Artificial intelligence calculated global longitudinal strain and left ventricular ejection fraction predicts cardiac events and all-cause mortality in patients with chest pain

Background: Assessment of left ventricular ejection fraction (LVEF) and myocardial deformation with global longitudinal strain (GLS) has shown promise in predicting adverse cardiovascular events. The aim of this study was to evaluate whether artificial intelligence (AI) calculated LVEF and GLS is associated with major adverse cardiac events (MACE) and all-cause mortality in patients presenting with chest pain. Methods: We studied 296 patients presenting with chest pain, who underwent transthoracic echocardiography (TTE). Clinical data, downstream clinical investigations and patient outcomes were collected. Resting TTE images underwent AI contouring for automated calculation of LVEF and GLS with Ultromics EchoGo Core 2.0. Regression analysis was performed to identify clinical and AI calculated parameters associated with MACE and all-cause mortality. Results: During a median follow-up period of 7.8 years (IQR 6.4, 8.8), MACE occurred in 34 (11.5%) patients and all-cause mortality in 60 (20%) patients. AI calculated LVEF (Odds Ratio [OR] 0.96; 95% CI 0.93-0.99 and 0.96; 95% CI 0.93-0.99) and GLS (1.11; 95% CI 1.01-1.21 and 1.08; 95% CI 1.00-1.16) were independently associated with MACE and all-cause mortality, respectively. According to Cox proportional hazards, a LVEF -15% was associated with a 2.5 times MACE and 2.3 times all-cause mortality hazard rate compared to those with a GLS ≤-15. Conclusion: AI calculated resting LVEF and GLS is independently associated with MACE and all-cause mortality in high CVD risk patients. These results may have significant clinical implications through improved risk stratification of patients with chest pain, accelerated workflow of labour-intensive technical measures, and reduced healthcare costs

Radiation and contrast-free characterization of an unexpected mass during pregnancy

n/

Safety of contrast flash-replenishment stress echocardiography in 500 patients with a chest pain episode of undetermined origin within the last 5 days

n/

Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography

<p>Abstract</p> <p>Background</p> <p>We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI) for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE).</p> <p>Wall motion (WM) assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD), particularly in patients with isolated intermediate (50%-70%) coronary stenosis.</p> <p>Methods</p> <p>We performed DASE with MPI in 150 patients with a suspected chest pain syndrome who were given clinical indication to coronary angiography.</p> <p>Results and discussion</p> <p>When CAD was defined as the presence of a ≥50% stenosis, the addition of MPI increased sensitivity (+30%) and decreased specificity (-14%), with a final increase in total diagnostic accuracy (+16%, p < 0.001). The addition of MPI data substantially increased the sensitivity to detect patients with isolated intermediate stenosis from 37% to 98% (p < 0.001); the incremental sensitivity was much lower in patients with severe stenosis, from 85% to 96% (p < 0.05), at the expense of a higher decrease in specificity and a final decrease in total diagnostic accuracy (-18%, p < 0.001).</p> <p>Conclusions</p> <p>The addition of MPI on top of WM analysis during DASE increases the diagnostic sensitivity to detect obstructive CAD, whatever its definition (≥50% or > 70% stenosis), but it is mainly driven by the sensitivity increase in the intermediate group (50%-70% stenosis).</p> <p>The total diagnostic accuracy increased only when defining CAD as ≥50% stenosis, since in patients with severe stenosis (> 70%) the decrease in specificity is not counterbalanced by the minor sensitivity increase.</p

Comparative prediction of cardiac events by wall motion, wall motion plus coronary flow reserve, or myocardial perfusion analysis: a multicenter study of contrast stress echocardiography

ObjectivesThis study sought to determine whether the increasing difficulty of assessing wall motion (WM), Doppler coronary flow reserve on the left anterior descending coronary artery (CFR-LAD), and myocardial perfusion (MP) during stress echocardiography (SE) was justified by increasing prognostic information in patients with known or suspected coronary artery disease.BackgroundThe use of echocardiographic contrast agents during SE permits the assessment of both CFR-LAD and MP, but their relative incremental prognostic value is undefined.MethodsThis study followed a multicenter cohort of 718 patients for 16 months after high-dose dipyridamole contrast SE for evaluation of known or suspected coronary artery disease. The ability of WM, CFR-LAD, and MP to predict cardiac events was studied by multivariable models and risk reclassification.ResultsAbnormal SE was detected as a reversible WM abnormality in 18%, reversible MP defect in 27%, and CFR-LAD <2 in 38% of subjects. Fifty cardiac events occurred (annualized event rate 6.0%). A normal MP stress test had a 1-year hard event rate of 1.2%. The C-index of outcomes prediction based on clinical data was improved with MP (p < 0.001) and WM/CFR-LAD (p = 0.037), and MP (p = 0.003) added to clinical and WM data. Net risk reclassification was improved by adding MP (p < 0.001) or CFR-LAD (net reclassification improvement p = 0.001) in addition to clinical and WM data. The model including clinical data, WM/CFR-LAD, and MP performed better than that without MP did (p = 0.012).ConclusionsThe multiparametric assessment of WM, CFR-LAD and MP during stress testing in patients with known or suspected coronary artery disease is feasible. Contrast SE allowed better prognostication, irrespective of the use of CFR-LAD or MP. The addition of either CFR-LAD or MP assessment to standard WM analysis and clinical parameters yielded progressively higher values for the prediction of cardiac events and may be required in today's intensively treated patients undergoing SE, because their average low risk of future cardiac events requires methods with higher predictive sensitivity than that available with standalone WM assessment

