Assessment of the relationships between myocardial contractility and infarct tissue revealed by serial magnetic resonance imaging in patients with acute myocardial infarction

Imaging changes in left ventricular (LV) volumes during the cardiac cycle and LV ejection fraction do not provide information on regional contractility. Displacement ENcoding with Stimulated Echoes (DENSE) is a strain-encoded cardiac magnetic resonance (CMR) technique that measures strain directly. We investigated the relationships between strain revealed by DENSE and the presence and extent of infarction in patients with recent myocardial infarction (MI). 50 male subjects were invited to undergo serial CMR within 7 days of MI (baseline) and after 6 months (follow-up; n = 47). DENSE and late gadolinium enhancement (LGE) images were acquired to enable localised regional quantification of peak circumferential strain (Ecc) and the extent of infarction, respectively. We assessed: (1) receiver operating characteristic (ROC) analysis for the classification of LGE, (2) strain differences according to LGE status (remote, adjacent, infarcted) and (3) changes in strain revealed between baseline and follow-up. 300 and 258 myocardial segments were available for analysis at baseline and follow-up respectively. LGE was present in 130/300 (43 %) and 97/258 (38 %) segments, respectively. ROC analysis revealed moderately high values for peak Ecc at baseline [threshold 12.8 %; area-under-curve (AUC) 0.88, sensitivity 84 %, specificity 78 %] and at follow-up (threshold 15.8 %; AUC 0.76, sensitivity 85 %, specificity 64 %). Differences were observed between remote, adjacent and infarcted segments. Between baseline and follow-up, increases in peak Ecc were observed in infarcted segments (median difference of 5.6 %) and in adjacent segments (1.5 %). Peak Ecc at baseline was indicative of the change in LGE status between baseline and follow-up. Strain-encoded CMR with DENSE has the potential to provide clinically useful information on contractility and its recovery over time in patients with MI

Feature-tracking myocardial strain in healthy adults- a magnetic resonance study at 3.0 tesla

We analyzed feature-tracking derived circumferential and longitudinal strain in healthy volunteers who underwent cardiac magnetic resonance imaging (CMR) at 3.0 T. 88 healthy adults (44.6 ± 18.0 years old, 49% male), without prior cardiovascular disease, underwent CMR at 3.0 T including cine, and late gadolinium enhancement in subjects >45 years. LV functional analysis and feature-tracking strain analyses were carried out. Global strain had better reproducibility than segmental strain. There was a sex specific difference global longitudinal strain (mean ± SD, −18.48 ± 3.65% (male), −21.91 ± 3.01% (female), p < 0.001), but not global circumferential strain (mean ± SD, −25.41 ± 4.50% (male), −27.94 ± 3.48% (female), p = 0.643). There was no association of strain with ageing after accounting for sex for both global longitudinal and circumferential strain. Feature-tracking strain analysis is feasible at 3.0 T. Healthy female volunteers demonstrated higher magnitudes of global longitudinal strain when compared to male counterparts. Whilst global cine-strain has good reproducibility, segmental strain does not

Early Contrast Enhancement: a novel Magnetic Resonance Imaging biomarker of pleural malignancy

Introduction: Pleural Malignancy (PM) is often occult on subjective radiological assessment. We sought to define a novel, semi-objective Magnetic Resonance Imaging (MRI) biomarker of PM, targeted to increased tumour microvessel density (MVD) and applicable to minimal pleural thickening. Materials and methods: 60 consecutive patients with suspected PM underwent contrast-enhanced 3-T MRI then pleural biopsy. In 58/60, parietal pleura signal intensity (SI) was measured in multiple regions of interest (ROI) at multiple time-points, generating ROI SI/time curves and Mean SI gradient (MSIG: SI increment/time). The diagnostic performance of Early Contrast Enhancement (ECE; which was defined as a SI peak in at least one ROI at or before 4.5 min) was compared with subjective MRI and Computed Tomography (CT) morphology results. MSIG was correlated against tumour MVD (based on Factor VIII immunostain) in 31 patients with Mesothelioma. Results: 71% (41/58) patients had PM. Pleural thickening was <10 mm in 49/58 (84%). ECE sensitivity was 83% (95% CI 61–94%), specificity 83% (95% CI 68–91%), positive predictive value 68% (95% CI 47–84%), negative predictive value 92% (78–97%). ECE performance was similar or superior to subjective CT and MRI. MSIG correlated with MVD (r = 0.4258, p = .02). Discussion: ECE is a semi-objective, perfusion-based biomarker of PM, measurable in minimal pleural thickening. Further studies are warranted

What are patient perspectives in atypical and idiopathic Parkinson’s disease of the benefits and timing of ACP and palliative care input? A rapid review

