Reliability of a 3D Body Scanner for Anthropometric Measurements of Central Obesity

Background Central obesity poses a significant risk for cardiovascular diseases, but the reproducibility of manual measurements of waist and hip circumferences has been questioned. An automated 3D body scanner that uses white light rays could potentially increase the reliability of these anthropometric measurements. Methods We assessed the reproducibility of anthropometric measurements performed manually and using a 3D-scanner in 83 adult volunteers. Manual measures of WC and HC were obtained using unmarked, non-elastic ribbons in order to avoid observer and confirmation bias. The 3D-scanner was used to create body images and to obtain WC and HC measurements in an automated fashion. Results The inter-observer mean differences were 3.9 ± 2.4 cm for WC; 2.7 ± 2.4 cm, for HC, and 0.006 ± 0.02 cm for WHR. Intra-observer mean differences for manual measurements were 3.1 ± 1.9 cm for WC, 1.8 ± 2.2 cm for HC and 0.11 ± 0.1 cm for WHR. The 3D-scanner variability for WC was 1.3 ± 0.9 cm, for HC was 0.8 ± 0.1 and 0.005 ± 0.01 cm for WHR. All means were significantly different (p<0.05) between manual and automated methods. Conclusion The 3D-scanner is a more reliable and reproducible method for measuring WC, HC and WHR to detect central obesity

External validation of a deep learning electrocardiogram algorithm to detect ventricular dysfunction

Objective - To validate a novel artificial-intelligence electrocardiogram algorithm (AI-ECG) to detect left ventricular systolic dysfunction (LVSD) in an external population. Background - LVSD, even when asymptomatic, confers increased morbidity and mortality. We recently derived AI-ECG to detect LVSD using ECGs based on a large sample of patients treated at the Mayo Clinic. Methods - We performed an external validation study with subjects from the Know Your Heart Study, a cross-sectional study of adults aged 35–69 years residing in two cities in Russia, who had undergone both ECG and transthoracic echocardiography. LVSD was defined as left ventricular ejection fraction ≤ 35%. We assessed the performance of the AI-ECG to identify LVSD in this distinct patient population. Results - Among 4277 subjects in this external population-based validation study, 0.6% had LVSD (compared to 7.8% of the original clinical derivation study). The overall performance of the AI-ECG to detect LVSD was robust with an area under the receiver operating curve of 0.82. When using the LVSD probability cut-off of 0.256 from the original derivation study, the sensitivity, specificity, and accuracy in this population were 26.9%, 97.4%, 97.0%, respectively. Other probability cut-offs were analysed for different sensitivity values. Conclusions - The AI-ECG detected LVSD with robust test performance in a population that was very different from that used to develop the algorithm. Population-specific cut-offs may be necessary for clinical implementation. Differences in population characteristics, ECG and echocardiographic data quality may affect test performance

Cardiac rehabilitation availability and characteristics in Latin America and the Caribbean: A global comparison

Background: This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. Methods: In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. Results: ≥1 CR program was identified in 24 LAC countries (68.5% availability; median = 3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally P < .001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0 ± 2.3 staff (vs 6.0 ± 2.8 globally; P < .001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; P < .001). Median dose of CR was 36 sessions (vs 24 globally; P < .001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; P < .01). Conclusion: In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.This work was supported by a research grant from York University’s Faculty of Health, Toronto, Canada, and by project number LQ1605 from the National Program of Sustainability II (MEYS CR), Czech Republic

Treatments for giant cell arteritis: Meta-analysis and assessment of estimates reliability using the fragility index

International audienc

Clinical presentation and outcome of tricuspid regurgitation in patients with systolic dysfunction

Aims The impact of tricuspid regurgitation (TR) in patients with left ventricular systolic dysfunction on presentation and clinical outcome is uncertain due to confounding comorbidities and mediocre regurgitation ascertainment. Methods and results In a cohort of patients with left ventricular systolic dysfunction (ejection fraction, EF &lt; 50%) and functional TR (assessed quantitatively), we matched TR grade-groups for age, sex, EF, and TR velocity. Association of quantified TR (effective regurgitant orifice, ERO, severe if 650.4 cm 2) to clinical presentation and outcome was analysed. In the 291 cohort patients (age 70 \ub1 12 years) with left ventricular dysfunction (EF 31 \ub1 10%), functional TR ERO was 0.26 \ub1 0.3 cm 2. Presentation with right heart failure was strongly related to TR quantified severity [adjusted odds ratios were 4.15 (1.95-8.84), P = 0.0002 for moderate TR and 6.86 (3.34-14.1), P &lt; 0.0001 for severe TR]. Effective regurgitant orifice 650.4 cm 2 was associated with increased mortality [hazard ratio 1.6 (1.17-2.2), P = 0.003] unadjusted and after comprehensive adjustment [hazard ratio 1.8 (1.16-2.8), P = 0.009]. Furthermore, ERO 650.4 cm 2 was associated with increased cardiac events (mortality, new atrial fibrillation or heart failure) unadjusted [hazard ratio 1.9 (1.3-2.7), P = 0.002] and after comprehensive adjustment [hazard ratio 2.2 (1.1-4.6), P = 0.02]. Conclusion Tricuspid regurgitation, even moderate, is associated at diagnosis with more severe heart failure presentation. While moderate TR is associated with heart failure at presentation, our quantitative data show that the threshold associated with reduced survival and more cardiac events is ERO 650.4 cm 2. These data emphasize the clinical impact of functional TR and warrant large cohort-analysis and clinical trials of treatment of TR associated with left ventricular dysfunction

