre qualidade e desempenho foram estatisticamente significantes e comprovadas. As relações entre governança e desempenho se mostraram fortes diante das correlações encontradas. Dentre os indicadores de Desempenho Financeiro, ressalta-se que os de lucratividade estão correlacionados com qualidade e governança com mais frequência do que aqueles de rentabilidade. O resultado comprovou os pressupostos iniciais sobre a existência de tais relações e mostrou que o mercado francês refletiu mais evolução do que o mercado brasileiro, ou seja, as relações entre a Governança Corporativa e o Desempenho Financeiro foram mais evidentes no caso das empresas francesas

HTAD patient pathway: Strategy for diagnostic work-up of patients and families with (suspected) heritable thoracic aortic diseases (HTAD). A statement from the HTAD working group of VASCERN

Loeys-dietz syndrome; Marfan syndrome; Thoracic aortic aneurysmSíndrome de Loeys-dietz; Síndrome de Marfan; Aneurisma aòrtic toràcicSíndrome de loeys-dietz; Síndrome de Marfan; Aneurisma aórtico torácicoHeritable thoracic aortic diseases (HTAD) are rare pathologies associated with thoracic aortic aneurysms and dissection, which can be syndromic or non-syndromic. They may result from genetic defects. Associated genes identified to date are classified into those encoding components of the (a) extracellular matrix (b) TGFβ pathway and (c) smooth muscle contractile mechanism. Timely diagnosis allows for prompt aortic surveillance and prophylactic surgery, hence improving life expectancy and reducing maternal complications as well as providing reassurance to family members when a diagnosis is ruled out. This document is an expert opinion reflecting strategies put forward by medical experts and patient representatives involved in the HTAD Rare Disease Working Group of VASCERN. It aims to provide a patient pathway that improves patient care by diminishing time to diagnosis, facilitating the establishment of a correct diagnosis using molecular genetics when possible, excluding the diagnosis in unaffected persons through appropriate family screening and avoiding overuse of resources. It is being recommended that patients are referred to an expert centre for further evaluation if they meet at least one of the following criteria: (1) thoracic aortic dissection (3.5 or 2.5–3.5 if non-hypertensive or hypertensive and 3), (3) family history of HTAD with/without a pathogenic variant in a gene linked to HTAD, (4) ectopia lentis without other obvious explanation and (5) a systemic score of >5 in adults and >3 in children. Aortic imaging primarily relies on transthoracic echocardiography with magnetic resonance imaging or computed tomography as needed. Genetic testing should be considered in those with a high suspicion of underlying genetic aortopathy. Though panels vary among centers, for patients with thoracic aortic aneurysm or dissection or systemic features these should include genes with a definitive or strong association to HTAD. Genetic cascade screening and serial aortic imaging should be considered for family screening and follow-up. In conclusion, the implementation of these strategies should help standardise the diagnostic work-up and follow-up of patients with suspected HTAD and the screening of their relatives.CHAFEA Specific Grant Agreement for Year 1 HP-ERN-SGA-2016 10 Project n° 769036 (from March 2017 to February 2018) 11 - CHAFEA Specific Grant Agreement for Year 2 HP-ERN-SGA-2017 12 Project n° 811609 (from March 2018 to February 2019) 13 - CHAFEA Specific Grant Agreement for Year 3 to 5 HP-ERN-SGA-2018 14 Project n° 847081 (from March 2019 to February 2022)

Angiotensin receptor blockers and β blockers in Marfan syndrome: an individual patient data meta-analysis of randomised trials

