10 research outputs found
Comprehensive characterization of cardiac contraction for improved post-infarction risk assessment
This study aims at identifying risk-related patterns of left ventricular contraction dynamics via novel volume transient characterization. A multicenter cohort of AMI survivors (nâ=â1021) who underwent Cardiac Magnetic Resonance (CMR) after infarction was considered for the study. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE, nâ=â73), consisting of all-cause death, reinfarction, and new congestive heart failure. Cardiac function was characterized from CMR in 3 potential directions: by (1) volume temporal transients (i.e. contraction dynamics); (2) feature tracking strain analysis (i.e. bulk tissue peak contraction); and (3) 3D shape analysis (i.e. 3D contraction morphology). A fully automated pipeline was developed to extract conventional and novel artificial-intelligence-derived metrics of cardiac contraction, and their relationship with MACE was investigated. Any of the 3 proposed directions demonstrated its additional prognostic value on top of established CMR indexes, myocardial injury markers, basic characteristics, and cardiovascular risk factors (Pâ<â0.001). The combination of these 3 directions of enhancement towards a final CMR risk model improved MACE prediction by 13% compared to clinical baseline (0.774 (0.771â0.777) vs. 0.683 (0.681â0.685) cross-validated AUC, Pâ<â0.001). The study evidences the contribution of the novel contraction characterization, enabled by a fully automated pipeline, to post-infarction assessment
Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials
Endpoints of large-scale trials in chronic heart failure have mostly been defined to evaluate treatments with regard to hospitalizations and mortality. However, patients with heart failure are also affected by very severe reductions in exercise capacity and quality of life. We aimed to evaluate the effects of heart failure treatments on these endpoints using available evidence from randomized trials. Interventions with evidence for improvements in exercise capacity include physical exercise, intravenous iron supplementation in patients with iron deficiency, and â with less certainty â testosterone in highly selected patients. Erythropoiesis-stimulating agents have been reported to improve exercise capacity in anaemic patients with heart failure. Sinus rhythm may have some advantage when compared with atrial fibrillation, particularly in patients undergoing pulmonary vein isolation. Studies assessing treatments for heart failure co-morbidities such as sleep-disordered breathing, diabetes mellitus, chronic kidney disease and depression have reported improvements of exercise capacity and quality of life; however, the available data are limited and not always consistent. The available evidence for positive effects of pharmacologic interventions using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists on exercise capacity and quality of life is limited. Studies with ivabradine and with sacubitril/valsartan suggest beneficial effects at improving quality of life; however, the evidence base is limited in particular for exercise capacity. The data for heart failure with preserved ejection fraction are even less positive, only sacubitril/valsartan and spironolactone have shown some effectiveness at improving quality of life. In conclusion, the evidence for state-of-the-art heart failure treatments with regard to exercise capacity and quality of life is limited and appears not robust enough to permit recommendations for heart failure. The treatment of co-morbidities may be important for these patient-related outcomes. Additional studies on functional capacity and quality of life in heart failure are required
Head-to-Head Comparison of Different Software Solutions for AVC Quantification Using Contrast-Enhanced MDCT
Aortic valve calcification (AVC) in aortic stenosis patients has diagnostic and prognostic implications. Little is known about the interchangeability of AVC obtained from different multidetector computed tomography (MDCT) software solutions. Contrast-enhanced MDCT data sets of 50 randomly selected aortic stenosis patients were analysed using three different software vendors (3Mensio, CVI42, Syngo.Via). A subset of 10 patients were analysed twice for the estimation of intra-observer variability. Intra- and inter-observer variability were determined using the ICC reliability method, Bland-Altman analysis and coefficients of variation. No differences were revealed between the software solutions in the AVC calculations (3Mensio 941 ± 623, Syngo.Via 948 mm3 ± 655, CVI42 941 ± 637; p = 0.455). The best inter-vendor agreement was found between the CVI42 and the Syngo.Via (ICC 0.997 (CI 0.995â0.998)), followed by the 3Mensio and the CVI42 (ICC 0.996 (CI 0.922â0.998)), and the 3Mensio and the Syngo.Via (ICC 0.992 (CI 0.986â0.995)). There was excellent intra- (3Mensio: ICC 0.999 (0.995â1.000); CVI42: ICC 1.000 (0.999â1.000); Syngo.Via: ICC 0.998 (0.993â1.000)) and inter-observer variability (3Mensio: ICC 1.000 (0.999â1.000); CVI42: ICC 1.000 (1.000â1.000); Syngo.Via: ICC 0.996 (0.985â0.999)) for all software types. Contrast-enhanced MDCT-derived AVC scores are interchangeable between and reproducible within different commercially available software solutions. This is important since sufficient reproducibility, interchangeability and valid results represent prerequisites for accurate TAVR planning and its widespread clinical use
Mitral valve reconstruction by Paneth and pericardial strip plasty by Hetzer in Patients with mitral valve insufficiency
FĂŒr die operative Versorgung der Mitralklappeninsuffizienz (MI), der
zweithÀufigsten Indikation zur operativen Herzklappenversorgung, stehen mit
dem Ersatz und der Rekonstruktion (MKR) zwei grundsÀtzliche Verfahren zu
VerfĂŒgung. Letztere ist nach aktueller Studienlage wenn möglich zu bevorzugen.
