Hepatitis C and hepatitis B virus infection in hemodialysis patients after nationwide direct antiviral agents therapy-experience of 10 Romanian HD centers.

PURPOSE: End-stage kidney disease patients (ESKD) receiving hemodialysis (HD) are at a greater risk of hepatitis virus (HV) infections due to the invasive nature of the procedures, frequent hospital stays and surgeries, as well as the immune deficiency status of ESKD. THE AIM: This study was to reassess the hepatitis virus infections prevalence in the HD population in Romania after 5 years of oral DAAs therapy and assess the impact on HD patients' outcomes in two cohorts (2015 and 2019). METHODS: We compared ESKD patients treated with HD in 10 HD centers from the historical regions of Romania in 2015 (n = 1401, Mean age 59.7 ± 12.92 years) with patients treated in the same centers in 2019 (n = 1698, mean age 61 ± 12.93 years). All patients went through HD therapy for more than 90 days. RESULTS: The patients from the 2019 cohort were significantly older (p = 0.005), had a longer duration of HD therapy (p < 0.0001), and had more vascular calcifications (p = 0.015); the crude one-year mortality rate did not differ from the 2015 cohort (9.9 vs. 10.7%, p = 0.46). The prevalence of HBV infection did not differ between the cohorts (4.7% vs. 4.8, p = 0.604) but the prevalence of HCV significantly decreased from 2015 to 2019 (16.9 vs. 10.5%, p < 0.0001). CONCLUSION: After 15 years of a nationwide infection prevention program for HV infections and 5 years of DAAs treatment in Romania, the prevalence of HBV did not change but HCV infections decreased significantly, however, it still remained high.

The Prevalence of Liver Fibrosis Stages on More than 23,000 Liver Stiffness Measurements by Vibration-Controlled Transient Elastography: A Single Center Study.

Vibration-controlled transient elastography (VCTE) was the first non-invasive method used for assessing liver fibrosis in patients with chronic liver disease. Over the years, many studies have evaluated its performance. It is now used globally, and, in some countries, it represents the primary step in evaluating liver fibrosis. The aim of this study is to assess the feasibility of VCTE and highlight the prevalence of liver fibrosis stages assessed by VCTE in a large cohort of patients at a single study center. We also aimed to observe the trends in liver stiffness (LS) values over the years according to each type of hepatopathy. A retrospective study was conducted over a period of 13 years (2007-2019) and included patients who presented to our clinic for LS measurements (LSMs), either with known liver diseases or with suspected liver pathology who were undergoing fibrosis screening. The database contained a total of 23,420 measurements. Valid LSMs were obtained in 90.91% (21,291/23,420) of the cases, while 2129 (9.09%) of the measurements were either failed or unreliable. In untreated patients with chronic viral hepatitis, LS values tended to increase during the years, while in patients undergoing antiviral therapy LS values significantly decreased. Our comprehensive study, one of the largest of its kind spanning 13 years, emphasizes the reliability and significance of VCTE in real-world clinical settings.

Beyond the Digital Competencies of Medical Students: Concerns over Integrating Data Science Basics into the Medical Curriculum.

Introduction. Data science is becoming increasingly prominent in the medical profession, in the face of the COVID-19 pandemic, presenting additional challenges and opportunities for medical education. We retrospectively appraised the existing biomedical informatics (BMI) and biostatistics courses taught to students enrolled in a six-year medical program. Methods. An anonymous cross-sectional survey was conducted among 121 students in their fourth year, with regard to the courses they previously attended, in contrast with the ongoing emergency medicine (EM) course during the first semester of the academic year 2020−2021, when all activities went online. The questionnaire included opinion items about courses and self-assessed knowledge, and questions probing into the respondents' familiarity with the basics of data science. Results. Appreciation of the EM course was high, with a median (IQR) score of 9 (7−10) on a scale from 1 to 10. The overall scores for the BMI and biostatistics were 7 (5−9) and 8 (5−9), respectively. These latter scores were strongly correlated (Spearman correlation coefficient R = 0.869, p < 0.001). We found no correlation between measured and self-assessed knowledge of data science (R = 0.107, p = 0.246), but the latter was fairly and significantly correlated with the perceived usefulness of the courses. Conclusions. The keystone of this different perception of EM versus data science was the courses' apparent value to the medical profession. The following conclusions could be drawn: (a) objective assessments of residual knowledge of the basics of data science do not necessarily correlate with the students' subjective appraisal and opinion of the field or courses; (b) medical students need to see the explicit connection between interdisciplinary or complementary courses and the medical profession; and (c) courses on information technology and data science would better suit a distributed approach across the medical curriculum.