Angiotensin receptor blockers; Marfan syndromeBloquejadors dels receptors d'angiotensina; Síndrome de MarfanBloqueadores de los receptores de angiotensina; Síndrome de MarfanBackground Angiotensin receptor blockers (ARBs) and β blockers are widely used in the treatment of Marfan syndrome to try to reduce the rate of progressive aortic root enlargement characteristic of this condition, but their separate and joint effects are uncertain. We aimed to determine these effects in a collaborative individual patient data meta-analysis of randomised trials of these treatments. Methods In this meta-analysis, we identified relevant trials of patients with Marfan syndrome by systematically searching MEDLINE, Embase, and CENTRAL from database inception to Nov 2, 2021. Trials were eligible if they involved a randomised comparison of an ARB versus control or an ARB versus β blocker. We used individual patient data from patients with no prior aortic surgery to estimate the effects of: ARB versus control (placebo or open control); ARB versus β blocker; and indirectly, β blocker versus control. The primary endpoint was the annual rate of change of body surface area-adjusted aortic root dimension Z score, measured at the sinuses of Valsalva. Findings We identified ten potentially eligible trials including 1836 patients from our search, from which seven trials and 1442 patients were eligible for inclusion in our main analyses. Four trials involving 676 eligible participants compared ARB with control. During a median follow-up of 3 years, allocation to ARB approximately halved the annual rate of change in the aortic root Z score (mean annual increase 0·07 [SE 0·02] ARB vs 0·13 [SE 0·02] control; absolute difference –0·07 [95% CI –0·12 to –0·01]; p=0·012). Prespecified secondary subgroup analyses showed that the effects of ARB were particularly large in those with pathogenic variants in fibrillin-1, compared with those without such variants (heterogeneity p=0·0050), and there was no evidence to suggest that the effect of ARB varied with β-blocker use (heterogeneity p=0·54). Three trials involving 766 eligible participants compared ARBs with β blockers. During a median follow-up of 3 years, the annual change in the aortic root Z score was similar in the two groups (annual increase –0·08 [SE 0·03] in ARB groups vs –0·11 [SE 0·02] in β-blocker groups; absolute difference 0·03 [95% CI –0·05 to 0·10]; p=0·48). Thus, indirectly, the difference in the annual change in the aortic root Z score between β blockers and control was –0·09 (95% CI –0·18 to 0·00; p=0·042). Interpretation In people with Marfan syndrome and no previous aortic surgery, ARBs reduced the rate of increase of the aortic root Z score by about one half, including among those taking a β blocker. The effects of β blockers were similar to those of ARBs. Assuming additivity, combination therapy with both ARBs and β blockers from the time of diagnosis would provide even greater reductions in the rate of aortic enlargement than either treatment alone, which, if maintained over a number of years, would be expected to lead to a delay in the need for aortic surgery.Marfan Foundation, the Oxford British Heart Foundation Centre for Research Excellence, and the UK Medical Research Council

Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long‐Term Survival

Insuficiència cardíaca; Hipertensió pulmonar; Malaltia valvular cardíacaInsuficiencia cardiaca; Hipertensión pulmonar; Enfermedad valvular cardíacaHeart failure; Pulmonary hypertension; Valvular heart diseaseBackground The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long‐term follow‐up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32–44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18–26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow‐up of 4.5 years, 91 deaths accounted for 4.21 higher‐than‐expected mortality in the age‐matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance—either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six‐month changes in the composite clinical score and in the 6‐minute walk test distance were related to survival. Conclusions Persistent valvular heart disease–pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures.This study was funded by the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Spain, the European Union–European Regional Development Fund (EC07/90772 and PI19/00649), and the Consorcio de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)

Comparative Risks of Initial Aortic Events Associated With Genetic Thoracic Aortic Disease

Pathogenic variant; Precision medicine; Thoracic aortic aneurysmVariante patógena; Medicina de precisión; Aneurisma de la aorta torácicaVariant patògena; Medicina de precisió; Aneurisma de l'aorta toràcicaBackground Pathogenic variants in 11 genes predispose individuals to heritable thoracic aortic disease (HTAD), but limited data are available to stratify the risk for aortic events associated with these genes. Objectives This study sought to compare the risk of first aortic event, specifically thoracic aortic aneurysm surgery or an aortic dissection, among 7 HTAD genes and variant types within each gene. Methods A retrospective cohort of probands and relatives with rare variants in 7 genes for HTAD (n = 1,028) was assessed for the risk of first aortic events based on the gene altered, pathogenic variant type, sex, proband status, and location of recruitment. Results Significant differences in aortic event risk were identified among the smooth muscle contraction genes (ACTA2, MYLK, and PRKG1; P = 0.002) and among the genes for Loeys-Dietz syndrome, which encode proteins in the transforming growth factor (TGF)-β pathway (SMAD3, TGFB2, TGFBR1, and TGFBR2; P < 0.0001). Cumulative incidence of type A aortic dissection was higher than elective aneurysm surgery in patients with variants in ACTA2, MYLK, PRKG1, and SMAD3; in contrast, patients with TGFBR2 variants had lower cumulative incidence of type A aortic dissection than elective aneurysm surgery. Cumulative incidence of type B aortic dissection was higher for ACTA2, PRKG1, and TGFBR2 than other genes. After adjusting for proband status, sex, and recruitment location, specific variants in ACTA2 and TGFBR2 were associated with substantially higher risk of aortic event with childhood onset. Conclusions Gene- and variant-specific data on aortic events in individuals with HTAD support personalized aortic surveillance and clinical management.These studies were funded by the National Institutes of Health (NIH) (NIH R01HL109942 to Dr Milewicz DMM and K23HL127266 to Dr Morris), Genetic Aortic Disorders Association Canada, Temerty Family Foundation, and the John Ritter Foundation. Dr LeMaire serves as a consultant for Terumo Aortic and Cerus; and serves as a principal investigator for clinical studies sponsored by Terumo Aortic and CytoSorbents. Dr Morris is on the scientific advisory board for vascular Ehlers Danlos syndrome clinical trial for Aytu Biopharma. Dr Regalado is an employee and shareholder of Invitae. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose

