Standard care vs. TRIVEntricular pacing in Heart Failure (STRIVE HF): a prospective multicentre randomized controlled trial of triventricular pacing vs. conventional biventricular pacing in patients with heart failure and intermediate QRS left bundle branch block.

AIMS: To determine whether triventricular (TriV) pacing is feasible and improves CRT response compared to conventional biventricular (BiV) pacing in patients with left bundle branch block (LBBB) and intermediate QRS prolongation (120-150 ms). METHODS AND RESULTS: Between October 2015 and November 2019, 99 patients were recruited from 11 UK centres. Ninety-five patients were randomized 1:1 to receive TriV or BiV pacing systems. The primary endpoint was feasibility of TriV pacing. Secondary endpoints assessed symptomatic and remodelling response to CRT. Baseline characteristics were balanced between groups. In the TriV group, 43/46 (93.5%) patients underwent successful implantation vs. 47/49 (95.9%) in the BiV group. Feasibility of maintaining CRT at 6 months was similar in the TriV vs. BiV group (90.0% vs. 97.7%, P = 0.191). All-cause mortality was similar between TriV vs. BiV groups (4.3% vs. 8.2%, P = 0.678). There were no significant differences in echocardiographic LV volumes or clinical composite scores from baseline to 6-month follow-up between groups. CONCLUSION: Implantation of two LV leads to deliver and maintain TriV pacing at 6 months is feasible without significant complications in the majority of patients. There was no evidence that TriV pacing improves CRT response or provides additional clinical benefit to patients with LBBB and intermediate QRS prolongation and cannot be recommended in this patient group. CLINICAL TRIAL REGISTRATION NUMBER: Clinicaltrials.gov: NCT02529410.

Improving the performance of an end-point PCR assay commonly used for the detection of Bacteroidales pertaining to cow feces.

Bacteroidales are normal gut flora of warm-blooded animals. Since each host species carries a different diversity of Bacteroidales, the detection of host-associated gene markers of Bacteroidales has emerged as a promising tool for the tracking of the source of fecal pollution in aquatic ecosystems. To detect cow-associated Bacteroidales, a commonly used method has been an end-point PCR assay with the 16S rRNA genes primers CF128F (cow-associated) and Bac708R (all Bacteroidales). The PCR assay has demonstrated high rates of true-positive detection (i.e., high sensitivity) in all previous studies. However, the assay also had high rates of false-positive detection to the samples of non-target hosts in some cases (i.e., low specificity). In opposite to the reason many investigators have proposed, our results suggested that false detection was not necessarily due to the presence of the target sequence of CF128F in the feces of non-target hosts. Instead, we found sequences of non-target hosts having single internal mismatches with CF128F. Those mismatches were well tolerated in PCR, partly due to the universality of Bac708R. To improve the detection performance, we designed a novel primer CF592R (targeting the same clade of sequences as CF128F) to substitute Bac708R. The use of CF529R alleviated false detection and also led to a tenfold reduction in detection limit in the samples tested, compared to the use of Bac708R. Many other end-point PCR assays that detect the 16S rRNA genes in Bacteroidales also use a host-associated primer to couple with Bac708R, and low specificity or sensitivity has been reported. Based on our findings for CF128F, we suggest that the suitability of Bac708R in those PCR assays needs to be revisited.

Validation of carotid arterial wall volume measurement by cardiovascular magnetic resonance.

PURPOSE: To validate cardiovascular magnetic resonance (CMR) arterial wall volume measurement using whole arterial specimens ex vivo. MATERIALS AND METHODS: Twenty cadaveric carotid arteries (from 10 patients) were fixed in formaldehyde and imaged with a clinical T1-weighted 2D CMR sequence and, for imaging validation, with a high-resolution 3D sequence. Histological validation was performed by sectioning the arteries and microscopically determining area and volume. RESULTS: Comparison between the clinical 2D CMR sequence and the 3D high-resolution validation sequence showed equivalent luminal volumes (889 vs. 880 mm(3); P = 0.54; R(2) = 0.99), and slightly higher 2D CMR arterial wall volumes (982 vs. 916 mm(3); +7%; P < 0.01; R(2) = 0.96) and adventitial volumes (1901 vs. 1826 mm(3); +4%; P < 0.01; R(2) = 0.99). Comparison between 2D CMR and microscopy, performed over a similar longitudinal extent of vessel, showed slightly higher 2D CMR volumes for the lumen (354 vs. 308 mm(3); +14%; P < 0.01; R(2) = 0.97), arterial wall (388 vs. 351 mm(3); +10%; P < 0.01; R(2) = 0.97) and total volumes (750 vs. 665 mm(3); +12%; P < 0.01; R(2) = 0.95). CONCLUSION: The accuracy of the clinical 2D CMR vessel wall sequence for measuring carotid lumen, adventitial, and wall volumes is good against ex vivo measurements, with minor overestimation. This study validates carotid arterial wall quantification by CMR for atherosclerosis research.

