070: Heterogeneity in regional peaks of left ventricular deformation is correlated with exercise capacity in primitive hypertrophic cardiomyopathy

ObjectivePrevious studies have described a left ventricular (LV) heterogeneity in regional peaks of deformation in patients with primitive hypertrophic cardiomyopathy (HCM). We studied this heterogeneity in HCM patients with echocardiography both at rest and during exercise in order to evaluate its correlation with exercise capacity.MethodsThirty consecutive HCM patients were evaluated with echocardiography at rest and during exercise on a dedicated table. 2D speckle tracking echocardiography (STE) was used to assess LV deformation heterogeneity according to the standard deviation between systolic peaks of regional longitudinal strains.ResultsAge was 55.1±12.7 yrs, maximal wall thickness was 20.3±.4mm. Maximal load during exercise was 94±41 Watts. LV ejection fraction was preserved both at rest and during exercise (67±8% at rest and 69±8% during exercise). Global longitudinal strain (GLS) was altered (-15.5±4.1% at rest and -15.2±5.9% during exercise). Heterogeneity in regional peaks of deformation was 54.6±27.8ms at rest and 41.3±23.9ms during exercise. We noted correlations between maximal load achieved (r=-0.48, p=0.007), exercise GLS (r=0.47, p=0.009) and maximal LV thickness (r=0.48, p=0.007) with the level of LV deformation heterogeneity recorded during exercise. These correlations were lower if we considered LV deformation heterogeneity at rest. The population was then divided in 2 groups according to the level of exercise heterogeneity in regional peaks of deformation (cut-off value of 41ms, i.e. mean value of the global population). The group with the more marked heterogeneity of LV deformation showed the thicker wall, the lower GLS at exercise and the weaker exercise capacity. This result was independent of the age.ConclusionIn CMH patients exercise echocardiography add information. Indeed heterogeneity in regional peaks of deformation in longitudinal LV is correlated with exercise capacity and importance of myocardial hypertrophy

The Role of Sound Source Perception in Gestural Sound Description

We investigated gesture description of sound stimuli performed during a listening task. Our hypothesis is that the strategies in gestural responses depend on the level of identification of the sound source, and specifically on the identification of the action causing the sound. To validate our hypothesis, we conducted two experiments. In the first experiment, we built two corpora of sounds. The first corpus contains sounds with identifiable causal actions. The second contains sounds where no causal actions could be identified. These corpora properties were validated through a listening test. In the second experiment, participants performed arm and hand gestures synchronously while listening to sounds taken from these corpora. Afterwards, we conducted interviews asking participants to verbalize their experience, watching their own video recordings. They were questioned on their perception of the listened sounds and on their gestural strategies. We showed that for the sounds where causal action can be identified, participants mainly mimic the action that has produced the sound. In the other case, when no action can be associated to the sound, participants trace contours related to sound acoustic features. We also found that the inter-participants gesture variability is higher for causal sounds compared to non-causal sounds. Variability demonstrates that in the first case, participants have several ways of producing the same action whereas in the second case, the sound features tend to make the gesture responses consistent

Reliability and Initial Validation of the Ulcerative Colitis Endoscopic Index of Severity

Background & AimsWe studied the reliability of the previously described Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and validated it with an independent cohort of investigators.MethodsWe created a new library of 57 videos of flexible sigmoidoscopy and stratified them based on disease severity. Twenty-five investigators were each randomly assigned to assess 28 videos (which included 4 duplicates to assess intraobserver reliability). Investigators were blinded to clinical details except for 2 of 4 duplicated videos (to assess the impact of knowledge of symptoms on assessment). Three descriptors (“vascular pattern”, “bleeding”, and “erosions and ulcers”) comprising the UCEIS were scored with a visual analogue scale (VAS) to assess overall severity. Intrainvestigator and interinvestigator agreement was characterized by κ statistical analysis; reliability ratios were used to compare VAS and UCEIS scores.ResultsThere was a high level of correlation between UCEIS scores and overall assessment of severity (correlation coefficient, 0.93). Internal consistency (Cronbach α analysis) was 0.86. Intrainvestigator and interinvestigator reliability ratios for UCEIS scores were 0.96 and 0.88, respectively. Intrainvestigator agreement in determination of the UCEIS score was good (κ = 0.72), with individual descriptors ranging from a κ of 0.47 (for bleeding) to 0.87 (for vascular pattern). Interinvestigator agreement in determination of UCEIS scores was moderate (κ = 0.50), with descriptors ranging from a κ of 0.48 (for bleeding) to 0.54 (for vascular pattern). Intrainvestigator variability in determining UCEIS scores did not change appreciably when a video was presented with clinical details.ConclusionsThe UCEIS and its components show satisfactory intrainvestigator and interinvestigator reliability. Among investigators, the UCEIS accounted for a median of 86% of the variability in evaluation of overall severity on the VAS when assessing the endoscopic severity of UC and was unaffected by knowledge of clinical details

