Contrast-free detection of myocardial fibrosis in hypertrophic cardiomyopathy patients with diffusion-weighted cardiovascular magnetic resonance

BACKGROUNDS: Previous studies have shown that diffusion-weighted cardiovascular magnetic resonance (DW-CMR) is highly sensitive to replacement fibrosis of chronic myocardial infarction. Despite this sensitivity to myocardial infarction, DW-CMR has not been established as a method to detect diffuse myocardial fibrosis. We propose the application of a recently developed DW-CMR technique to detect diffuse myocardial fibrosis in hypertrophic cardiomyopathy (HCM) patients and compare its performance with established CMR techniques. METHODS: HCM patients (N = 23) were recruited and scanned with the following protocol: standard morphological localizers, DW-CMR, extracellular volume (ECV) CMR, and late gadolinium enhanced (LGE) imaging for reference. Apparent diffusion coefficient (ADC) and ECV maps were segmented into 6 American Heart Association (AHA) segments. Positive regions for myocardial fibrosis were defined as: ADC > 2.0 μm(2)/ms and ECV > 30 %. Fibrotic and non-fibrotic mean ADC and ECV values were compared as well as ADC-derived and ECV-derived fibrosis burden. In addition, fibrosis regional detection was compared between ADC and ECV calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using ECV as the gold-standard reference. RESULTS: ADC (2.4 ± 0.2 μm(2)/ms) of fibrotic regions (ADC > 2.0 μm(2)/ms) was significantly (p < 0.01) higher than ADC (1.5 ± 0.2 μm(2)/ms) of non-fibrotic regions. Similarly, ECV (35 ± 4 %) of fibrotic regions (ECV > 30 %) was significantly (p < 0.01) higher than ECV (26 ± 2 %) of non-fibrotic regions. In fibrotic regions defined by ECV, ADC (2.2 ± 0.3 μm(2)/ms) was again significantly (p < 0.05) higher than ADC (1.6 ± 0.3 μm(2)/ms) of non-fibrotic regions. In fibrotic regions defined by ADC criterion, ECV (34 ± 5 %) was significantly (p < 0.01) higher than ECV (28 ± 3 %) in non-fibrotic regions. ADC-derived and ECV-derived fibrosis burdens were in substantial agreement (intra-class correlation = 0.83). Regional detection between ADC and ECV of diffuse fibrosis yielded substantial agreement (κ = 0.66) with high sensitivity, specificity, PPV, NPV, and accuracy (0.80, 0.85, 0.81, 0.85, and 0.83, respectively). CONCLUSION: DW-CMR is sensitive to diffuse myocardial fibrosis and is capable of characterizing the extent of fibrosis in HCM patients

Measurement of matter–antimatter differences in beauty baryon decays

Differences in the behaviour of matter and antimatter have been observed in K and B meson decays, but not yet in any baryon decay. Such differences are associated with the non-invariance of fundamental interactions under the combined charge-conjugation and parity transformations, known as CP violation. Here, using data from the LHCb experiment at the Large Hadron Collider, we search for CP-violating asymmetries in the decay angle distributions of Lambda(0)(b) baryons decaying to p pi(-) pi(+) pi(-) and p pi(-) K+K- final states. These four-body hadronic decays are a promising place to search for sources of CP violation both within and beyond the standard model of particle physics. We find evidence for CP violation in Lambda(0)(b) to p pi(-) pi(+) pi(-) decays with a statistical significance corresponding to 3.3 standard deviations including systematic uncertainties. This represents the first evidence for CP violation in the baryon sector