Mit der nach Hetzer modifizierten Paneth-Plastik hat ein weiteres Verfahren
zur MKR in den Operationssaal Einzug erhalten. Hierbei wird zur Stabilisierung
ein unbehandelter autologer Perikardstreifen dem posterioren Klappenanulus
aufgenÀht. Ziel dieser Arbeit ist es, den postoperativen Verlauf von 104
Patienten, die im Deutschen Herzzentrum Berlin nach dieser Methode durch einen
Chirurgen versorgt wurden, zu erfassen und den postoperativen Verlauf
auszuwerten. Hierzu wurden die Patienten in die Gruppe mit ischÀmisch
bedingter MI (n=44) und in die Gruppe mit nicht ischÀmisch bedingter MI (n=60)
eingeteilt und diese anschlieĂend untereinander verglichen. Die Auswertung
erfolgte im Sinne einer retrospektiven Datenanalyse, wobei besonderes
Augenmerk auf die echokardiographisch erhobenen Befunde (u.a. Schweregrad der
MI, linksventrikulÀre Funktion (LVEF), Diameter des linken Atriums (LA),
linksventrikulÀrer Diameter (LVESD bzw. LVEDD) endsystolisch bzw.
enddiastolisch) gelegt wurde. Beachtung fanden zudem weitere Daten aus dem
prÀ-, intra- und postoperativen Verlauf. Die statische Auswertung erfolgte
mittels âPASW 18â. Das Durchschnittsalter fĂŒr das Gesamtkollektiv ist mit 52
Jahren anzugeben, wobei es in der IschĂ€mie Gruppe mit 63 Jahren ±10 ĂŒber dem
in der nicht IschÀmie Gruppe mit 44 Jahren ±28 liegt. Bei der Auswertung
echokardiographischer Daten zeigte sich in beiden untersuchten Gruppen eine
signifikante Abnahme der MI von 2,97 ±0,54 auf 0,34 ±0,56 nach dem 30.
postoperativen Tag (POD 30) und auf 0,59 ±0,75 nach dem ersten postoperativen
Jahr (POM 12) in der nicht IschÀmie Gruppe und in der IschÀmie Gruppe von 2,49
±0,5 auf 0,03 ±0,19 zum Zeitpunkt POD 30 und 0,17 ±0,41 zum Zeitpunkt POM 12.
Ebenfalls als signifikant erwies sich die Verkleinerung des LVEDD in beiden
Patientengruppen. Ebenso zeigte sich eine Abnahme des LVESD sowie des
Durchmessers des LA. Eine Signifikanz konnte jedoch nicht nachgewiesen werden.
Die LVEF ist in beiden Gruppen im postoperativen Verlauf signifikant
angestiegen. So betrug die LVEF im Mittel prÀoperativ in der IschÀmie Gruppe
30 % und in der nicht IschÀmie Gruppe 50 %. Zum Zeitpunkt POM 12 zeigte sich
eine LVEF von 45 % in der IschĂ€mie Gruppe gegenĂŒber 58 % in der nicht IschĂ€mie
Gruppe. Zudem zeigte sich in der nicht IschÀmie Gruppe eine signifikant
reduzierte 1- Jahressterblichkeit mit 8% gegenĂŒber 23% in der IschĂ€mie Gruppe.