Mapping Through Listening

Gesture-to-sound mapping is generally defined as the association between gestural and sound parameters. This article describes an approach that brings forward the perception-action loop as a fundamental design principle for gesture–sound mapping in digital music instrument. Our approach considers the processes of listening as the foundation – and the first step – in the design of action-sound relationships. In this design process, the relationship between action and sound is derived from actions that can be perceived in the sound. Building on previous works on listening modes and gestural descriptions we proposed to distinguish between three mapping strategies: instantaneous, temporal, and metaphoric. Our approach makes use of machine learning techniques for building prototypes, from digital music instruments to interactive installations. Four different examples of scenarios and prototypes are described and discussed

Developing an instrument to assess the endoscopic severity of ulcerative colitis : The Ulcerative Colitis Endoscopic Index of Severity (UCEIS)

Full list of Investigators is given at the end of the article.Background: Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC). Objective: To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated. Design: A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0-11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0-100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors. Results: There was 76% agreement for 'severe', but 27% agreement for 'normal' appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/ complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR2, Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity). Conclusion: The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall assessment of endoscopic severity of UC. Validity and responsiveness need further testing before it can be applied as an outcome measure in clinical trials or clinical practice.publishersversionPeer reviewe

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Republication de: Trop de sport délétère pour le cœur ?

National audiencePhysical activity is beneficial for health. Intense sport practice can induce an acute cardiac event in case of underlying heart disease. Sports activity can accelerate the progression of some cardiopathies. In a small number of subjects, excessive sports activity may be the cause of complications: atrial fibrillation, coronary calcifications, aortic dilatation, exercise induced arrhythmogenic right ventricular cardiopathy. It is difficult to predict who will develop these rare deleterious effects and studies on this subject must be continued. © 2020 Elsevier Masson SA

Les limites de l'ECG du sportif

National audienc

Republication de : ECG du sportif : distinguer le normal du pathologique

National audienceAn ECG is recommended by the French Society of Cardiology in the screening of a competitive athlete. An intense and prolonged physical activity (> 4 hours of intense sport/week) can lead to a physiological electric remodeling. In addition to physical activity (type, intensity, duration), the ECG should be interpreted according to the athlete's ethnicity and age. It is necessary to know the physiological modifications related to sport practice to avoid either false reassurances or the realization of unjustified additional examinations because of a wrong interpretation. The latest athlete ECG classification published in 2017 can be used to identify in which athlete additional tests are recommended (figure 1). © 2019 Elsevier Masson SASPoints essentiels La réalisation d’un ECG est recommandée par la société française de cardiologie lors de la visite d’absence de contre-indication à la pratique sportive. L’activité physique intense et prolongée (> 4 heures de sport intense/semaine) peut entrainer un remodelage électrique d’origine physiologique. Outre l’activité physique (type, intensité, durée), il convient d’interpréter l’ECG en fonction de l’origine ethnique et de l’âge du sportif. Il est nécessaire de connaître les modifications physiologiques en lien avec la pratique sportive pour éviter d’une part les fausses réassurances et d’autre part la réalisation d’examens complémentaires injustifiés du fait d’une mauvaise interprétation. La dernière classification internationale de l’ECG de l’athlète publiée en 2017 permet de repérer chez quel athlète des examens complémentaires sont recommandés (figure 1)