Multicentric Atrial Strain COmparison between Two Different Modalities: MASCOT HIT Study

Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference

The Role of Noninvasive Imaging for Detection High Risk Patients with Subclinical Atherosclerosis

Non-invasive imaging is widely used to assess vascular dysfunction, including measurement of flow-mediated vasodilatation of the brachial artery (FMD), pulse wave velocity (PWV), the augmentation index (AI), and central blood pressure. Endothelial dysfunction, a main contributor of atherosclerosis is possible diagnostic tool by FMD. An arterial stiffness, assessing by the PWV and/or arterial dispensability and beta stiffness index have been associated with cardiovascular risk. Ultrasound-based methods are used to assess elastic properties of the arterial walls in studies of arterial stiffness and atherosclerosis. In asymptomatic individuals is essential in order to detect, predict and prevent cardiovascular diseases first be estimated based on the global assessment of risk factors? Nowadays is recommended in daily routine screening for coronary artery disease in asymptomatic individuals with intermediate (10-20% 10-year risk of coronary artery disease) or high risk (&gt;20% 10-year risk of coronary artery disease) to provide a&nbsp; urther screening.</p

Caputo Fractional Differential Equations with Non-Instantaneous Random Erlang Distributed Impulses

The p-moment exponential stability of non-instantaneous impulsive Caputo fractional differential equations is studied. The impulses occur at random moments and their action continues on finite time intervals with initially given lengths. The time between two consecutive moments of impulses is the Erlang distributed random variable. The study is based on Lyapunov functions. The fractional Dini derivatives are applied

Hypertension in pregnancy as an early sex-specific risk factor for cardiovascular diseases: evidence and awareness

Despite being a physiological condition, human pregnancy is known to cause numerous complications that can endanger the life of the mother and the fetus alike. While the majority of complications are mostly limited within the peripartum period, more and more information is available about persistently higher short- and long-term cardiovascular risk after a pregnancy complicated by a hypertensive disorder. There is evidence that women after gestational hypertension or preeclampsia are more likely to develop arterial hypertension, coronary atherosclerosis, myocardial infarction, stroke, peripheral artery disease, and even diabetes mellitus and venous thromboembolism years after the target pregnancy. This has urged some authors to view hypertensive disorders of pregnancy as a “stress test” for the maternal organism that unmasks latent endothelial dysfunction. An explanation is sought in the presence of common risk factors and underlying pathological pathways with cardiovascular diseases, although a certain etiological mechanism for the development of hypertensive disorders in pregnancy has not been established yet. More attention is needed towards the follow-up of women after a hypertensive pregnancy as it could be an opportunity for early prevention of cardiovascular diseases

Genetic Risk Factors of Coronary Artery Disease

Detecting genetic risk factors for better targeting of statin administration can further enhance the benefit of this therapy. Coronary artery disease (CAD) is a polygenic disorder with multiple genetic variants. A composite of some of these variants could ascertain the risk of both incident and recurrent CAD events and help in the diagnosis of patients at greater risk who could get greater clinical benefit from statin treatment [1]. The role of genetic risk factors in CAD has become more relevant with the discovery of the proprotein convertase subtilisin kexin type 9 (PCSK9) enzyme, which is responsible for regulating cholesterol metabolism [2, 3]. Gain-of-function mutations of the PCSK9 gene may be associated with increased cholesterol and increased risk of CVDs, whereas loss-of-function mutations are linked to lower blood cholesterol and a reduction of CVDs risk without any known adverse effects [2-5]. This included a community-based landmark assessment employing multiple studies involving 48,421 individuals and 3,477 events [1]. This analysis examined the association of a genetic risk score based on 27 genetic variants with either incident or recurrent CAD, adjusting for traditional clinical risk factors. All subjects were divided into low (quintile 1), intermediate (quintiles 2–4), and high (quintile 5) genetic risk categories, to demonstrate a significant gradient in risk for incident or recurrent CAD. The multivariable-adjusted hazard ratio for CAD events for the intermediate genetic risk category was 1.34 (95% CI: 1.22–1.47, p < 0.0001) and that for the high genetic risk category was 1.72 (1.55–1.92, p < 0.0001) compared with the low genetic risk subjects [1]. There was a significant gradient (p = 0.0277) of increasing relative risk across the low (13%), intermediate (29%), and high (48%) genetic risk categories. Absolute risk reduction from statin treatment was greater in some patients with higher genetic risk categories (p = 0.0101). In the primary prevention trials, the number needed to treat to prevent one CAD event in 10 years was 66 in people at low genetic risk, 42 in those at intermediate genetic risk, and 25 in those at high genetic risk in the JUPITER, and 57, 47, and 20, respectively, in the ASCOT trial. We can conclude from this analysis that a genetic risk score can identify the high risk subjects with increased risk for both incident and recurrent CAD events. Patients with the highest burden of genetic risk obtained the greatest relative and absolute clinical benefit from statin treatment. We propose that patients with highest genetic risk might also get greatest benefit by treatment with PCSK9 inhibitors

