Automatic Detection of Cardiomyopathy in Cardiac Left Ventricle Ultrasound Images

This paper presents development of an automatic diagnostic tool based on machine learning that analyses cardiac ultrasound images of patients with cardiomyopathy in several views (4 chamber apical,2 chamber apical and M mode view). The main aim of the developed tool is to perform automatic left ventricle (LV) segmentation and to extract relevant parameters in order to estimate the severeness of cardiomyopathy in patients. Dataset included 1809 images with apical view and 53 images with M view from real patients collected at three Clinical Centers in UK and Serbia. Separate methodologies have been implemented for analyzing apical and M mode view,including U-net for segmentation,after which parameters such as left ventricular length (LVL),internal dimension (LVID),posterior wall thickness (LVPW) and interventricular septum thickness (IVS) are calculated,both in systole and diastole. The tool has also been implemented on the platform with a user-friendly interface,which allows these two modules to be used either separately or combined. In order to validate the model and compare the results between gold standard and developed methodology,two cardiology specialists have independently manually annotated LV and measured relevant parameters. The results show that the model achieves dice coefficient of 92.091% for segmentation and average root mean square error (RMSE) of 0.3052cm for parameter extraction in apical view images and average RMSE of 1.3548cm for parameter extraction in M mode view. Fully automatic detection of cardiomyopathy in cardiac LV ultrasound images can help clinicians in supporting diagnostic decision making and prescribing adequate therapy

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

The effects of combined physical procedures on the functional status of patients with diabetic polyneuropathy

Background/Aim. Diabetic polyneuropathy is a common chronic complication in patients with diabetes mellitus. The aim of this study was to determine the importance of applied physical procedures on the functional status of diabetic polyneuropathy patients compared to the group of respondents treated by alpha-lipoic acid. Methods. Sixty subjects were divided into two groups: group A – diabetic polyneuropathy patients treated with physical procedures, and group B – diabetic polyneuropathy patients treated with alpha-lipoic acid. The study has lasted for three diagnostic and therapeutic cycles, each lasting for 16 days with a time between cycles of 6 weeks. Results. Manual muscle test, range of motion, Michigan Neuropathy Screening Instrument, and Berg balance scale values showed statistically significant improvement at the end of testing group A respondents, while no improvement was shown in group B respondents. Conclusion. The application of the combined physical procedures shows clear benefits for the improvement of muscle strength and mobility of the ankle joint in respondents with diabetic polyneuropathy

Focal Myocarditis in Professonal Female Athlete: A Case Report

A 35-year-old female athlete appealed to her sports physician on new onset of frequent palpitations, just before an important competition. Initial electrocardiography revealed unifocal premature ventricular complexes in the form of bigeminy. Echocardiography revealed fine-granulated hyperdensic changes in septum. Global strain rate was within a range normal, as well as pulsed tissue Doppler ultrasound. Patient was referred for cardiac MRI, which revealed interventricular septum with rougher compounds, but with preserved continuity, with thickness of 10 mm, which is in the middle of the LV, in length of 5 mm, thinned to a thickness of 4 mm. ELISA laboratory test demonstrated an increased titer of IgM antibodies for adenovirus. Six months later, the patient was referred for control MRI of the heart, which showed pronounced trabeculation of infero-lateral wall of the left ventricle, but without certain criteria for non-compaction cardiomyopathy. There was T1 oedema component in apical septal segment and apical segment of the left ventricle. There was increase of the signal in late gadolinium enhancement in the medial parts of the same segments but also in the segment of the basomedial septum, with previous focal myocarditis. These findings suggest myocardial fibrosis in the segments that were stricken by myocarditis, now without active ongoing myocarditis, but without consequent myocardial fibrosis

Multisystem inflammatory syndrome in a young adult successfully treated with plasmapheresis, immunoglobulins, and corticosteroids: a case report