Acute gastrointestinal bleeding: A comparison between variceal and nonvariceal gastrointestinal bleeding.

Acute upper gastrointestinal bleeding (UGIB) is a typical medical emergency, with an incidence of 84 to 160 cases per 100,000 individuals and a mortality rate of approximately 10%. This study aimed to identify all cases of UGIB hospitalized in a tertiary gastroenterology department, to identify possible predictive factors involved in rebleeding and mortality, potential associations between different elements and the severity of bleeding, and the differences between the upper digestive hemorrhage due to nonvariceal and variceal bleeding. This was an observational, retrospective study of patients with UGIB admitted to the tertiary Department of Gastroenterology between January 2013 and December 2020. A total of 1499 patients were enrolled in the study. One thousand four hundred and ninety-nine patients were hospitalized for 7 years with active upper digestive hemorrhage, 504 variceal bleeding, and 995 nonvariceal bleeding. When comparing variceal with nonvariceal bleeding, in nonvariceal bleeding, the mean age was higher, similar sex, higher mortality rate, higher rebleeding rate, and higher hemorrhagic shock rate. Endoscopy treatment was also performed more frequently in variceal bleeding than in nonvariceal bleeding. Severe anemia was found more frequently in patients with variceal bleeding. The mortality rate was 10% in the entire study group, which was not significantly different between the 2 batches. However, the rebleeding rate is higher in patients with variceal gastrointestinal bleeding.

Dynamic Changes in Liver Stiffness in Patients with Chronic Hepatitis B Undergoing Antiviral Therapy.

This is a retrospective single-center study that included 87 subjects. All subjects had chronic hepatitis B or HBV cirrhosis and underwent nucleos(t)ide analogs (NUC) treatment for more than one year. The study aimed to evaluate the dynamic changes in liver stiffness (LS) measured by transient elastography (TE) during a median interval of 64 months. Patients were assessed prior to starting therapy and followed up annually. Liver stiffness measurements (LSM) were performed annually, and ten valid LSMs were obtained in each session. Reliable LSMs were defined as the median value of 10 measurements with Interquartile range/median (IQR/M) ≤ 30%. A significant decrease in liver stiffness values (p < 0.001) was observed during follow-up. In patients with liver cirrhosis, the LSMs decreased significantly after only one year, 24.6 ± 4.3 kPa vs. 13.5 ± 4.2 kPa (p = 0.007), whereas the decrease in non-cirrhotic patients was not significant, 7.31 ± 3.62 vs. 6.80 ± 2.41 (p = 0.27). Liver stiffness decrease was more significant in patients with initially higher transaminases. Undetectable viral load was achieved in 73.5% of patients in year one, 82.7% in year two, and 90.8% in year three of treatment. In conclusion, our study reveals a decrease in liver stiffness by TE in patients with chronic hepatitis B when undergoing anti-HBV therapy in the first two years. It can be used as a method for follow-up in patients undergoing NUC therapy.

Spleen Stiffness for Predicting Varices Needing Treatment: Comparison between Two Different Elastography Techniques (Point vs. 2D-SWE).

The study aimed to establish the benefits of using spleen stiffness values measured by two elastography techniques as noninvasive markers for predicting varices needing treatment and comparing their performances. A prospective study was performed, including 107 subjects with compensated liver cirrhosis, who underwent upper digestive endoscopy, as well as spleen stiffness measurements by means of two elastography techniques: pSWE (point shear wave elastography using Virtual Touch Quantification-Siemens Acuson S2000) and 2D-SWE (2D-shear wave elastography-LOGIQ E9, General Electric). Reliable spleen stiffness measurements were obtained in 96.2% (103/107) patients by means of 2D-SWE and in 94.4% (101/107) subjects with pSWE; therefore, 98 subjects were included in the final analysis, of which 40.8% (40/98) had varices needing treatment. The optimal spleen stiffness cut-off value by 2D-SWE for predicting varices needing treatment was 13.2 kPa (AUROC 0.84), while for pSWE, it was 2.91 m/s (AUROC 0.90). Based on AUROC comparison, no difference between the performance of the two techniques for predicting varices needing treatment was found (p=0.1606). In conclusion, spleen stiffness measured by either 2D-SWE or pSWE is a reliable surrogate marker, with good feasibility, applicability, and predictive accuracy for varices needing treatment, with no significant difference between techniques.