Análise estrutural de endividamento: um estudo das políticas de financiamento e investimento em hospitais filantrópicos brasileiros / Structural debt analysis: a study of financing and investment policies in brazilian philanthropic hospitals

O estudo apresenta a realidade de endividamento de hospitais filantrópicos brasileiros. Define uma estrutura de avaliação da gestão financeira organizacional, investiga a influência de fatores diversos sobre a gestão, bem como o padrão de investimento hospitalar e o uso ou não de passivo não oneroso como fonte alternativa de financiamento. A avaliação foi realizada por meio do cálculo de indicadores econômico-financeiros, análises horizontal e vertical e uso de modelos tradicional e dinâmico. A capacidade de geração de fluxo de caixa foi observada através de informações contidas em demonstrações contábeis disponíveis, notas explicativas e relatórios da administração publicados. Foram coletadas as informações de três hospitais filantrópicos selecionados aleatoriamente, a categoria hospitalar, em função da prestação de serviços comunitários, e filantrópica, por tenderem a apresentar maiores riscos financeiros, incertezas de fluxos de caixas e dependência por repasses governamentais e de doações para financiamento de atividades. Todos os hospitais apresentaram dificuldades financeiras significativas por receberem poucos recursos e ainda que beneficiados pelo governo com isenção de obrigações sociais, os métodos indicaram que os recursos de convênios e doações foram insuficientes para manutenção das atividades com crescimento anual do endividamento

Glycoprotein and Lipoprotein Profiles Assessed by 1H-NMR and Its Relation to Ascending Aortic Dilatation in Bicuspid Aortic Valve Disease

Bicuspid aortic valve; Glycoprotein; Lipoprotein metabolismVàlvula aòrtica bicúspide; Glicoproteïna; Metabolisme de les lipoproteïnesVálvula aórtica bicúspide; Glicoproteína; Metabolismo de las lipoproteínasIntroduction: The bicuspid aortic valve (BAV) confers a high risk of ascending aorta dilatation (AAoD), although its progression seems highly variable. Furthermore, the implication of lipoprotein metabolism and inflammation in the mechanisms that underlie AAoD is not fully established. The aim of this study consisted of evaluating the impact of the lipoprotein and glycoprotein profiles in AAOD as well as its progression in BAV aortopathy. Methods: Using 1H-nuclear magnetic resonance (1H-NMR), we analyzed and compared the lipoprotein and glycoprotein profiles of plasma samples from 152 BAV patients with dilated and nondilated ascending aorta. Additionally, these profiles were also compared for 119 of these patients who were prospectively followed-up clinically and by echocardiography in the long-term (5 years). Ascending aorta dilation velocity (mm/year) was calculated for this analysis. Results: Several parameters related to the lipoprotein profile including remnant cholesterol, small LDL and IDL-cholesterol were found to be significantly increased in the dilated group compared to those in the nondilated group. The glycoprotein A-nuclear magnetic resonance (NMR) signal, a novel inflammation biomarker, was also observed to be increased in the dilated group. After performing multivariate analysis, remnant cholesterol remained an independent variable related to AAoD. In the long-term follow-up, proatherogenic lipoprotein parameters were related to ascending aorta dilatation velocity ascending. After a lineal regression analysis, non-HDL particles remained as an independent predictor of ascending aorta dilation velocity. Conclusions: Patients with BAV and AAoD presented a more pro-atherogenic profile assessed by 1H-NMR, especially related to triglyceride-rich lipoproteins. This pro-atherogenic profile seems to contribute to the higher growth rate of ascending aorta diameter.This research was funded by “Proyectos de Investigación Clínica” from the Spanish Society of Cardiology, grant Bayer 2019. BA-G received a research scholarship within the Martí-Franquès Research Fellowship Program from the University of Rovira i Virgili

