A new 4D trajectory-based approach unveils abnormal LV revolution dynamics in hypertrophic cardiomyopathy.

The assessment of left ventricular shape changes during cardiac revolution may be a new step in clinical cardiology to ease early diagnosis and treatment. To quantify these changes, only point registration was adopted and neither Generalized Procrustes Analysis nor Principal Component Analysis were applied as we did previously to study a group of healthy subjects. Here, we extend to patients affected by hypertrophic cardiomyopathy the original approach and preliminarily include genotype positive/phenotype negative individuals to explore the potential that incumbent pathology might also be detected. Using 3D Speckle Tracking Echocardiography, we recorded left ventricular shape of 48 healthy subjects, 24 patients affected by hypertrophic cardiomyopathy and 3 genotype positive/phenotype negative individuals. We then applied Generalized Procrustes Analysis and Principal Component Analysis and inter-individual differences were cleaned by Parallel Transport performed on the tangent space, along the horizontal geodesic, between the per-subject consensuses and the grand mean. Endocardial and epicardial layers were evaluated separately, different from many ecocardiographic applications. Under a common Principal Component Analysis, we then evaluated left ventricle morphological changes (at both layers) explained by first Principal Component scores. Trajectories' shape and orientation were investigated and contrasted. Logistic regression and Receiver Operating Characteristic curves were used to compare these morphometric indicators with traditional 3D Speckle Tracking Echocardiography global parameters. Geometric morphometrics indicators performed better than 3D Speckle Tracking Echocardiography global parameters in recognizing pathology both in systole and diastole. Genotype positive/phenotype negative individuals clustered with patients affected by hypertrophic cardiomyopathy during diastole, suggesting that incumbent pathology may indeed be foreseen by these methods. Left ventricle deformation in patients affected by hypertrophic cardiomyopathy compared to healthy subjects may be assessed by modern shape analysis better than by traditional 3D Speckle Tracking Echocardiography global parameters. Hypertrophic cardiomyopathy pathophysiology was unveiled in a new manner whereby also diastolic phase abnormalities are evident which is more difficult to investigate by traditional ecocardiographic techniques

Il pubblico di Palazzo Davanzati nei libri dei visitatori. 1910-1924

A pochi mesi dall\u2019apertura di Palazzo Davanzati, Elia Volpi ebbe l\u2019idea di mettere a disposizione dei visitatori del suo museo privato un libro, dalle pagine bianche, sul quale ognuno avrebbe potuto lasciare la propria firma e un commento, seguendo forse l\u2019esempio di altri musei privati come quello di Frederick Stibbert o il milanese Bagatti Valsecchi. I due libri con le firme dei visitatori dal 1910 al 1924 furono poi donati, per volont\ue0 della moglie Marina Volpi, da Mario Vannini Parenti, genero dell\u2019antiquario e sono oggi conservati nel museo. Lo spoglio sistematico dei dati contenuti in questi straordinari documenti ha fatto emergere aspetti molto significativi riguardanti il numero e la provenienza dei visitatori di Palazzo Davanzati, cos\uec come i riflessi della societ\ue0 del tempo e del contesto storico, rappresentando un interessante caso di studio sul pubblico dei musei in un\u2019epoca precedente all\u2019affermazione del turismo di massa. \uc8 il museo visto dalla parte dei suoi visitatori, studenti, educande, persone comuni o aristocratici d\u2019alto lignaggio, turisti stranieri e non con la passione per Firenze e la sua storia, molti dei quali lasciano un commento, una battuta, anche una poesia, o semplicemente la traccia della loro visita. Davvero numerosi, poi, sono i nomi dei personaggi celebri: storici dell\u2019arte (Adolfo e Lionello Venturi, Roberto Longhi), artisti, letterati e intellettuali (Giovanni Boldini, Sibilla Aleramo, Benedetto Croce), mercanti e collezionisti (Salvatore Romano, Georges Wildenstein, Peggy Guggenheim) o personaggi dello spettacolo (Ettore Petrolini, Rodolfo Valentino). La loro presenza, cos\uec come quella di moltissimi architetti e decoratori stranieri e dei tanti visitatori meno noti, restituiscono un feedback importante a tutte quelle iniziative di promozione del museo che Elia Volpi aveva intrapreso sin dal giorno della sua inaugurazione, attraverso campagne fotografiche, pubblicazioni, cartoline illustrate ed eventi a tema

UPGMA analyses performed at the nine homologous times on pure shapes.

<p>(A) Endocardial shapes. (B) Epicardial shapes. Circles represent the analysis where g+p- individuals cluster together with HCM patients.</p

Box plots of the univariate attributes of trajectories.

<p>(A) Size and shape space. (B) Shape space.</p

Results of logistic regressions using Control/HCM as a binary response and the entire bulk of morphological parameters used in this study.

<p>The y-axis always represents the Akaike Information Criterion value for any analysis, while the x-axis represents the nine homologous times. Smaller AICs indicate the best models. (A) STE global parameters; corresponding <i>p</i>-values can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122376#pone.0122376.t003" target="_blank">Table 3</a>. (B) Trajectory attributes in the size and shape space; as these attributes are proper of the entire shape trajectory they are not referred to any particular homologous time; corresponding <i>p</i>-values can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122376#pone.0122376.t005" target="_blank">Table 5</a>. (C) Trajectory attributes in the shape space: as these attributes are proper of the entire shape trajectory they are not referred to any particular homologous time; corresponding <i>p</i>-values can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122376#pone.0122376.t005" target="_blank">Table 5</a>. (D) LV static shape analyses using pure shapes, shape transported in the size and shape space and shapes transported in the shape space; corresponding <i>p</i>-values can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122376#pone.0122376.t004" target="_blank">Table 4</a>. (E) Shape differences from the R peak for the same types of parameters in D; corresponding <i>p</i>-values can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122376#pone.0122376.t004" target="_blank">Table 4</a>. Among static parameters we found that global longitudinal displacement is the best traditional descriptor at end systolic homologous time. Differences of pure epicardial shapes from R peak perform nearly in the same way. Static shapes (pure shapes in size and shape space, shapes transported in the size and space and shapes transported in the shape space), instead, are performing also in diastole. Endocardial shapes transported in both size and shape space and shape space show the lowest AICs. The courses of transported shapes and pure shapes follow inverse patterns. All trajectory attributes returned significant logistic regressions (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122376#pone.0122376.t005" target="_blank">Table 5</a>) except for endocardial trajectory size and RV coefficient, both computed in the shape space.</p

ROC curves for epicardium and endocardium transported in the size and shape space and in the shape space in three meaningful homologous times covering the entire cardiac revolution.

<p>(A-C) Size and shape space. (D-F) Shape space. Delong method was adopted to test differences in ROC curve prediction.</p

Descriptive statistics ± standard deviation for the populations under study.

<p>Descriptive statistics ± standard deviation for the populations under study.</p

UPGMA analyses performed at the nine homologous times on shapes transported on the shape space.

<p>(A) Epicardial shapes. (B) Endocardial shapes. Circles represent the analysis where g+p- individuals cluster together with HCM patients.</p

UPGMA analyses performed at the nine homologous times on pure shapes.

<p>(A) Endocardial shapes. (B) Epicardial shapes. Circles represent the analysis where g+p- individuals cluster together with HCM patients.</p