Clinical and Rehabilitative Predictors of Peak Oxygen Uptake Following Cardiac Transplantation

The measurement of peak oxygen uptake (VO2peak) is an important metric for evaluating cardiac transplantation (HTx) eligibility. However, it is unclear which factors (e.g., recipient demographics, clinical parameters, cardiac rehabilitation (CR) participation) influence VO2peak following HTx. Consecutive HTx patients with cardiopulmonary exercise testing (CPET) between 2007&ndash;2016 were included. VO2peak was measured from CPET standard protocol. Regression analyses determined predictors of the highest post-HTx VO2peak (i.e., quartile 4: VO2peak &gt; 20.1 mL/kg/min). One hundred-forty HTx patients (women: n = 41 (29%), age: 52 &plusmn; 12 years, body mass index (BMI): 27 &plusmn; 5 kg/m2) were included. History of diabetes (Odds Ratio (OR): 0.17, 95% Confidence Interval (CI): 0.04&ndash;0.77, p = 0.021), history of dyslipidemia (OR: 0.42, 95% CI: 0.19&ndash;0.93, p = 0.032), BMI (OR: 0.90, 95% CI: 0.82&ndash;0.99, p = 0.022), hemoglobin (OR: 1.29, 95% CI: 1.04&ndash;1.61, p = 0.020), white blood cell count (OR: 0.81, 95% CI: 0.66&ndash;0.98, p = 0.033), CR exercise sessions (OR: 1.10, 95% CI: 1.04&ndash;1.15, p &lt; 0.001), and pre-HTx VO2peak (OR: 1.17, 95% CI: 1.07&ndash;1.29, p = 0.001) were significant predictors. Multivariate analysis showed CR exercise sessions (OR: 1.10, 95% CI: 1.03&ndash;1.16, p = 0.002), and pre-HTx VO2peak (OR: 1.16, 95% CI: 1.04&ndash;1.30, p = 0.007) were independently predictive of higher post-HTx VO2peak. Pre-HTx VO2peak and CR exercise sessions are predictive of a greater VO2peak following HTx. These data highlight the importance of CR exercise session attendance and pre-HTx fitness in predicting VO2peak post-HTx

Investigating cognition in midlife

We here posit that measurements of midlife cognition can be instructive in understanding cognitive disorders. Even though molecular events signal possible onset of cognitive disorders decades prior to their clinical diagnoses, cognition and its possible early changes in midlife remain poorly understood. We characterize midlife cognition in a cognitively healthy population-based sample using the Cogstate Brief Battery and test for associations with cardiovascular, adiposity-related, lifestyle-associated, and psychosocial variables. Learning and working memory showed significant variability and vulnerability to psychosocial influences in midlife. Furthermore, midlife aging significantly and progressively increased prevalence of suboptimal cognitive performance. Our findings suggest that physiological changes in cognition, measured with simple tests suitable for use in everyday clinical setting, may signal already in midlife the first clinical manifestations of the presymptomatic biologically defined cognitive disorders. This pilot study calls for longitudinal studies investigating midlife cognition to identify clinical correlates of biologically defined cognitive disorders

Sleep duration and excessive daytime sleepiness are associated with obesity independent of diet and physical activity

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. In the European Union, Czech Republic ranks 3rd and 6th for the incidence of obesity and cardiovascular diseases, respectively. Worldwide, short sleep duration and excessive daytime sleepiness (EDS) characterize obese subjects, which in turn exhibit scarce physical activity and unhealthy diet. We aimed to understand the relationship between irregular sleep patterns, obesity and lifestyle factors, such as diet and physical activity, in a vulnerable Czech population. 1482 members of the Kardiovize cohort, a random sample of the Czech urban population, were included in a cross-sectional study. Exposure variables included self-reported sleep duration and EDS, assessed by the Epworth Sleepiness Scale. Primary outcomes were BMI and waist-to-hip ratio or prevalence of obesity and central obesity. Covariates included physical activity and diet. Associations and interactions between variables were evaluated using logistic regression analyses. After adjustment for covariates, short sleep duration (\u3c7 h) was associated with greater odds of overweight (BMI \u3e 25; OR = 1.42; 95%CI = 1.06–1.90; p = 0.020) and obesity (BMI \u3e 30; OR = 1.40; 95%CI = 1.02–1.94; p = 0.047), while EDS was associated with greater odds of central obesity (OR = 1.72; 95%CI = 1.06–2.79; p = 0.030), independent of diet and physical activity. However, due to the cross-sectional nature of our study, further prospective, large-scale studies are needed to evaluate the etiological link and causality between sleep disturbances and obesity