Parkinson’s Disease (PD) is a progressive neurological condition affecting 145,000 people living in the UK. The disease trajectory is both unpredictable and highly variable with a re-cent review of patients dying with a diagnosis of idiopathic PD in Cardiff, (personal commu-nication) showed the time from diagnosis to death ranged from 2-23 years. The review also showed that fewer than 5% of patients had any documented advanced care planning (ACP) and only 8.5% had been referred to a palliative care service prior to being in their last days of life in hospital. This rapid review aims to examine the evidence on patient perception of these issues. The review findings will be used to identify patients perspectives on the benefit and timing of advanced care planning (ACP) and palliative care team involvement and subsequently a Cardiff and Vale University Health Board development project enhancing palliative care in advanced Parkinson’s Disease

Comparing the interobserver reproducibility of different regions of interest on multi-parametric renal magnetic resonance imaging in healthy volunteers, patients with heart failure and renal transplant recipients

Objective: To assess interobserver reproducibility of different regions of interest (ROIs) on multi-parametric renal MRI using commercially available software. Materials and methods: Healthy volunteers (HV), patients with heart failure (HF) and renal transplant recipients (Tx) were recruited. Localiser scans, T1 mapping and pseudo-continuous arterial spin labelling (pCASL) were performed. HV and Tx also underwent diffusion-weighted imaging to allow calculation of apparent diffusion coefficient (ADC). For T1, pCASL and ADC, ROIs were drawn for whole kidney (WK), cortex (Cx), user-defined representative cortex (rep-Cx) and medulla. Intraclass correlation coefficient (ICC) and coefficient of variation (CoV) were assessed. Results: Forty participants were included (10 HV, 10 HF and 20 Tx). The ICC for renal volume was 0.97 and CoV 6.5%. For T1 and ADC, WK, Cx, and rep-Cx were highly reproducible with ICC ≥ 0.76 and CoV < 5%. However, cortical pCASL results were more variable (ICC > 0.86, but CoV up to 14.2%). While reproducible, WK values were derived from a wide spread of data (ROI standard deviation 17% to 55% of the mean value for ADC and pCASL, respectively). Renal volume differed between groups (p < 0.001), while mean cortical T1 values were greater in Tx compared to HV (p = 0.009) and HF (p = 0.02). Medullary T1 values were also higher in Tx than HV (p = 0.03), while medullary pCASL values were significantly lower in Tx compared to HV and HF (p = 0.03 for both). Discussion: Kidney volume calculated by manually contouring a localiser scan was highly reproducible between observers and detected significant differences across patient groups. For T1, pCASL and ADC, Cx and rep-Cx ROIs are generally reproducible with advantages over WK values

A Randomized Controlled Trial of the Effect of Allopurinol on Left Ventricular Mass Index in Hemodialysis Patients

Introduction: Increased left ventricular mass index (LVMI) is associated with mortality in end-stage renal disease. LVMI regression may improve outcomes. Allopurinol has reduced LVMI in randomized controlled trials in chronic kidney disease, diabetes, and ischemic heart disease. This study investigated whether allopurinol would regress LVMI in hemodialysis patients. Methods: This was a randomized placebo-controlled double-blind multicenter trial. A total of 80 patients undergoing regular maintenance hemodialysis were recruited from NHS Tayside, NHS Greater Glasgow and Clyde and NHS Ayrshire and Arran in Scotland, UK. Participants were randomly assigned on a 1:1 ratio to 12 months of therapy with allopurinol 300 mg or placebo after each dialysis session. The primary outcome was change in LVMI, as assessed by cardiac magnetic resonance imaging (MRI) at baseline and 12 months. Secondary outcomes were change in BP, flow-mediated dilation (FMD), augmentation indices (AIx), and pulse wave velocity (PWV). Results: A total of 53 patients, with a mean age of 58 years, completed the study and had MRI follow-up data for analysis. Allopurinol did not regress LVMI (change in LVMI: placebo +3.6 ± 10.4 g/m2; allopurinol: +1.6 ± 11 g/m2; P = 0.49). Allopurinol had no demonstrable effect on BP, FMD, AIx, or PWV. Conclusion: Compared with placebo, treatment with allopurinol did not regress LVMI in this trial

Dialogue across Indigenous, local and scientific knowledge systems reflecting on the IPBES Assessment on Pollinators, Pollination and Food Production

The Dialogue across Indigenous, local and scientific knowledge systems reflecting on the IPBES Assessment on Pollinators, Pollination and Food Production report presents the main outcomes of a Dialogue across Indigenous, local and scientific knowledge systems that revisited and reflected on the key messages derived from the Assessment Report on Pollinators, Pollination and Food Production of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES). The Dialogue was hosted from the 21st to the 25th of January 2019 by the Karen community of Hin Lad Nai, Chiang Rai, Thailand, and it was co-convened and jointly designed by the Inter Mountain Peoples Education and Culture in Thailand Association (IMPECT) and Pgakenyaw Association for Sustainable Development (PASD) together with SwedBio at the Stockholm Resilience Centre and UNESCO Natural Science Sector