Ultra-short echo time cardiovascular magnetic resonance of atherosclerotic carotid plaque.

BACKGROUND: Multi-contrast weighted cardiovascular magnetic resonance (CMR) allows detailed plaque characterisation and assessment of plaque vulnerability. The aim of this preliminary study was to show the potential of Ultra-short Echo Time (UTE) subtraction MR in detecting calcification. METHODS: 14 ex-vivo human carotid arteries were scanned using CMR and CT, prior to histological slide preparation. Two images were acquired using a double-echo 3D UTE pulse, one with a long TE and the second with an ultra-short TE, with the same TR. An UTE subtraction (DeltaUTE) image containing only ultra-short T2 (and T2*) signals was obtained by post-processing subtraction of the 2 UTE images. The DeltaUTE image was compared to the conventional 3D T1-weighted sequence and CT scan of the carotid arteries. RESULTS: In atheromatous carotid arteries, there was a 71% agreement between the high signal intensity areas on DeltaUTE images and CT scan. The same areas were represented as low signal intensity on T1W and areas of void on histology, indicating focal calcification. However, in 15% of all the scans there were some incongruent regions of high intensity on DeltaUTE that did not correspond with a high intensity signal on CT, and histology confirmed the absence of calcification. CONCLUSIONS: We have demonstrated that the UTE sequence has potential to identify calcified plaque. Further work is needed to fully understand the UTE findings.

Effect of rosiglitazone on progression of atherosclerosis: insights using 3D carotid cardiovascular magnetic resonance.

BACKGROUND: There is recent evidence suggesting that rosiglitazone increases death from cardiovascular causes. We investigated the direct effect of this drug on atheroma using 3D carotid cardiovascular magnetic resonance. RESULTS: A randomized, placebo-controlled, double-blind study was performed to evaluate the effect of rosiglitazone treatment on carotid atherosclerosis in subjects with type 2 diabetes and coexisting vascular disease or hypertension. The primary endpoint of the study was the change from baseline to 52 weeks of carotid arterial wall volume, reflecting plaque burden, as measured by carotid cardiovascular magnetic resonance. Rosiglitazone or placebo was allocated to 28 and 29 patients respectively. Patients were managed to have equivalent glycemic control over the study period, but in fact the rosiglitazone group lowered their HbA1c by 0.88% relative to placebo (P < 0.001). Most patients received a statin or fibrate as lipid control medication (rosiglitazone 78%, controls 83%). Data are presented as mean +/- SD. At baseline, the carotid arterial wall volume in the placebo group was 1146 +/- 550 mm3 and in the rosiglitazone group was 1354 +/- 532 mm3. After 52 weeks, the respective volumes were 1134 +/- 523 mm3 and 1348 +/- 531 mm3. These changes (-12.1 mm3 and -5.7 mm3 in the placebo and rosiglitazone groups, respectively) were not statistically significant between groups (P = 0.57). CONCLUSION: Treatment with rosiglitazone over 1 year had no effect on progression of carotid atheroma in patients with type 2 diabetes mellitus compared to placebo.

Novel technique used to detect swallowing in volume-selective turbo spin-echo (TSE) for carotid artery wall imaging.

PURPOSE: To improve three-dimensional (3D) volume-selective turbo spin-echo (TSE) carotid wall imaging by the addition of a novel body surface swallowing detection device. MATERIAL AND METHODS: A 3D volume-selective TSE sequence was used to image the carotid artery. A novel carbon-fiber motion device, positioned over the laryngeal prominence, was used to detect swallowing movement. An electrical output generated by coil movement was used to detect motion, and an algorithm was programmed to reject data acquired during swallowing and for a short period afterwards. Images were acquired with and without the algorithm and scored on a scale of 0-5 by four independent blinded observers according to the clarity of the vessel wall, e.g., 0 = poor image quality and 5 = excellent quality images with little or no artifact. RESULTS: The scans with the rejection algorithm on were scored higher than the scans without the algorithm. The comparison of scores with the algorithm on vs. the algorithm off were as follows: mean +/- standard deviation (SD) = 3.76 +/- 0.25, 95% confidence interval (CI) = 3.27-4.25 vs. 2.64 +/- 0.25, 95% CI = 2.15-3.13; with good interobserver correlation (Kendall's W score 0.77). CONCLUSION: Image quality can be improved by the algorithm during acquisition. This can be achieved by a novel, anatomically positioned superficial device. This may help in prolonged 3D scans where a single movement can corrupt the entire acquisition.