Accuracy of electrocardiographic criteria for atrial enlargement: validation with cardiovascular magnetic resonance

<p>Abstract</p> <p>Background</p> <p>Anatomic atrial enlargement is associated with significant morbidity and mortality. However, atrial enlargement may not correlate with clinical measures such as electrocardiographic (ECG) criteria. Past studies correlating ECG criteria with anatomic measures mainly used inferior M-mode or two-dimensional echocardiographic data. We sought to determine the accuracy of the ECG to predict anatomic atrial enlargement as determined by volumetric cardiovascular magnetic resonance (CMR).</p> <p>Methods</p> <p>ECG criteria for left (LAE) and right atrial enlargement (RAE) were compared to CMR atrial volume index measurements for 275 consecutive subjects referred for CMR (67% males, 51 ± 14 years). ECG criteria for LAE and RAE were assessed by an expert observer blinded to CMR data. Atrial volume index was computed using the biplane area-length method.</p> <p>Results</p> <p>The prevalence of CMR LAE and RAE was 28% and 11%, respectively, and by any ECG criteria was 82% and 5%, respectively. Though nonspecific, the presence of at least one ECG criteria for LAE was 90% sensitive for CMR LAE. The individual criteria P mitrale, P wave axis < 30°, and negative P terminal force in V1 (NPTF-V1) > 0.04s·mm were 88–99% specific although not sensitive for CMR LAE. ECG was insensitive but 96–100% specific for CMR RAE.</p> <p>Conclusion</p> <p>The presence of at least one ECG criteria for LAE is sensitive but not specific for anatomic LAE. Individual criteria for LAE, including P mitrale, P wave axis < 30°, or NPTF-V1 > 0.04s·mm are highly specific, though not sensitive. ECG is highly specific but insensitive for RAE. Individual ECG P wave changes do not reliably both detect and predict anatomic atrial enlargement.</p

Chiral corrections to the isovector double scattering term for the pion-deuteron scattering length

The empirical value of the real part of the pion-deuteron scattering length can be well understood in terms of the dominant isovector $\pi N$-double scattering contribution. We calculate in chiral perturbation theory all one-pion loop corrections to this double scattering term which in the case of $\pi N$-scattering close the gap between the current-algebra prediction and the empirical value of the isovector threshold T-matrix $T_{\pi N}^-$. In addition to closing this gap there is in the $\pi d$-system a loop-induced off-shell correction for the exchanged virtual pion. Its coordinate space representation reveals that it is equivalent to $2\pi$-exchange in the deuteron. We evaluate the chirally corrected double scattering term and the off-shell contribution with various realistic deuteron wave functions. We find that the off-shell correction contributes at most -8% and that the isovector double scattering term explains at least 90% of the empirical value of the real part of the $\pi d$-scattering length.Comment: 4 pages, 2 figures, to be published in The Physical Review

Killing Tensors and Conformal Killing Tensors from Conformal Killing Vectors

Koutras has proposed some methods to construct reducible proper conformal Killing tensors and Killing tensors (which are, in general, irreducible) when a pair of orthogonal conformal Killing vectors exist in a given space. We give the completely general result demonstrating that this severe restriction of orthogonality is unnecessary. In addition we correct and extend some results concerning Killing tensors constructed from a single conformal Killing vector. A number of examples demonstrate how it is possible to construct a much larger class of reducible proper conformal Killing tensors and Killing tensors than permitted by the Koutras algorithms. In particular, by showing that all conformal Killing tensors are reducible in conformally flat spaces, we have a method of constructing all conformal Killing tensors (including all the Killing tensors which will in general be irreducible) of conformally flat spaces using their conformal Killing vectors.Comment: 18 pages References added. Comments and reference to 2-dim case. Typos correcte

Context Preserving Focal Probes for Exploration of Volumetric Medical Datasets

During real-time medical data exploration using volume rendering, it is often difficult to enhance a particular region of interest without losing context information. In this paper, we present a new illustrative technique for focusing on a user-driven region of interest while preserving context information. Our focal probes define a region of interest using a distance function which controls the opacity of the voxels within the probe, exploit silhouette enhancement and use non-photorealistic shading techniques to improve shape depiction.187-19

Crowdsourced earthquake early warning

Earthquake early warning (EEW) can reduce harm to people and infrastructure from earthquakes and tsunamis, but it has not been implemented in most high earthquake-risk regions because of prohibitive cost. Common consumer devices such as smartphones contain low-cost versions of the sensors used in EEW. Although less accurate than scientific-grade instruments, these sensors are globally ubiquitous. Through controlled tests of consumer devices, simulation of an M_w (moment magnitude) 7 earthquake on California’s Hayward fault, and real data from the M_w 9 Tohoku-oki earthquake, we demonstrate that EEW could be achieved via crowdsourcing

Scar heterogeneity on cardiovascular magnetic resonance as a predictor of appropriate implantable cardioverter defibrillator therapy

Background: Despite the survival benefit of implantable-cardioverter-defibrillators (ICDs), the vast majority of patients receiving an ICD for primary prevention do not receive ICD therapy. We sought to assess the role of heterogeneous scar area (HSA) identified by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) in predicting appropriate ICD therapy for primary prevention of sudden cardiac death (SCD). Methods: From September 2003 to March 2011, all patients who underwent primary prevention ICD implantation and had a pre-implantation LGE-CMR were identified. Scar size was determined using thresholds of 4 and 6 standard deviations (SD) above remote normal myocardium; HSA was defined using 3 different criteria; as the region between 2 SD and 4 SD (HSA2-4SD), between 2SD and 6SD (HSA2-6SD), and between 4SD and 6SD (HSA4-6SD). The end-point was appropriate ICD therapy. Results: Out of 40 total patients followed for 25 ± 24 months, 7 had appropriate ICD therapy. Scar size measured by different thresholds was similar in ICD therapy and non-ICD therapy groups (P = NS for all). However, HSA2-4SD and HSA4-6SD were significantly larger in the ICD therapy group (P = 0.001 and P = 0.03, respectively). In multivariable model HSA2-4SD was the only significant independent predictor of ICD therapy (HR = 1.08, 95%CI: 1.00-1.16, P = 0.04). Kaplan-Meier analysis showed that patients with greater HSA2-4SD had a lower survival free of appropriate ICD therapy (P = 0.026). Conclusions: In primary prevention ICD implantation, LGE-CMR HSA identifies patients with appropriate ICD therapy. If confirmed in larger series, HSA can be used for risk stratification in primary prevention of SCD

Determination of pi-N scattering lengths from pionic hydrogen and pionic deuterium data

The pi-N s-wave scattering lengths have been inferred from a joint analysis of the pionic hydrogen and the pionic deuterium x-ray data using a non-relativistic approach in which the pi-N interaction is simulated by a short-ranged potential. The pi-d scattering length has been calculated exactly by solving the Faddeev equations and also by using a static approximation. It has been shown that the same very accurate static formula for pi-d scattering length can be derived (i) from a set of boundary conditions; (ii) by a reduction of Faddeev equations; and (iii) through a summation of Feynman diagrams. By imposing the requirement that the pi-d scattering length, resulting from Faddeev-type calculation, be in agreement with pionic deuterium data, we obtain bounds on the pi-N scattering lengths. The dominant source of uncertainty on the deduced values of the pi-N scattering lengths are the experimental errors in the pionic hydrogen data.Comment: RevTeX, 20 pages,4 PostScript figure