Ejection Fraction, Biomarkers, and Outcomes and Impact of Vericiguat on Outcomes Across EF in VICTORIA

Background: Vericiguat reduced the risk of cardiovascular death (CVD) or hospitalization for heart failure (HF) in patients with worsening HF and reduced left ventricular ejection fraction (LVEF).Objectives: The authors assessed the association of LVEF with biomarker levels, risk of outcome, and whether the effect of vericiguat was homogeneous across LVEF in the VICTORIA (Vericiguat Global Study in Subjects with Heart Failure With Reduced Ejection Fraction) trial.Methods: Patients were grouped by LVEF tertiles (≤24%, 25%-33%, and &gt;33%). Patient characteristics, clinical outcomes, and efficacy and safety of vericiguat were examined by tertile. Prespecified biomarkers including N-terminal pro–B-type natriuretic peptide, cardiac troponin T, growth differentiation factor 15, interleukin 6, high-sensitivity C-reactive protein, and cystatin C were examined.Results: The mean LVEF was 29% ± 8% (range: 5%-45%). A pattern of higher N-terminal pro–B-type natriuretic peptide, high-sensitivity C-reactive protein, and interleukin 6 was evident in patients in the lowest LVEF tertile vs the other tertiles. Patients with lower LVEF experienced higher rates of the composite outcome (41.7%, 36.3%, and 33.4% for LVEF ≤24, 25-33, and &gt;33; P &lt; 0.001). There was no significant treatment effect heterogeneity of vericiguat across LVEF groups (adjusted HR from lowest to highest tertiles: 0.79 [95% CI: 0.68-0.94]; 0.95 [95% CI: 0.82-1.11]; 0.94 [95% CI: 0.79-1.11]; P for interaction = 0.222), although the HR was numerically lower in the lowest tertile. There was also no heterogeneity of effect for CVD and HF hospitalization individually (P interaction for CVD = 0.964; HF hospitalization = 0.438). Discontinuation of treatment because of adverse events, symptomatic hypotension, or syncope was consistent across the range of LVEF.Conclusions: Patients with lower LVEF had a distinctive biomarker profile and a higher risk for adverse clinical outcomes vs those with a higher LVEF. There was no significant interaction for the benefit of vericiguat across LVEF tertiles, although the largest signal for benefit in both the primary outcome and HF hospitalizations was noted in tertile 1 (LVEF ≤24%).</p

Hemoglobin and Clinical Outcomes in the Vericiguat Global Study in Patients With Heart Failure and Reduced Ejection Fraction (VICTORIA)

BACKGROUND: In the VICTORIA trial (Vericiguat Global Study in Patients with Heart Failure with Reduced Ejection Fraction), anemia occurred more often in patients treated with vericiguat (7.6%) than with placebo (5.7%). We explored the association between vericiguat, randomization hemoglobin, development of anemia, and whether the benefit of vericiguat related to baseline hemoglobin. METHODS: Anemia was defined as hemoglobin <13.0 g/dL in men and <12.0 g/dL in women (World Health Organization Anemia). Adverse events reported as anemia were also evaluated. We assessed the risk-adjusted relationship between hemoglobin and hematocrit with the primary outcome (composite of cardiovascular death or heart failure hospitalization) and the time-updated hemoglobin relationship to outcomes. RESULTS: At baseline, 1719 (35.7%) patients had World Health Organization anemia; median hemoglobin was 13.4 g/L (25th, 75th percentile: 12.1, 14.7 g/dL). At 16 weeks from randomization, 1643 patients had World Health Organization anemia (284 new for vericiguat and 219 for placebo), which occurred more often with vericiguat than placebo (P<0.001). After 16 weeks, no further decline in hemoglobin occurred over 96 weeks of follow-up and the ratio of hemoglobin/hematocrit remained constant. Overall, adverse event anemia occurred in 342 patients (7.1%). A lower hemoglobin was unrelated to the treatment benefit of vericiguat (versus placebo) on the primary outcome. In addition, analysis of time-updated hemoglobin revealed no association with the treatment effect of vericiguat (versus placebo) on the primary outcome. CONCLUSIONS: Anemia was common at randomization and lower hemoglobin was associated with a greater frequency of clinical events. Although vericiguat modestly lowered hemoglobin by 16 weeks, this effect did not further progress nor was it related to the treatment benefit of vericiguat. Registration: URL: https://www.clinicaltrials.gov: Unique identifier: NCT02861534

Image Bi-Level Thresholding Based on Gray Level-Local Variance Histogram

Thresholding is a popular method of image segmentation. Many thresholding methods utilize only the gray level information of pixels in the image, which may lead to poor segmentation performance because the spatial correlation information between pixels is ignored. To improve the performance of thresolding methods, a novel two-dimensional histogram—called gray level-local variance (GLLV) histogram—is proposed in this paper as an entropic thresholding method to segment images with bimodal histograms. The GLLV histogram is constructed by using the gray level information of pixels and its local variance in a neighborhood. Local variance measures the dispersion of gray level distribution of pixels in a neighborhood. If a pixel’s gray level is close to its neighboring pixels, its local variance is small, and vice versa. Therefore, local variance can reflect the spatial information between pixels. The GLLV histogram takes not only the gray level, but also the spatial information into consideration. Experimental results show that an entropic thresholding method based on the GLLV histogram can achieve better segmentation performance

Efficient Ohmic Contact in Monolayer CrX2N4 (X = C, Si) Based Field‐Effect Transistors

Abstract Developing Ohmic contact systems or achieving low contact resistance is significant for high‐performance semiconductor devices. This work comprehensively investigates the interfacial properties of CrX2N4 (X = C, Si) based field‐effect transistors (FETs) with different metal (Ag, Au, Cu, Ni, Pd, Pt, Ti, and graphene) electrodes by using electronic structure calculations and quantum transport simulations. It is highlighted that the stronger interlayer coupling allows CrC2N4 to form an n‐type Ohmic contact with Ti electrode in the vertical direction. Furthermore, the absence of tunneling barrier at the CrC2N4–Ti interface greatly improves the electron injection efficiency. On the other hand, the studied metals form Schottky contact with CrC2N4 at the lateral interface due to Fermi level pinning (FLP) effects. Surprisingly, the strong FLP effects restrict the Schottky barrier heights of CrSi2N4‐metal contacts to a narrow range. Where Ag, Au, Ni, Pd, Pt, Ti electrodes and Ag, Ti electrodes form ideal ohmic contact with CrSi2N4 in the vertical and lateral directions, respectively, while the other metals form quasi‐ohmic contact. Ti exhibits the highest contact performance as the electrode in both CrC2N4 and CrSi2N4 based FETs. The findings may provide fundamental understanding for designing high‐performance and energy‐efficient FETs based on CrX2N4