Creation, Contingency, and Early Modern Science: The Impact of Voluntarist Theology on Seventeenth-Century Natural Philosophy

Could God have made it true that 2 + 2 = 5? Was he bound to make the best of all possible worlds? Is he able at this moment to alter the course of nature, either in whole or in part? Questions like these are often associated with medieval theology, not with early modern science. But science is done by people, and people have not always practiced the rigorous separation of science and theology that has come to characterize the modern world. Although many 17th century scientists sought validity for their work apart from revelation, divorcing science from religion was something they never intended. Indeed most natural philosophers of the scientific revolution assumed without question that the world and the human mind had been created by God. This was no small admission, for it meant that both the manner in which and the degree to which the world could be understood depended upon how God had acted in creating it and how he continued to act in sustaining it. Fifty years ago the late British philosopher M.B. Foster identified two different theologies of creation which differ profoundly in their implications for natural science. Rationalist theology, which assigns to God the activity of pure reason, involves both a rationalist X philosophy of nature and a rationalist theory of knowledge of nature. Voluntarist theology, which attributes to God an activity of will not wholly determined by reason, implies that the products of his creative activity are contingent and can be known only empirically. By a careful analysis of four natural philosophies of the early modern period--those of Galileo, Descartes, Boyle, and Newton--! intend to show that there was indeed a connection between theological voluntarism and empirical science in the 17th century

The histopathological correlate of peri-vascular adipose tissue attenuation on computed tomography in surgical ascending aorta aneurysms: Is this a measure of tissue inflammation?

On computed tomography (CT) imaging, a peri-vascular adipose tissue attenuation (pVAT) measure has been proposed as a non-invasive correlate of inflammation in the coronary artery vessels, and a single research group provided histopathological demonstration of this radiologi-cal/pathological correspondence. Our group has shown that patients with surgical-grade ascending aorta (AA) aneurysm display higher pVAT compared with patients with smaller aneurysms or normal AA. Based on histopathological studies on coronary arteries, we speculated that this correlation may be related to a non-otherwise specified aortic inflammatory process. However, since adipose tissue around the AA is often scant, and there are no histopathological studies confirming such hypothesized association between higher pVAT and inflammation around the AA, we cannot exclude that this pVAT change is secondary to different mechanisms, unrelated to the actual presence of peri-vascular inflammation. We performed a retrospective clinical/radiological/pathological study in 78 patients who underwent AA surgery with the aim to correlate pre-operatory pVAT on CT with histopathological findings from the surgical specimens. Histopathological review and immunohisto-chemistry were performed on the surgical aortic samples. The AA adventitial/periadventitial adipose tissue had higher pVAT by an increasing collagen fiber deposition, which progressively makes the fat hypotrophic and, in the late stages of this process, it replaces the normal soft tissue composition in this location. In the ascending aorta, pVAT on CT imaging is probably not a proxy for the presence of current vascular inflammation, although it may track changes involving the progressive substitution of perivascular adipose cells by higher-pVAT tissues, mainly fibrotic replacement

Human coronary inflammation by computed tomography: Relationship with coronary microvascular dysfunction

Background A new imaging metric using coronary computed tomography angiography (CCTA), addressing the peri-coronary adipose tissue (PCAT) computed tomography (CT) attenuation, has been clinically validated. This method provides information regarding coronary inflammation. It is unclear how coronary inflammation affects microvascular function. The non-invasive evaluation of coronary flow velocity reserve is widely used in clinical practice using Doppler measurement on the left anterior descending coronary artery (CFVR-lad) during stress-echocardiography (SE). We hypothesize that coronary inflammation affects CFVR-lad and, in the absence of overt CAD, they are significantly correlated. Methods We evaluated the relationship between coronary inflammation (by PCAT CT attenuation) and coronary microvascular function (by CFVR-lad) in subjects with no or non-obstructive (diameter stenosis &lt;70%) coronary artery disease (CAD). Results Two-hundred and two subjects were enrolled in the study. The relationship between PCAT CT attenuation and CFVR-lad show a significant inverse relationship in the entire group of subjects enrolled in the study (r = −0.32, p &lt; 0.001). Correlation between PCAT CT attenuation and CFVR-lad was significant in subjects with no or mild CAD-lad, while this was not the case in subjects with intermediate CAD-lad. The R and R2 were respectively −0.40, −0.16 in subjects without CAD (p &lt; 0.001) and − 0.35 and − 0.12 in subjects with mild CAD-lad (p = 0.001). Conclusions The main finding of the current study is the independent relationship between coronary microvascular function, by Doppler CFVR-lad during SE, in subjects without severely obstructive CAD in the left anterior descending coronary artery, and the level of local coronary inflammation, by PCAT attenuation measurement on CCTA