Impact of Sarcopenia on Survival and Clinical Outcomes in Patients With Liver Cirrhosis.

Background: Sarcopenia is now recognized more and more as a biomarker with poor outcomes in cirrhotic patients. Aims: The purpose of this study was to investigate the prevalence of sarcopenia in patients with liver cirrhosis and prospectively investigate the association between sarcopenia and different complications and its impact on survival. Material and Methods: This prospective study included patients with liver cirrhosis admitted to our department from 2018 to 2020. Sarcopenia was assessed according to EWGSOP2 criteria, incorporating low Handgrip strength (<27 kg for men and <16 kg for women) with low skeletal muscle index evaluated by CT (<50 for men and <39 for women). Associations between sarcopenia and portal hypertension-related complications, infectious complications, and risk of hepatocellular carcinoma, the number of in-hospital days, 30-day readmission, and survival over the next 6 and 12 months were analyzed. Results: A total of 201 patients were enrolled in the study, 63.2% male, mean age 61.65 ± 9.49 years, 79.6% Child-Pugh class B and C. The primary etiology of liver cirrhosis was alcohol consumption (55.2%). The prevalence of sarcopenia was 57.2 %, with no significant differences between the male and female groups. Significant associations were found between sarcopenia and portal hypertension-related complications, infectious complications, and risk of hepatocellular carcinoma. In multivariate analysis, sarcopenia was assessed as a risk factor alone, increasing the risk for ascites 3.78 times, hepatocellular carcinoma by 9.23 times, urinary tract infection by 4.83 times, and spontaneous peritonitis 2.49 times. Sarcopenia was associated with more extended hospital stay and higher 30 days readmission. Six months and 1-year survival were reduced in the sarcopenia group than in the non-sarcopenia group (p < 0.0001). Conclusion: Sarcopenia is a common complication of liver cirrhosis and associates with adverse health-related outcomes and poor survival rates.

Monitoring Approach of Fatality Risk Factors for Patients with Severe Acute Pancreatitis Admitted to the Intensive Care Unit. A Retrospective, Monocentric Study.

Acute pancreatitis is an unpredictable disease affecting the pancreas and it is characterized by a wide range of symptoms and modified lab tests, thus there is a continuing struggle to classify this disease and to find risk factors associated with a worse outcome. The main objective of this study was to identify the risk factors associated with the fatal outcome of the intensive care unit's patients diagnosed and admitted for severe acute pancreatitis, the secondary objective was to investigate the prediction value for the death of different inflammatory markers at the time of their admission to the hospital. This retrospective study included all the patients with a diagnosis of acute pancreatitis admitted to the Intensive Care Unit of the Emergency County Hospital Timisoara between 1 January 2016 and 31 May 2021. The study included 53 patients diagnosed with severe acute pancreatitis, out of which 21 (39.6%) survived and 32 (60.4%) died. For the neutrophils/lymphocytes ratio, a cut-off value of 12.4 was found. When analyzing age, we found out that age above 52 years old can predict mortality, and for the platelets/lymphocytes ratio, a cut-off value of 127 was found. Combining the three factors we get a new model for predicting mortality, with an increased performance, AUROC = 0.95, p < 0.001. Multiple persistent organ failure, age over 50, higher values of C reactive protein, and surgery were risk factors for death in the patients with severe acute pancreatitis admitted to the intensive care unit. The model design from the neutrophils/lymphocytes ratio, platelets/lymphocytes ratio, and age proved to be the best in predicting mortality in severe acute pancreatitis.

Extending and validating the Baveno VI criteria for the exclusion of high-risk varices.

