Longitudinal assessment of cardiac parameters through MRI in breast cancer patients treated with anti-HER2 therapy.

BACKGROUND: We evaluated the early changes in left ventricular (LV) volumetric, functional, and tissue characteristics in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients treated with trastuzumab and/or pertuzumab at cardiac magnetic resonance imaging (MRI). METHODS: HER2-positive breast cancer patients undergoing planned anti-HER2 therapy and nonanthracycline-based chemotherapy were enrolled and subdivided into dual anti-HER2 (trastuzumab plus pertuzumab) group and trastuzumab group. Cardiac MRI was performed before treatment and three months after starting, covering ventricular volumes, cardiac function, systolic myocardial strain, myocardial oedema, and T1 and T2 relaxation times. Cardiac dysfunction was primarily defined as a > 10% reduction in LV ejection fraction (LVEF) to < 55% and/or a > 15% global longitudinal strain (GLS) change at the follow-up MRI examination. RESULTS: Twenty-four HER2-positive patients were evaluated (16 in the dual anti-HER2 group, 8 in the trastuzumab group). Six patients developed cardiac dysfunction at follow-up, five of them in the dual anti-HER2 group. One patient developed symptomatic heart failure, and five patients developed asymptomatic cardiac dysfunction. Patients displayed significantly decreased systolic function and increased T1 and T2 relaxation time at follow-up (p ≤ 0.031). Systolic dysfunction remained significant in the dual anti-HER2 group. The decrease in GLS in the trastuzumab group was not significant (p = 0.169). T1 and T2 relaxation times tended to increase, but this was not significant at subgroup analysis. CONCLUSIONS: Cardiac MRI scans showed frequent signs of subclinical cardiotoxicity after short-term anti-HER2 therapy and nonanthracycline-based chemotherapy; the effect was slightly stronger in patients treated with dual therapy. KEY POINTS: • A frequent subclinical cardiotoxicity was detected by cardiac magnetic resonance imaging after short-term anti-human epidermal growth factor receptor 2 (HER2) therapy. • The change in myocardial strain was more marked in patients treated with dual (trastuzumab plus pertuzumab) than with trastuzumab only anti-HER2 therapy. • Cardiotoxicity surveillance through MRI is an interesting option particularly in patients treated with dual anti-HER2 therapy.

Research on the Effect of Digital Economy on Carbon Emissions under the Background of "Double Carbon".

(1) Background: In light of the global economy's digitalization and the "double carbon" target constraint, the digital economy is essential to fostering scientific and technological innovation, green growth, and lowering energy emissions. (2) Methods: This paper measures the digital economic index and carbon emission intensity and analyzes their characteristics in spatial and temporal dimensions using 282 Chinese urban panel data by improving various statistical methods of panel data, such as the entropy method, fixed effect model, multi-period DID model, moderating effect model and intermediary effect model. This paper examines the extent and mechanism of the digital economy's impact on urban carbon emissions. (3) Results: During the sample period, the overall trend of the digital economy in China was one of constant growth, showing an unbalanced distribution pattern of "high in the eastern regions, lower in the central regions and lowest in the western regions" in the spatial dimension. Carbon emissions can be significantly decreased by the digital economy, which has a dynamic effect and an inverted U-shaped trend in its influence. The digital economy plays a significant role in reducing carbon emissions through the rational layout of industrial structures. The transmission mechanisms for the digital economy's goal of reducing carbon emissions include environmental regulation and green technology innovation. (4) Conclusion: The research findings provide a reference for multiple decision makers to better formulate carbon emission policies and realize carbon emission decrease in the digital economy.

Research on Theoretical Mechanism and Promotion Path of Digital Economy Driving China's Green Development under "Double Carbon" Background.

(1) Background: Under the background of building a new pattern of "double cycle" development, the green meaning of the digital economy is highly valued. The innovative feature of the digital economy is forming a new economic growth pole, and gradually becomes the driving force for China's economic restructuring and green development; (2) methods: this paper empirically tests whether the digital economy can promote green development by using various econometric models based on panel dataset with 30 provinces from 2011 to 2019 in mainland China and measuring the development level of the digital economy and the greening index; (3) results: it is found that the digital economy can directly boost green development in greening degree of economic growth, resources and environment-carrying potential, and government policy support. The digital economy's influence on green development has an inverted U-shaped trend; environmental control is an effective regulatory variable with a substitution effect on green development. With an obvious regional heterogeneity, the digital economy promotes green development; the digital economy can greatly affect green growth through technical innovation through mechanism analysis. The robustness test supports the above conclusion; (4) conclusions: the findings provide a foundation for multi-party policymakers to effectively formulate and implement policies for the digital economy that encourage green growth.

CMR assessment and clinical outcomes of hypertrophic cardiomyopathy with or without ventricular remodeling in the end-stage phase.

End-stage phase of hypertrophic cardiomyopathy (ES-HCM) is a recognized part of HCM disease spectrum. Information on cardiac magnetic resonance (CMR) studies for ES-HCM especially for those without ventricular remodeling has been limited. We aimed to evaluate the morpho-functional and tissue features of ES-HCM with or without ventricular remodeling and to explore CMR prognostic value in these patients. We analysed CMR scans of sixty-three ES-HCM patients and divided them into those with ventricular dilatation (D-ES, n = 41) and those with normal ventricular size (N-ES, n = 22). Cox proportional hazards models were used to assess the association between CMR parameters and outcomes. Patients in D-ES showed hypokinetic-dilated HCM phenotype, while patients in N-ES showed hypokinetic-restrictive HCM phenotype. LGE extent was significantly larger in D-ES (34.7% ± 15.4% vs. 22.8% ± 7.7%; P < 0.01). Atrial fibrillation and edema of lower extremity were more common in N-ES (72.7 vs. 29.3% and 54.5 vs. 24.4%, respectively; P < 0.05). Log-rank test found no significant difference between 2 groups in combined end point of cardiovascular events (χ2 = 0.66, P = 0.418). In multivariate analysis, LGE (HR 1.57-1.83 per 10% LGE increase, P < 0.01) and indexed left atrial volume (LAVI) (HR 1.14-1.21 per 20 mL/m2 increase, P < 0.05) remained independently associated with combined end point when adjusted by other risk factors. The CMR features of HCM in end-stage span between two extremes. LGE is more extensive in those with ventricular remodeling and LAVI is larger in those with normal ventricular size. Both LGE and LAVI are significant predictors of poor outcomes.