Extended consensus on blood pressure variability beyond blood pressure for management of hypertension

[no abstract available

An in-vivo study on the difference between principal and cardiac strains

Regional myocardial deformation is an important parameter for the assessment of regional myocardial function. As such, ultrasound methods have been proposed to estimate myocardial strain non-invasively in one, two or - more recently - in three dimensions. Although strain is most often reported in a local cardiac coordinate system (radial, longitudinal, circumferential), its calculation implies that these directions are known. As this typically requires (manual) segmentation of the myocardium, authors sometimes report on the principal strains instead as they can simply be obtained through diagonalization of the strain tensor. The assumption made is that the normal cardiac strain components are close to the principal strains but this has not explicitly been tested. The aim of this study was therefore to quantify the difference in strain values obtained in both the principal and cardiac coordinate systems and to define the average position of both coordinate systems with respect to each other in an in-vivo setting. ©2009 IEEE.Barbosa D., Claus P., Choi H.F., Hristova K., Loeckx D., D’hooge J., ''An in-vivo study on the difference between principal and cardiac strains'', Proceedings IEEE international ultrasonics symposium, pp. 1411-1414, September 20-23, 2009, Roma, Italy.status: publishe

KETOGENIC DIET – FROM THE IMPLEMENTATION IN CLINICAL PRACTICE TO NOWADAYS

Introduction: The ketogenic diet (KGD) is a high-fat, adequate-protein, low-carbohydrate diet. In 1920`s the diet was developed to treat difficult-to-control epilepsy in children. Nowadays its efficacy has been proven in many other diseases, such as metabolic disorders, brain tumours, autism, Rett syndrome, and in other areas, it has been actively studied. Aim: The aim of this article is to represent the historical review of the therapeutic implication of KGD, as well as to reveal the contemporary clinical trends in which it is being used. Material and Methods: A literature review of 96 scientific reports in English has been made. Results and Discussion: The KGD was developed in the early 1920s. In the period 1970-1990, the therapeutic use of the diet was discontinued, due to the breakthrough of the new anticonvulsants for epilepsy. The interest in KGD was recovered after a meeting of the “American Epilepsy Society” in 1996. The diet demonstrates anticonvulsant efficacy in epilepsy therapy. According to a survey in 2013, the incidence of seizures among half of the number of children was reduced by at least a half, and 15% of them were completely discontinued. The diet is also used in the treatment of metabolic diseases, such as GLUT 1-deficiency syndrome, reducing the incidence of seizures, improving muscle coordination and concentration. It is also effective in pyruvate dehydrogenase deficiency syndrome by replacing the major energy source - glucose with ketones. Along with these, it is also used in patients with autism (in approximately 60% of patients it improves learning ability and social skills), Rett syndrome, Alzheimer's disease, Parkinson's disease, and others. Its mechanism of action is not fully clarified, as well as its degree of effectiveness in some areas. Conclusion: The ketogenic diet is widely implemented worldwide. It comprises a tremendous therapeutic potential that has been growing considerably during the past decades

A Comparison Between Methods for Automatic Quantification of Global Left Ventricular Function

In recent years, volumetric (3D) cardiac ultrasound imaging has become more readily available in daily clinical practice due to the introduction of matrix array transducer technology. To date, quantitative analysis of these data sets typically requires a significant amount of user interaction. Recently, our teams introduced methods that could help in automating this process. On the one hand, an edge detection algorithm in combination with a deformable subdivision surface was presented for automatic segmentation of the LV cavity. A real-time, dynamic implementation of this segmentation approach in combination with a Kalman filter allows tracking the subendocardial boundary throughout the cardiac cycle. This method is referred to as RCTL. On the other hand, an automatic 3D motion estimation algorithm was presented in which subsequent image volumes are elastically registered using a B-spline transformation field. This method is called splineMIRIT. Both methods were applied to clinical data to extract relevant functional parameters on global left ventricular (LV) function (i.e. stroke volume (SV) and ejection fraction (EF)). Both methods show a good correlation with the reference method and might thus be used for fully automated estimation of global LV function. Given that RCTL is a fully integrated method (accounting for both segmentation and tracking) it seems to be the better approach towards extracting these parameters. However, whether this remains true when assessing parameters for regional LV function remains to be investigated. ©2009 IEEE.Barbosa D., Kiss G., Claus P., Hristova K., Amundsen B., Loeckx D., Orderud F., Torp H., D’hooge J., ''A comparison between methods for automatic quantification of global left ventricular function'', Proceedings IEEE international ultrasonics symposium, pp. 313-316, September 20-23, 2009, Roma, Italy.status: publishe