AIM: The updated Baveno VI guidelines recommend that screening for high-risk varices (HRV) by esophago-gastro-duodenoscopy (EGD) can be avoided in patients with compensated advanced chronic liver disease (cACLD) who have liver stiffness LSM<20 kPa and platelet count PLT>150,000/L. The aims of this study were to validate extended Baveno VI criteria in patients with chronic liver disease and to establish cut-off values for our cohort. MATERIALS AND METHODS: This retrospective study included 839 patients with liver cirrhosis evaluated by Transient Elastography (TE), biological tests, and upper endos-copy, all within one year. The Baveno VI criteria were validated on a sub-group of 728 patients (Cohort 1, randomly selected from the study sample) and tailored cut-off points were determined. The remaining 111 patients comprised the validating set (Cohort 2) for these specific cut-off values. RESULTS: In Cohort 1, Baveno VI criteria had 86.2% accuracy. The calculated cut-offs to rule-in HRV were PLT<150,000/mm3 and LSM >35.3 kPa; while to rule-out HRV they were PLT >150.000/mm3 and LSM <19.6 kPa. In patients in the "grey-zone", by multivariate analysis, albumin was independently associated with HRV at a cut-off of ˂3.4 g/dl. In the validation cohort, the calculated rule out cut-offs had 100% accuracy. CONCLUSIONS: The Baveno VI criteria had a good accuracy for exclusion of HRV in this large cohort of cirrhotic patients. Adding an albumin-related threshold increased performance and broadened applicability. Using the calculated rule-out criteria for HRV, all unnecessary EGD could be excluded.

Multiparametric Ultrasound Approach Using a Tree-Based Decision Classifier for Inconclusive Focal Liver Lesions Evaluated by Contrast Enhanced Ultrasound.

BACKGROUND: Multiparametric ultrasound (MPUS) is a concept whereby the examiner is encouraged to use the latest features of an ultrasound machine. The aim of this study was to reanalyze inconclusive focal liver lesions (FLLs) that had been analyzed via contrast enhanced ultrasound (CEUS) using the MPUS approach with the help of a tree-based decision classifier. MATERIALS AND METHODS: We retrospectively analyzed FLLs that were inconclusive upon CEUS examination in our department, focusing our attention on samples taken over a period of two years (2017-2018). MPUS reanalysis followed a three-step algorithm, taking into account the liver stiffness measurement (LSM), time-intensity curve analysis (TIC), and parametric imaging (PI). After processing all steps of the algorithm, a binary decision tree classifier (BDTC) was used to achieve a software-assisted decision. RESULTS: Area was the only TIC-CEUS parameter that showed a significant difference between malign and benign lesions with a cutoff of >-19.3 dB for washout phenomena (AUROC = 0.58, Se = 74.0%, Sp = 45.7%). Using the binary decision tree classifier (BDTC) algorithm, we correctly classified 71 out of 91 lesions according to their malignant or benignant status, with an accuracy of 78.0% (sensitivity = 62%, specificity = 45%, and precision = 80%). CONCLUSIONS: By reevaluating inconclusive FLLs that had been analyzed via CEUS using MPUS, we managed to determine that 78% of the lesions were malignant and, in 28% of them, we established the lesion type.

Liver Steatosis: Better Predictor of CKD in MAFLD Than Liver Fibrosis as Determined by Transient Elastography With Controlled Attenuation Parameter.

Background: Changing the term/concept of the non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction associated fatty liver disease (MAFLD) may broaden the pathological definition that can include chronic renal involvement, and, possibly, changes chronic kidney disease's (CKD's) epidemiological association with liver disease, because CKD is associated with metabolic disorders and almost all patients with CKD present some form of an atherogenic dyslipidemia. Our study explores the relationship between MAFLD and CKD using Transient Elastography (TE) with a Controlled Attenuated Parameter (CAP). Methods: We evaluated 335 patients with diabetes with MAFLD and with high CKD risk using TE with CAP (FibroScan®). The CKD was defined according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines. Logistic regression and stepwise multiple logistic regression were used to evaluate the factors associated with CKD. In addition, a receiver operating characteristic curve (ROC) analysis was used to assess the performance of CAP and TE in predicting CKD and its optimal threshold. Results: The prevalence of CKD in our group was 60.8%. Patients with CKD had higher mean liver stiffness measurements (LSM) and CAP values than those without CKD. We found that hepatic steatosis was a better predictor of CKD than fibrosis. Univariate regression showed that CAP values >353 dB/m were predictive of CKD; while the multivariate regression analysis (after adjustment according to sex, body mass index (BMI), low-density lipoprotein cholesterol (LDLc), and high-density lipoprotein cholesterol (HDLc), and fasting glucose) showed that CAP values >353 dB/m were more strongly associated with the presence of CKD compared to the LSM (fibrosis) values. Conclusion: In patients with MAFLD, CAP-assessed steatosis appears to be a better predictor of CKD compared to LSM-assessed hepatic fibrosis.