A novel condition named multisystem inflammatory syndrome has raised the alarm worldwide and is leading to severe illness and long-term effects in the post-COVID era. This condition includes infection with fever, abdominal symptoms, acute cardiac injury, and shock. It has similarities with severe forms of Kawasaki disease (KD). In this study, we present a case of a 20-year-old male patient with multisystem inflammatory syndrome associated with COVID-19 infection who was successfully treated with plasmapheresis, immunoglobulins, and steroids for 4 h/day without heparinization or ultrafiltration. Plasmapheresis represents a therapeutic option for KD in patients with all other therapeutic strategies that have failed. However, there is no evidence from controlled clinical trials confirming this option. In our case, plasmapheresis was beneficial in stabilizing and improving the patient's clinical condition. Given the pathophysiological and therapeutic similarities between KD and multisystem inflammatory syndrome, it could be considered a therapeutic option

Cardiopulmonary exercise test in the detection of unexplained post-COVID-19 dyspnea: A case report

There is emerging evidence of prolonged recovery in survivors of coronavirus disease 2019 (COVID-19), even in those with mild COVID-19. In this paper, we report a case of a 39-year-old male with excessive body weight and a history of borderline values of arterial hypertension without therapy, who was mainly complaining of progressive dyspnea after being diagnosed with mild COVID-19. According to the recent guidelines on the holistic assessment and management of patients who had COVID-19, all preferred diagnostic procedures, including multidetector computed tomography (CT), CT pulmonary angiogram, and echocardiography, should be conducted. However, in our patient, no underlying cardiopulmonary disorder has been established. Therefore, considering all additional symptoms our patient had beyond dyspnea, our initial differential diagnosis included anxiety-related dysfunctional breathing. However, psychiatric evaluation revealed that our patient had only a mild anxiety level, which was unlikely to provoke somatic complaints. We decided to perform further investiga-tions considering that cardiopulmonary exercise test (CPET) represents a reliable diagnostic tool for patients with unexplained dyspnea. Finally, the CPET elucidated the diastolic dysfunction of the left ventricle, which was the most probable cause of progressive dyspnea in our patient. We suggested that, based on uncontrolled cardiovascular risk factors our patient had, COVID-19 triggered a subclinical form of heart failure (HF) with preserved ejection fraction (HFpEF) to become clinically manifest. Recently, the new onset, exacerbation, or transition from subclinical to clinical HFpEF has been associated with COVID-19. Therefore, in addition to the present literature, our case should warn physicians on HFpEF among survivors of COVID-19

Does the severity of obstructive sleep apnea have an independent impact on systemic inflammation?

Background and Objectives: This paper aims to show whether obstructive sleep apnea (OSA) severity increases the level of systemic inflammation markers regardless of body mass index (BMI) and body composition. Materials and Methods: In total, 128 patients with OSA were included in the study. Examinees were divided into two groups: one with mild OSA (apnea–hypopnea index (AHI) < 15) and one with moderate and severe OSA (AHI ≥ 15). Nutritional status was assessed using body mass index, body composition by dual X-ray absorptiometry. Systemic inflammation was assessed on the basis of plasma concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and serum level of C-reactive protein (CRP). Results: We found elevated mean values of the evaluated systemic inflammation markers (CRP, TNF-α, IL-6) in a group with AHI ≥ 15, although there was no statistical significance. Our research found a significant positive correlation with BMI (r = 0.633, p < 0.001), as well as with body fat percentage (r = 0.450, p = 0.024) and serum CRP values. Significant correlation was found between the plasma IL-6 concentration and body fat percentage (FM%) (r = 0.579, p = 0.003) and lean body mass (r = −0.501, p = 0.013). Multivariate regression analysis did not show any independent predictor (parameters of OSA, nutritional status, body composition) of the systemic inflammation markers. Conclusions: Neither one tested parameter (nutritional status and body composition) of the severity of OSA was identified as an independent prognostic factor for the severity of systemic inflammation in patients with OSA