Texture Analysis in Magnetic Resonance Imaging: Review and Considerations for Future Applications

Texture analysis is a technique used for the quantification of image texture. It has been successfully used in many fields, and in the past years it has been applied in magnetic resonance imaging (MRI) as a computer-aided diagnostic tool. Quantification of the intrinsic heterogeneity of different tissues and lesions is necessary as they are usually imperceptible to the human eye. In the present chapter, we describe texture analysis as a process consisting of six steps: MRI acquisition, region of interest (ROI) definition, ROI preprocessing, feature extraction, feature selection, and classification. There is a great variety of methods and techniques to be chosen at each step and all of them can somehow affect the outcome of the texture analysis application. We reviewed the literature regarding texture analysis in clinical MRI focusing on the important considerations to be taken at each step of the process in order to obtain maximum benefits and to avoid misleading results

Effect of insulin on readmission for heart failure following a hospitalization for acute heart failure

Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and is related with worse outcomes. Insulin treatment is associated with sodium and water retention, weight gain, and hypoglycaemia-all pathophysiological mechanisms related to HF decompensation. This study aimed to evaluate the association between insulin treatment and the risk of 1 year readmission for HF in patients discharged for acute HF. We prospectively included 2895 consecutive patients discharged after an episode of acute HF in a single tertiary hospital. Multivariable Cox regression, adapted for competing events, was used to assess the association between insulin treatment and 1 year readmission for HF in patients discharged after acute HF. Participants' mean age was 73.4 ± 11.2 years, 50.8% were women, 44.7% had T2DM [including 527 (18.2%) on insulin therapy], and 52.7% had preserved ejection fraction. At 1 year follow-up, 518 (17.9%) patients had died and 693 (23.9%) were readmitted for HF. The crude risk of readmission for HF was higher in patients on insulin, with no differences in 1 year mortality. After multivariable adjustment, patients on insulin were at significantly higher risk of 1 year readmission for HF than patients with diabetes who were not on insulin (hazard ratio 1.28; 95% confidence interval 1.04-1.59, P = 0.022) and patients without diabetes (hazard ratio 1.26; 95% confidence interval 1.02-1.55, P = 0.035). Following acute HF, patients with T2DM on insulin therapy are at increased risk of readmission for HF. Further studies unravelling the mechanisms behind this association are warranted

Differential mortality association of loop diuretic dosage according to blood urea nitrogen and carbohydrate antigen 125 following a hospitalization for acute heart failure

AimsRecent observations in chronic stable heart failure suggest that high-dose loop diuretics (HDLDs) have detrimental prognostic effects in patients with high blood urea nitrogen (BUN), but recent findings have also indicated that diuretics may improve renal function. Carbohydrate antigen 125 (CA125) has been shown to be a surrogate of systemic congestion. We sought to explore whether BUN and CA125 modulate the mortality risk associated with HDLDs following a hospitalization for acute heart failure (AHF).Methods and resultsWe analysed 1389 consecutive patients discharged for AHF. CA125 and BUN were measured at a mean of 72 ± 12 h after admission. HDLDs (≥120 mg/day in furosemide equivalent dose) were interacted to a four-level variable according to CA125 (>35 U/mL) and BUN (above the median), and related to all-cause mortality. At a median follow-up of 21 months, 561 (40.4%) patients died. The use of HDLDs was independently associated with increased mortality [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.01–1.50], but this association was not homogeneous across CA125–BUN categories (P for interaction <0.001). In patients with normal CA125, use of HDLDs was associated with high mortality if BUN was above the median (HR 2.29, 95% 1.51–3.46), but not in those with BUN below the median (HR 1.22, 95% CI 0.73–2.04). Conversely, in patients with high CA125, HDLDs showed an association with increased survival if BUN was above the median (HR 0.73, 95% CI 0.55–0.98) but was associated with increased mortality in those with BUN below the median (HR 1.94, 95% CI 1.36–2.76).ConclusionThe risk associated with HDLDs in patients after hospitalization for AHF was dependent on the levels of BUN and CA125. The information provided by these two biomarkers may be helpful in tailoring the dose of loop diuretics at discharge for AHF

Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

The treatment of acute coronary syndrome (ACS) in elderly patients continues to be a challenge because of the characteS.G.B.ristics of this population and the lack of data and specific recommendations. This review summarizes the current evidence about critical points of oral antithrombotic therapy in elderly patients. To this end, we discuss the peculiarities and differences reported referring to dual antiplatelet therapy (DAPT) in ACS management in elderly patients and what might be the best option considering these population characteristics. Furthermore, we analyze antithrombotic strategies in patients with atrial fibrillation (AF), with a particular focus on those cases that also present coronary artery disease (CAD). It is imperative to deepen our knowledge regarding the management of these challenging patients through real-world data and specifically designed geriatric studies to help resolve the questions remaining in their disease management

Daño microvascular tras un infarto agudo de miocardio. Foco en el laboratorio de hemodinámica

This study was funded by the Instituto de Salud Carlos III and the European Regional Development Fund (FEDER) (grants PI20/00637, CIBERCV16/11/00486 and FI18/00320), the Conselleria de Educació de la Generalitat Valenciana (PROMETEO/2021/008) and the Agencia Estatal de Investigación (grant FJC2020-043981).Ríos-Navarro, C.; Gavara-Doñate, J.; Bodí, V. (2022). Microvascular injury after acute myocardial infarction. Focus on the catheterization laboratory. Revista Española de Cardiología. 75(10):777-779. https://doi.org/10.1016/j.rec.2022.05.011777779751