Diagnostic Performance of 2-D Shear-Wave Elastography with Propagation Maps and Attenuation Imaging in Patients with Non-Alcoholic Fatty Liver Disease.

We aimed to investigate the diagnostic performance of new 2-D shear-wave elastography (SWE) with propagation maps and attenuation imaging (ATI) for quantification of fibrosis and steatosis in non-alcoholic fatty liver disease (NAFLD). Consecutive patients with NAFLD and healthy volunteers underwent liver stiffness measurement and steatosis quantification by means of vibration-controlled transient elastography coupled with the controlled attenuation parameter as the reference and by 2-D shear-wave elastography (2-D-SWE) with propagation maps and ATI as the investigational methods. We included 232 participants (164 in the NAFLD group and 68 in the healthy control group): 51.7%/49.3% women/men; mean age, 54.2 ± 15.2 y; mean body mass index, 29.4 ± 6.5 kg/m2. Significant correlations were found between 2-D-SWE and vibration-controlled transient elastography (r = 0.71, p < 0.0001) and between ATI and the controlled attenuation parameter (r = 0.72, p < 0.0001). NAFLD-specific 2-D-SWE liver stiffness measurement cutoffs were as follows-F ≥ 2: 7.9 kPa (area under the curve [AUC] = 0.91); F ≥ 3: 10 kPa (AUC = 0.92); and F = 4: 11.4 kPa (AUC = 0.95). For steatosis, the best cutoffs by ATI were as follows-S1 = 0.73 dB/cm/MHz (AUC = 0.86); S2 = 0.76 dB/cm/MHz (AUC = 0.86); and S3 = 0.80 dB/cm/MHz (AUC = 0.83). According to Baveno VI criteria, the optimal 2-D-SWE liver stiffness measurement for diagnosing liver cirrhosis is 15.5 kPa (AUC = 0.94), and for ruling out compensated advanced chronic liver disease it is 9.2 kPa (AUC = 0.92). To conclude, 2-D-SWE with propagation maps and ATI is reliable for quantification of liver fibrosis and steatosis in patients with NAFLD.

Are there different cut-off values for staging liver fibrosis using 2D-SWE implemented on different systems from the same manufacturer?

AIM: To evaluate the range of liver stiffness (LS) cut-off values for predicting different stages of liver fibrosis (LF) for 2D-SWE-GE implemented on three different systems from General Electric Healthcare (LOGIQ E9, LOGIQ S8, LOGIQ P9). MATERIAL AND METHOD: We performed a comparative study evaluating the performance of 2D-SWE-GE (LOGIQ E9, S8, P9) for predicting different stages of LF using Transient Elastography (TE) as the reference method. All patients (with or without chronic hepatopathies) were evaluated by TE, 331 patients were included in the LOGIQ E9 study, 179 in the LOGIQ S8 study and 234 in the LOGIQ P9 study. Reliable liver stiffness measurements (LSM) were defined for TE as the median value of 10 measurements with an interquartile range/median ratio (IQR/M)≤0.30 and for 2D-SWE-GE as the median value of 10 measurements and IQR/M≤0.30. RESULTS: Reliable LSM was obtained by both methods in 91.5% subjects of the LOGIQ E9 group, in 95.5% subjects from the LOGIQ S8 group and in 87.6% subjects in the LOGIQ P9 group. The performance of 2DSWE-GE for predicting F≥2 with LOGIQ E9, LOGIQ S8 and LOGIQ P9 systems were: cut-offs 6.7 kPa, 6.9 kPa and 6.8 kPa; AUCs 0.95, 0.92 and 0.93. For predicting F≥3, the performances were: cut-offs - 8.2 kPa, 8.2 kPa and 7.6 kPa; AUCs - 0.97, 0.93 and 0.94. For predicting F4, the performances were: cut-offs - 9.3 kPa, 9.3 kPa and 9.3 kPa; AUCs - 0.96, 0.91 and 0.91. CONCLUSION: The LS cut-off values for 2D-SWE-GE implemented on different systems for predicting F≥2, F≥3 and F=4 are not significantly different.