Análise do jogo Racing Limits como instrumento de ensino de cinemática

This article aims to analyze the electronic game Racing Limits, to identify whether there are coerces or inconsistencies in the numerical values related to the quantities displacement, speed and time provided by him and propose the game as a teaching tool of Kinematics. To do so, we apply the scalar velocity equation to assess whether there is equivalence between the speeds provided by the game and the calculated speeds. With our research, it was possible to conclude that there is equivalence between the values of the velocities provided by the game and the calculated speeds, which allowed us to interpret this game as coherent. In this way, we propose that teachers use the game in the classroom, instigating students to do the same analysis of the game.Este artículo tiene como objetivo analizar el juego electrónico Racing Limits, para identificar si hay copresiones o inconsistencias en los valores numéricos relacionados con las cantidades de desplazamiento, la velocidad y el tiempo proporcionado por él y proponer el juego como una herramienta de enseñanza de Cinemática. Para ello, aplicamos la ecuación de velocidad escalar para evaluar si existe equivalencia entre las velocidades proporcionadas por el juego y las velocidades calculadas. Con nuestra investigación, fue posible concluir que existe equivalencia entre los valores de las velocidades proporcionadas por el juego y las velocidades calculadas, lo que nos permitió interpretar este juego como coherente. De esta manera, proponemos que los profesores utilicen el juego en el aula, instigando a los estudiantes a hacer el mismo análisis del juego.Este artigo objetiva analisar o jogo eletrônico Racing Limits, para identificar se há coerências ou incoerências nos valores numéricos referentes às grandezas deslocamento, velocidade e tempo fornecidos por ele e propor o game como ferramenta de ensino de cinemática. Para tanto, aplicamos a equação da velocidade escalar para avaliar se há uma equivalência entre as velocidades fornecidas pelo jogo e as velocidades calculadas. Com nossa pesquisa, foi possível concluir que existe uma equivalência entre os valores das velocidades fornecidas pelo jogo e as velocidades calculadas, o que nos permitiu interpretar esse jogo como coerente. Dessa forma, propomos que os professores utilizem o jogo em sala de aula, instigando os alunos a fazerem a mesma análise do jogo

Fully Three-Dimensional Hemodynamic Characterization of Altered Blood Flow in Bicuspid Aortic Valve Patients With Respect to Aortic Dilatation: A Finite Element Approach

Bicuspid aortic valve; Congenital heart disease; Magnetic resonance imagingVàlvula aòrtica bicúspide; Cardiopatia congènita; Imatges per ressonància magnèticaVálvula aórtica bicúspide; Cardiopatía congénita; Imágenes de resonancia magnéticaBackground and Purpose: Prognostic models based on cardiovascular hemodynamic parameters may bring new information for an early assessment of patients with bicuspid aortic valve (BAV), playing a key role in reducing the long-term risk of cardiovascular events. This work quantifies several three-dimensional hemodynamic parameters in different patients with BAV and ranks their relationships with aortic diameter. Materials and Methods: Using 4D-flow CMR data of 74 patients with BAV (49 right-left and 25 right-non-coronary) and 48 healthy volunteers, aortic 3D maps of seventeen 17 different hemodynamic parameters were quantified along the thoracic aorta. Patients with BAV were divided into two morphotype categories, BAV-Non-AAoD (where we include 18 non-dilated patients and 7 root-dilated patients) and BAV-AAoD (where we include the 49 patients with dilatation of the ascending aorta). Differences between volunteers and patients were evaluated using MANOVA with Pillai's trace statistic, Mann–Whitney U test, ROC curves, and minimum redundancy maximum relevance algorithm. Spearman's correlation was used to correlate the dilation with each hemodynamic parameter. Results: The flow eccentricity, backward velocity, velocity angle, regurgitation fraction, circumferential wall shear stress, axial vorticity, and axial circulation allowed to discriminate between volunteers and patients with BAV, even in the absence of dilation. In patients with BAV, the diameter presented a strong correlation (> |+/−0.7|) with the forward velocity and velocity angle, and a good correlation (> |+/−0.5|) with regurgitation fraction, wall shear stress, wall shear stress axial, and vorticity, also for morphotypes and phenotypes, some of them are correlated with the diameter. The velocity angle proved to be an excellent biomarker in the differentiation between volunteers and patients with BAV, BAV morphotypes, and BAV phenotypes, with an area under the curve bigger than 0.90, and higher predictor important scores. Conclusions: Through the application of a novel 3D quantification method, hemodynamic parameters related to flow direction, such as flow eccentricity, velocity angle, and regurgitation fraction, presented the best relationships with a local diameter and effectively differentiated patients with BAV from healthy volunteers.This work was funded by ANID – Millennium Science Initiative Program – ICN2021_004 and ANID – Millennium Science Initiative Program – NCN17_129, CONICYT-FONDECYT Postdoctorado #3170737, ANID – FONDECYT Postdoctorado #3220266, ANID Ph. D. Scholarship 21170592, ANID FONDECYT de Iniciación en Investigación #11200481, ANID FONDECYT #1181057, ANID Ph. D. Scholarship 21180391, the Spanish Society of Cardiology (SEC/FEC-INV-CLI 20/015) and the Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV). AG has received funding from the Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I)