AbschlieĂend gilt es zu konstatieren, dass die nach Hetzer modifizierte
Paneth-Plastik sehr gute Ergebnisse im postoperativen Verlauf aufzeigt und bei
minimierter Einbringung von Fremdmaterial im Vergleich zu anderen
Operationstechniken mehr als nur eine Alternative darstellt.Mitral valve insufficiency is after aortic valve stenosis the second important
indication for valve operation. There are two different surgical options:
mitral valve reconstruction (MVR) and mitral valve replacement. Several
studies have shown that reconstruction has definite advantage over replacement
with regard to perioperative mortality and morbidity. There are a lot of
different surgical methods for MVR. A young technique is the paneth technique
modified by Hetzer: to stabilize the posterior annulus an autologous untreated
pericardial strip is used. The postoperative outcome was documented in
patients who underwent this operation method. The two subgroups of patients
suffered by ischemic mitral insufficiency versus non ischemic mitral
insufficiency were evaluated. A retrospective data analysis was done for the
first year post operationem. Patients were included who underwent surgery
between 1992 and 2009 in the German Heart Institute. Therefore
echocardiographic parameters were evaluated according to severity of the MI,
diameter of the left atrium and the leftventricular endsystolic (LVESD) and
enddiastolic diameter (LVEDD). 104 included Patients were separated into two
groups: ischemic mitral valve insufficiency (n=44) and non ischemic mitral
valve insufficiency (n=60). Differences between the two groups were analyzed
according to the pre-, intra- and postoperative datas. Therefore âPASW 18
Statisticâ was used. Data analysis revealed a middle age of 52 years. Patients
with ischemic MI were in the middle 63 ± 10 years old and Patients with non
ischemic MI were in the middle 44 ± 28 years old. 86% men were in the ischemic
MI group and 58% men in the non ischemic group. A significant decrease of the
mitral valve insufficiency from 2,97 ± 0,54 to 0,34 ± 0,56 could be shown
after the 30th postoperative day and to 0,59 ± 0,75 after the first
postoperative year in the non ischemic MI group. A significant reduction of
the mitral valve insufficiency occurred also in the ischemic MI group from
2,49 ± 0,5 to 0,03 ± 0,19 30 days after operation and to 0,17 ± 0,41 after the
first year post operation. A significant decrease of the LVEDD could be shown
in both groups. Otherwise a decrease of the LVESD could be shown, but was not
significant. A tendency for the LA decrease was also shown but not
significant. The left ventricular ejection fraction (LVEF) increased
significantly in both groups. The average for the LVEF was 30% preoperative in
the ischemic MI group and 50% in the non ischemic MI group. After one year
postoperative an increase to 45% in the ischemic group could be shown towards
58% in the non ischemic MI group. The overall 1-year mortality was 14%, 8% for
the non ischemic MI group and 23 % for the ischemic MI group. This was a
significant difference. It is to conclude that the Paneth technique modified
by Hetzer shows very good results in the postoperative follow up. With the
minimal need of foreign material it is more than only an option to other
operative methods
Interpretable cardiac anatomy modeling using variational mesh autoencoders
Cardiac anatomy and function vary considerably across the human population with important implications for clinical diagnosis and treatment planning. Consequently, many computer-based approaches have been developed to capture this variability for a wide range of applications, including explainable cardiac disease detection and prediction, dimensionality reduction, cardiac shape analysis, and the generation of virtual heart populations. In this work, we propose a variational mesh autoencoder (mesh VAE) as a novel geometric deep learning approach to model such population-wide variations in cardiac shapes. It embeds multi-scale graph convolutions and mesh pooling layers in a hierarchical VAE framework to enable direct processing of surface mesh representations of the cardiac anatomy in an efficient manner. The proposed mesh VAE achieves low reconstruction errors on a dataset of 3D cardiac meshes from over 1,000 patients with acute myocardial infarction, with mean surface distances between input and reconstructed meshes below the underlying image resolution. We also find that it outperforms a voxelgrid-based deep learning benchmark in terms of both mean surface distance and Hausdorff distance while requiring considerably less memory. Furthermore, we explore the quality and interpretability of the mesh VAE's latent space and showcase its ability to improve the prediction of major adverse cardiac events over a clinical benchmark. Finally, we investigate the method's ability to generate realistic virtual populations of cardiac anatomies and find good alignment between the synthesized and gold standard mesh populations in terms of multiple clinical metrics
Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials
Endpoints of large-scale trials in chronic heart failure have mostly been defined to evaluate treatments with regard to hospitalizations and mortality. However, patients with heart failure are also affected by very severe reductions in exercise capacity and quality of life. We aimed to evaluate the effects of heart failure treatments on these endpoints using available evidence from randomized trials. Interventions with evidence for improvements in exercise capacity include physical exercise, intravenous iron supplementation in patients with iron deficiency, and â with less certainty â testosterone in highly selected patients. Erythropoiesis-stimulating agents have been reported to improve exercise capacity in anaemic patients with heart failure. Sinus rhythm may have some advantage when compared with atrial fibrillation, particularly in patients undergoing pulmonary vein isolation. Studies assessing treatments for heart failure co-morbidities such as sleep-disordered breathing, diabetes mellitus, chronic kidney disease and depression have reported improvements of exercise capacity and quality of life; however, the available data are limited and not always consistent. The available evidence for positive effects of pharmacologic interventions using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists on exercise capacity and quality of life is limited. Studies with ivabradine and with sacubitril/valsartan suggest beneficial effects at improving quality of life; however, the evidence base is limited in particular for exercise capacity. The data for heart failure with preserved ejection fraction are even less positive, only sacubitril/valsartan and spironolactone have shown some effectiveness at improving quality of life. In conclusion, the evidence for state-of-the-art heart failure treatments with regard to exercise capacity and quality of life is limited and appears not robust enough to permit recommendations for heart failure. The treatment of co-morbidities may be important for these patient-related outcomes. Additional studies on functional capacity and quality of life in heart failure are required
Additional file 1 of Cardiovascular magnetic resonance-derived left atrioventricular coupling index and major adverse cardiac events in patients following acute myocardial infarction
Additional file 1: Figure S1. KaplanâMeier curves for survival analyses in subgroup of low-risk patients. Left atrioventricular coupling index (LACI) and survival in low-risk patients according to left ventricular ejection fraction (LVEF) after acute myocardial infarction. Incidence of MACE (major adverse cardiac events) according to high and low LACI classified according to Youden Index
Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials
Endpoints of large-scale trials in chronic heart failure have mostly been defined to evaluate treatments with regard to hospitalizations and mortality. However, patients with heart failure are also affected by very severe reductions in exercise capacity and quality of life. We aimed to evaluate the effects of heart failure treatments on these endpoints using available evidence from randomized trials. Interventions with evidence for improvements in exercise capacity include physical exercise, intravenous iron supplementation in patients with iron deficiency, and â with less certainty â testosterone in highly selected patients. Erythropoiesis-stimulating agents have been reported to improve exercise capacity in anaemic patients with heart failure. Sinus rhythm may have some advantage when compared with atrial fibrillation, particularly in patients undergoing pulmonary vein isolation. Studies assessing treatments for heart failure co-morbidities such as sleep-disordered breathing, diabetes mellitus, chronic kidney disease and depression have reported improvements of exercise capacity and quality of life; however, the available data are limited and not always consistent. The available evidence for positive effects of pharmacologic interventions using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists on exercise capacity and quality of life is limited. Studies with ivabradine and with sacubitril/valsartan suggest beneficial effects at improving quality of life; however, the evidence base is limited in particular for exercise capacity. The data for heart failure with preserved ejection fraction are even less positive, only sacubitril/valsartan and spironolactone have shown some effectiveness at improving quality of life. In conclusion, the evidence for state-of-the-art heart failure treatments with regard to exercise capacity and quality of life is limited and appears not robust enough to permit recommendations for heart failure. The treatment of co-morbidities may be important for these patient-related outcomes. Additional studies on functional capacity and quality of life in heart failure are required
Improving exercise capacity and quality of life using nonâinvasive heart failure treatments: evidence from clinical trials
Predictors of lower exercise capacity in patients with cancer
Abstract Maintaining cancer patientsâ exercise capacity and therefore patientsâ ability to live a self-determined life is of huge importance, but little is known about major determinants. We sought to identify determinants of exercise capacity in patients with a broad spectrum of cancer types, who were already receiving cancer treatment or about to commence such therapy. Exercise capacity was assessed in 253 consecutive patients mostly suffering from advanced cancer using the 6-min walk test (6-MWT). All patients underwent echocardiography, physical examination, resting electrocardiogram, hand grip strength (HGS) measurement, and laboratory assessments. Patients were divided into two groups according to the median distance in the 6-MWT (459Â m). Patients with lower exercise capacity were older, had significantly lower HGS and haemoglobin and higher values of high sensitive (hs) Troponin T and NT-proBNP (all pââ0.2). Using multivariable logistic regression, we found that the presence of anaemia (odds ratio (OR) 6.172, 95% confidence interval (CI) 1.401â27.201, pâ=â0.016) as well as an increase in hs Troponin T (OR 3.077, 95% CI 1.202â5.301, pâ=â0.019) remained independent predictors of impaired exercise capacity. Increasing HGS was associated with a reduced risk of a lower exercise capacity (OR 0.896, 95% CI 0.813â0.987, pâ=â0.026). Screening patients for elevated hs troponin levels as well as reduced HGS may help to identify patients at risk of lower exercise capacity during cancer treatment