Screening for Liver Fibrosis and Steatosis in a Large Cohort of Patients with Type 2 Diabetes Using Vibration Controlled Transient Elastography and Controlled Attenuation Parameter in a Single-Center Real-Life Experience.

BACKGROUND: Type 2 diabetes mellitus (T2DM), obesity, hyperlipidemia, and hypertension are considered risk factors for developing non-alcoholic fatty liver disease (NAFLD). This study aims to assess steatosis and fibrosis severity in a cohort of T2DM patients, using vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP). MATERIAL AND METHOD: We performed a prospective study in which, in each patient, we aimed for 10 valid CAP and liver stiffness measurements (LSM). To discriminate between fibrosis stages, we used the following VCTE cut-offs: F ≥ 2-8.2 kPa, F ≥ 3-9.7 kPa, and F4 - 13.6 kPa. To discriminate between steatosis stages, we used the following CAP cut-offs: S1 (mild) - 274 dB/m, S2 (moderate) - 290dB/m, S3 (severe) - 302dB/m. RESULTS: During the study period, we screened 776 patients; 60.3% had severe steatosis, while 19.4% had advanced fibrosis. Female gender, BMI, waist circumference, elevated levels of AST, total cholesterol, triglycerides, blood glucose, and high LSM were associated with severe steatosis (all p-value < 0.05). BMI, waist circumference, elevated levels of AST, HbA1c, and CAP were associated with advanced fibrosis (all p-values < 0.05). CONCLUSION: Higher BMI (obesity) comprises a higher risk of developing severe steatosis and fibrosis. Individualized screening strategies should be established for NAFLD according to different BMI.

Comparative study between pSWE and 2D-SWE techniques integrated in the same ultrasound machine, with Transient Elastography as the reference method.

AIM: To evaluate the feasibility of two elastographic methods, point Shear Wave Elastography (pSWE) and two dimensional Shear Wave Elastography (2D-SWE), integrated in the same ultrasound machine, for liver fibrosis (LF) assessment, using Transient Elastography (TE) as the reference method. MATERIAL AND METHODS: We included in the study 115 subjects in which LF was evaluated in the same session by TE (FibroScan, EchoSens), pSWE and 2D-SWE (Samsung-Medison RS85). Reliable liver stiffness (LS) measurements were defined: for TE the median value of 10 measurements with interquartile range (IQR/M)≤30%,while for pSWE and 2D-SWE the median value of 10 measurements, with a reliability measurement index (RMI)≥0.5 and IQR/M≤30%. For classification of LF severity we used TE as the reference method with the following cut-offs: F2≥7kPa, F3≥9.5kPa and F4≥12kPa. RESULTS: Reliable measurements by TE were obtained in 98.2% of cases (113/115), by pSWE in 93.9% of cases (108/115) and by 2D-SWE in 92.1% of cases (106/115), so the final analysis included 101 patients. We divided the cohort into 3 groups: fibrosis 5.9 kPa [AUROC=0.95, 95%CI(0.89;0.98), p<0.0001, Se=94.1%, Sp=89.5%, PPV=82.1%, NPV=96.8%]; F4 LS >8 kPa [AUROC=0.98, 95%CI(0.94;0.99), p<0.0001, Se=94.4%, Sp=95.1%, PPV=81%, NPV=98.7%], while for 2D-SWE they were: F≥2 LS >6.1 kPa [AUROC=0.93, 95%CI(0.86;0.97), p<0.0001, Se=91.1%, Sp=80.6%, PPV=70.5%, NPV=94.7%]; F4 LS >7.6 kPa [AUROC=0.98, 95%CI(0.93;0.99), p<0.0001, Se=100%, Sp=91.5%, PPV=72%, NPV=100%]. We observed strong correlations between LS values obtained by TE and 2D-SWE (r=0.85), between TE and pSWE (r=0.88) and between pSWE and 2D-SWE (r=0.90) (p=0.37), respectively. There were no significant differences between the mean values obtained by pSWE and 2D-SWE (p=0.96). CONCLUSION: The pSWE and 2D-SWE are feasible methods for assessing liver fibrosis, both techniques strongly correlating with TE results.

Dynamics of Epicardiac Fat and Heart Function in Type 2 Diabetic Patients Initiated with SGLT-2 Inhibitors.

PURPOSE: The aim of this study was to assess the dynamics of epicardiac adipose tissue (EAT) thickness and total volume as well as that of systolic and diastolic dysfunction in a group of patients with type 2 diabetes (T2D) after initiation of sodium glucose co-transporter 2 (SGLT 2) inhibitors therapy. PATIENTS AND METHODS: This prospective, observational study included 53 patients with T2D who received SGLT-2 inhibitors for 24 weeks. In all patients, echocardiographic screening for EAT, systolic and diastolic dysfunction and non-contrast computed tomography scans were performed, both before and after 24 weeks of SGLT-2 inhibition. Imagistic evaluation was followed by the association's analysis between the dynamics of EAT and heart function, as well as the patient's clinical and biological parameters. We considered a decrease or increase of more than 10% in EAT as being clinically significant. RESULTS: The mean volume of EAT decreased significantly after SGLT 2 inhibition (37.8±17.2 vs. 20.7±7 cm3; p<0.001). Median values of EAT thickness also decreased significantly (5.95 vs. 3.01 mm; p<0.001). Most patients, 75.4% (40/53), presented more than 10% decrease in EAT volume, 9.5% (5/53) had stable EAT volume values, while in 15.1% (8/53) the means of EAT volume increased. 73.5% of the patients had diastolic dysfunction type 1 (DD 1) at baseline. No significant change was observed in the left ventricular ejection fraction or diastolic dysfunction after 24 weeks of treatment. Although not statistically significant, an improvement in cardiac function has been noticed throughout the duration of 1 year of treatment with SGLT 2 inhibitors. CONCLUSION: This study showed the beneficial effect of SGLT 2 inhibitors on EAT after a short period of treatment, but there were no significant changes in the systolic function during the 1st year of study. However, reducing epicardial fat has led to remission of diastolic dysfunction.

Comparative study between four ultrasound Shear Waves Elastographic methods for liver fibrosis assessment.

AIMS: Non-invasive methods to assess the severity of chronic liver diseases have become more and more popular. The aim of our study was to evaluate the correlation of four Shear Waves Elastographic methods in a cohort of patients with chronic liver diseases of mixed etiologies and to compare their performances for liver fibrosis evaluation. MATERIAL AND METHODS:  A prospective study was conducted on 127 consecutive patients with chronic liver diseases of mixed etiologies. LS measurements were performed in all subjects, in one session, during the same day, by means of 4 elastographic methods: Transient Elastography (TE), Virtual Touch Quantification (VTQ), ElastPQ and 2D-SWE.SSI. The diagnosis accuracies of VTQ, ElastPQ, 2D-SWE.SSI were then compared using TE as reference method. RESULTS: Valid LS measurements by all four shear waves ultrasound elastographic methods were obtained in 116/127 subjects with VTQ, in 108/127 subjects with 2D-SWE.SSI, in 111/127 with TE and in 109/127 with ElastPQ, so the final analysis included 82/127 subjects (64.5%). A good and significant correlation was found between all 4 elastographic methods. The diagnostic accuracy of VTQ, 2D-SWE.SSI and ElastPQ for the diagnosis of significant and severe fibrosis (F2/F3), and liver cirrhosis were similar for all elastographic techniques: VTQ vs 2D-SWE.SSI vs ElastPQ: 84.1% vs 85.3% vs. 84% (p>0.05); 93.9% vs 94% vs 94% (p>0.05). CONCLUSION: considering TE as the reference method for liver fibrosis evaluation, VTQ, ElastPQ, and 2D-SWE.SSI obtained similar accuracies for diagnosing at least significant fibrosis (F≥2) and liver cirrhosis.

The value of ElastPQ for the evaluation of liver stiffness in patients with B and C chronic hepatopathies.

The aim of this study was to evaluate the diagnostic performance of a point shear wave elastography using ARFI technique - ElastPQ, in patients with B and C chronic hepatopathies, using Transient Elastography (TE) as the reference method, since it is a validated method for liver fibrosis assessment. SUBJECTS AND METHODS: the study included 228 consecutive subjects with chronic hepatopathies (26% HBV, 74% HCV) from whom 51% had liver cirrhosis. Liver stiffness (LS) was evaluated in the same session by means of 2 elastographic methods: TE (FibroScan, EchoSens) and ElastPQ (Affinity, Philips) techniques. For TE 10 valid LS measurements were performed for each patient and the median value was calculated. Reliable LS measurements by TE (M or XL probe) were considered the median value of 10LS measurements with a success rate ≥60% and an interquartile range <30%. For ElastPQ we calculated the median value of 10LS measurements in the liver parenchyma, at least 1cm below the capsule, avoiding large vessels. For differentiating between stages of liver fibrosis we used the TE cut-off values published in the Tsochatzis meta-analysis: significant fibrosis (F≥2)- 7.0kPa, severe fibrosis (F≥3)- 9.5kPa and for liver cirrhosis (F=4)-12kPa (Tsochatzis et al., 2011). The areas under the receiver operating characteristic curve (AUROCs) were used to assess the diagnostic performance of ElastPQ, correlations between ElastPQ and TE were evaluated. RESULTS: Valid LS measurements were obtained in 90.7% (207/228) cases by means of TE and in 98.7% (225/228) cases with ElastPQ. In the final analysis 205 patients were included. The ElastPQ values ranged from 2.32 to 44.07kPa (median=10.42kPa). Based on TE cut-off values (Tsochatzis et al., 2011) we divided our cohort into 4 groups: F0-F1:61/205 (29.8%); F2: 14/205 (6.8%); F3: 15/205 (7.3%); F=4: 115/205 (56.1%). The best cut-off values for discriminating, significant, severe fibrosis and cirrhosis were 7.2, 8.5 and 8.9kPa, respectively. The AUROCs were calculated considering TE as the reference method: 0.94 for significant fibrosis (F≥2), 0.97 for severe fibrosis (F≥3) and 0.97 for cirrhosis (F=4). In our cohort there was a strong correlation between measurements obtained by Transient Elastography and ElastPQ (r=0.85, p<0.001). CONCLUSIONS: ElastPQ seems to have a good diagnostic accuracy for staging liver fibrosis.

Performance of 2D-SWE.GE for predicting different stages of liver fibrosis, using Transient Elastography as the reference method.

AIM: To evaluate the performance of 2D shear-wave elastography from General Electric (2D-SWE.GE) for the noninvasiveassessment of liver fibrosis and to identify liver stiffness (LS) cut-off values for predicting different stages of fibrosisusing Transient Elastography (TE) as the reference method. MATERIAL AND METHOD: We included 331 consecutive subjectswith or without chronic hepatopathies in whom LS was evaluated in the same session by means of 2 elastographic techniques:TE and 2D-SWE.GE. Reliable LS measurements were defined for TE as the median value of 10 measurements with a successrate of ≥60% and an interquartile range (IQR)<30% and for 2D-SWE.GE as the median value of 10 measurements acquiredin a homogenous area and an IQR<30%. To discriminate between TE fibrosis stages we used the following cut-offs: F2- 7;F3- 9.5 and F4- 12kPa. RESULTS: Reliable LS measurements were obtained in 95.8% subjects by 2D-SWE.GE, and 94.2%by TE (p=0.44). Based on TE cut-off values we divided our cohort into four groups: F<2: 30.1%; F=2: 10.2%; F=3: 12.2%;F=4: 47.5%. A strong correlation was found between the LS values obtained by the 2 methods: r=0.83, p<0.0001.LS valuesobtained by 2D-SWE.GE were significantly lower than those obtained by TE: 10.14±4.24 kPa vs. 16.72±13.4 kPa (p<0.0001).The best cut-off value for F≥2, F≥3 and for F=4 were 6.7, 8.2 and 9.3 kPa. CONCLUSIONS: The best 2D-SWE.GE cut-off valuesfor predicting F≥2, F≥3 and F=4 were 6.7, 8.2 and 9.3kPa.