Implications of serial measurements of natriuretic peptides in heart failure: insights from BIOSTAT‐CHF

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Cardiopoietic cell therapy for advanced ischemic heart failure: results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial

Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort

Expert system based on ontological model to support the detailed project of products in the context of agricultural mechinery

The large amount of available design information from different areas has become common in most organizations. Under these conditions, there are difficulties in sharing and reusing knowledge, especially by the fact that this knowledge is available within the company in different formats and locations. Due to this, design engineers often fail to use such information. To ensure a better use, it is important to organize and integrate the available knowledge in a collaborative manner. In this context, the Knowledge-based Engineering (KBE) approach can be associated. Through KBE concepts, the current study aims to develop an expert system based on an ontology model for assisting decision making, by storing and providing useful information in a timely manner. Such solution should meet the needs of its users (i.e. designers), as well as improve the quality of design activities along the Product Development Process (PDP). For this study, the following steps have been adopted: (a) delimitation of action scope (i.e. steps of PDP to be focused); (b) knowledge capture; (c) standardization; (d) knowledge structuring through ontologies; (e) building of queries; (f) evaluation of solution performance. The application of the present proposal aims to facilitate the access to information, significantly reduce the appearance of failures along the PDP, as well as allow acquired knowledge to be used in subsequent projects (e.g. lessons learned).Uma grande quantidade de informações de projeto, provenientes de diferentes áreas, tornou-se comum na maioria das organizações. Nessas condições, há dificuldades no compartilhamento e reutilização de conhecimento, especialmente pelo fato de que este conhecimento está disponível dentro da empresa em diferentes formatos e em diferentes locais. Devido a isso, os engenheiros de projeto muitas vezes não conseguem utilizar essas informações. Assim, é importante que as empresas possam organizar e integrar o conhecimento disponível de forma colaborativa, a fim de garantir seu melhor aproveitamento. Nesse contexto, a abordagem chamada Engenharia Baseada em Conhecimento (KBE) pode ser associada. Através de conceitos KBE, a presente dissertação tem como objetivo desenvolver um sistema especialista baseado em um modelo de ontologia, que permita o armazenamento e fornecimento de informações úteis no momento certo do desenvolvimento de produtos. Tal solução deve atender às necessidades de seus usuários (i.e. projetistas), bem como melhorar a qualidade de atividades de projeto ao longo do Processo de Desenvolvimento de Produto (PDP). Para este estudo os seguintes passos foram adotados: (a) a delimitação do escopo de ação (i.e. etapas do PDP a serem definidas como foco); (b) captura do conhecimento; (c) normalização; (d) estruturação do conhecimento através de ontologias; (e) elaboração de buscas; e (f) avaliação de desempenho da solução. A presente proposta tem como finalidade facilitar o acesso à informações, reduzir o aparecimento de falhas ao longo do PDP, bem como permitir que o conhecimento adquirido possa ser utilizado em projetos subsequentes (e.g. lições aprendidas)

Beta-blockers can improve survival in medically-treated patients with severe symptomatic aortic stenosis

In patients with symptomatic severe aortic stenosis (AS), surgical or percutaneous aortic valve replacement (AVR) is the only treatment with proven ability to improve survival [1]. Nonetheless, a consistent proportionof symptomatic patients with severe AS remain un-operated [2]. This patient group has an extremely unfavorable prognosis with no available medical therapy of proven efficacy. Although the majority ofthese patients are also affected by heart failure, the recommended drugs able to counteract the negative effects of heart failure are generally precluded due to the fear that they could worsen flow obstruction atthe valve level. In particular, AS is traditionally considered a contraindication for beta-blockers (BBs) although, in asymptomatic patients with AS, BB use has been associatedwith improved survival [3]. We aimed toassess whether BBs could have a protective effect also on patients with symptomatic medically treated AS

Plaque quantification by coronary computed tomography angiography using intravascular ultrasound as a reference standard: a comparison between standard and last generation computed tomography scanners

AIMS: The emerging role of coronary computed tomography angiography (CCTA) as a non-invasive tool for atherosclerosis evaluation is supported by data reporting a good correlation between CCTA and intravascular ultrasound (IVUS) for plaque volume quantification. Aim of the present study was to evaluate whether a last generation CT-scanner may improve coronary plaque volume assessment using IVUS as standard-of-reference. METHODS AND RESULTS: From a registry of 1915 consecutive, all-comers, patients who underwent a clinically indicated IVUS evaluation we enrolled 59 patients who underwent CCTA with a 64-slice CT (Group 1) and 59 patients who underwent CCTA with whole-heart coverage CT scanner (Group 2). Patients who underwent CCTA with unfavourable heart rhythm were not excluded from the analysis. Image quality (4-point Likert scale) focused on plaque analysis was evaluated. Plaque volume quantification by CCTA was compared to IVUS. No difference in clinical characteristics was found between Group 1 and Group 2. Plaque volume quantification by CCTA was considered not feasible in 11 plaques of Group 1 and in 4 plaques of Group 2 (P = 0.09). Higher correlation for plaque volume quantification by CCTA vs. IVUS was demonstrated in Group 2 when compared with Group 1 (r = 0.9888 vs. 0.9499; P < 0.0001). The Bland-Altman analysis showed plaque volume overestimation by CCTA of 11.9 mm3 in Group 1 and 4 mm2 in Group 2 (P < 0.001). Effective radiation dose of CCTA was significantly lower in Group 2 vs. Group 1 (2.7 ± 0.9 vs. 8.1 ± 3.6 mSv, respectively; P < 0.001). CONCLUSIONS: CCTA using a new scanner generation showed to be an accurate non-invasive tool to assess and quantify coronary plaque volume

CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression

Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation. Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses. Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv. Conclusions: In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard