Pulmonary Blood Volume Measured by Dual-Energy Computed Tomography Can Help Distinguish Patients With Pulmonary Hypertension.

Purpose: To evaluate the correlation between whole lung enhancement (WLE) and pulmonary blood volume (PBV) obtained through dual energy computed tomography pulmonary angiography (DECTPA) and echocardiography-derived systolic pulmonary arterial pressure (SPAP). Methods: Sixty-eight patients who underwent DECTPA were enrolled in the study after giving informed consent. A transthoracic echocardiography was performed for all the subjects within 48 h of their DECTPA study to measure SPAP. The correlation of the two DECTPA-derived parameters, WLE and PBV, with SPAP was assessed. In addition, the predictive strength of these parameters was compared with that of traditional computed tomography (CT) signs of pulmonary hypertension (PH). Results: The SPAP value showed a moderate correlation with main pulmonary artery (MPA) diameter (r = 0.48, P < 0.001), while having a weak correlation with WLE (r = -0.33, P = 0.007), PBV (r = -0.31, P = 0.01) and MPA/ascending aorta (MPA/AA) ratio (r = 0.26, P = 0.03). On regression analysis, MPA diameter (B ± SE: 1.8 ± 0.6, P = 0.004) and WLE (B ± SE: -0.5 ± 0.3, P = 0.042) had significant association with SPAP. In addition, SPAP ≥30 mmHg was related to the right to left ventricular diameter (RV/LV) ratio [OR (CI 95%): 24.39 (1.3-573.2), P = 0.04] and reversely associated with PBV [OR (CI 95%): 0.96 (0.93-0.98), P = 0.005]. Acquired cutoff value of 83% for PBV showed sensitivity and specificity of 73% to identify SPAP ≥30 mmHg [AUC (CI 95%):0.727 (0.588-0.866), P = 0.008]. Conclusions: Automated postprocessing calculation of iodine distribution analysis by DECTPA could be considered as an adjunctive tool to investigate for PH.

Myocardial strain by cardiac magnetic resonance: A valuable predictor of outcome after infarct revascularization.

PURPOSE: To evaluate the prognostic value of left ventricular strains by cardiac magnetic resonance feature tracking (CMR-FT) in patients with re-perfused myocardial infarction (MI). METHODS: The study enrolled 58 patients with re-vascularized MI who underwent CMR within a week from acute MI. An 18-month follow-up was carried out for the composite endpoint of major adverse cardiovascular events (MACE). A 3 to 6-month post-MI ejection fraction (EF) was also measured. The predictive value of global longitudinal, circumferential, and radial strains (GLS, GCS, and GRS, respectively) for MACE and the follow-up EF was evaluated. RESULTS: All the global strains showed significant impairment in MACE positive cases (P < 0.05 for all). On univariate regression, MACE was reversely associated with early post-MI EF (OR: 0.90, 95% CI: 0.83-0.98, P: 0.01), and directly associated with GLS (OR: 1.32, 95% CI: 1.03-1.69, P: 0.02), GCS (OR: 1.23, 95% CI: 1.00-1.50, P: 0.04) and EDVI (OR:1.02, 95 %CI: 1.00-1.04, P: 0.01). On multivariate regression model, only the interaction between EF and GLS showed a significant association with MACE (OR[CI95%]: 1.1 [1.06-1.21]). EF < 30% and GLS > -8.9% had the highest sensitivity (78.9% and 89.5%, respectively) and specificity (45.2% and 54.8%, respectively) to predict MACE. The combination of EF < 30% and GLS > -8.9% increased the sensitivity to 94.7%. In addition, the cutoff values of 35.1% for early post-MI EF and -10% for GLS could identify patients with impaired follow-up EF with more than 80% sensitivity and specificity [AUC (CI95%): 0.893(0.76-1.00) for EF and AUC (CI95%):0.836(0.67-1,00) for GLS, P < 0.05 for both)]. CONCLUSIONS: GLS by CMR-FT is a powerful prognosticator of MACE and functional recovery in MI survivors, with incremental value added to early post-MI EF alone.

Efficacy of Novel Noncontrast Cardiac Magnetic Resonance Methods in Indicating Fibrosis in Hypertrophic Cardiomyopathy.

OBJECTIVE: In hypertrophic cardiomyopathy (HCM), myocardial fibrosis is routinely shown by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) imaging. We evaluated the efficacy of 2 novel contrast-free CMR methods, namely, diffusion-weighted imaging (DWI) and feature-tracking (FT) method, in detecting myocardial fibrosis. METHODS: This cross-sectional study was conducted on 26 patients with HCM. Visual and quantitative comparisons were made between DWI and LGE images. Regional longitudinal, circumferential, and radial strains were compared between LGE-positive and LGE-negative segments. Moreover, global strains were compared between LGE-positive and LGE-negative patients as well as between patients with mild and marked LGE. RESULTS: All 3 strains showed significant differences between LGE-positive and LGE-negative segments (P < 0.001). The regional longitudinal and circumferential strain parameters showed significant associations with LGE (P < 0.001), while regional circumferential strain was the only independent predictor of LGE in logistic regression models (OR: 1.140, 95% CI: 1.073 to 1.207, P < 0.001). A comparison of global strains between patients with LGE percentages of below 15% and above 15% demonstrated that global circumferential strain was the only parameter to show impairment in the group with marked myocardial fibrosis, with borderline significance (P=0.09). A review of 212 segments demonstrated a qualitative visual agreement between DWI and LGE in 193 segments (91%). The mean apparent diffusion coefficient was comparable between LGE-positive and LGE-negative segments (P=0.51). CONCLUSIONS: FT-CMR, especially regional circumferential strain, can reliably show fibrosis-containing segments in HCM. Further, DWI can function as an efficient qualitative method for the estimation of the fibrosis extent in HCM.

Clinical and imaging features predict mortality in COVID-19 infection in Iran.

The new coronavirus disease 2019 (COVID-19) pandemic has challenged many healthcare systems around the world. While most of the current understanding of the clinical features of COVID-19 is derived from Chinese studies, there is a relative paucity of reports from the remaining global health community. In this study, we analyze the clinical and radiologic factors that correlate with mortality odds in COVID-19 positive patients from a tertiary care center in Tehran, Iran. A retrospective cohort study of 90 patients with reverse transcriptase-polymerase chain reaction (RT-PCR) positive COVID-19 infection was conducted, analyzing demographics, co-morbidities, presenting symptoms, vital signs, laboratory values, chest radiograph findings, and chest CT features based on mortality. Chest radiograph was assessed using the Radiographic Assessment of Lung Edema (RALE) scoring system. Chest CTs were assessed according to the opacification pattern, distribution, and standardized severity score. Initial and follow-up Chest CTs were compared if available. Multiple logistic regression was used to generate a prediction model for mortality. The 90 patients included 59 men and 31 women (59.4 ± 16.6 years), including 21 deceased and 69 surviving patients. Among clinical features, advanced age (p = 0.02), low oxygenation saturation (p<0.001), leukocytosis (p = 0.02), low lymphocyte fraction (p = 0.03), and low platelet count (p = 0.048) were associated with increased mortality. High RALE score on initial chest radiograph (p = 0.002), presence of pleural effusions on initial CT chest (p = 0.005), development of pleural effusions on follow-up CT chest (p = 0.04), and worsening lung severity score on follow-up CT Chest (p = 0.03) were associated with mortality. A two-factor logistic model using patient age and oxygen saturation was created, which demonstrates 89% accuracy and area under the ROC curve of 0.86 (p<0.0001). Specific demographic, clinical, and imaging features are associated with increased mortality in COVID-19 infections. Attention to these features can help optimize patient management.

Computed Tomography Radiomics Can Predict Disease Severity and Outcome in Coronavirus Disease 2019 Pneumonia.

PURPOSE: This study aimed to assess if computed tomography (CT) radiomics can predict the severity and outcome of patients with coronavirus disease 2019 (COVID-19) pneumonia. METHODS: This institutional ethical board-approved study included 92 patients (mean age, 59 ± 17 years; 57 men, 35 women) with positive reverse transcription polymerase chain reaction assay for COVID-19 infection who underwent noncontrast chest CT. Two radiologists evaluated all chest CT examinations and recorded opacity type, distribution, and extent of lobar involvement. Information on symptom duration before hospital admission, the period of hospital admission, presence of comorbid conditions, laboratory data, and outcomes (recovery or death) was obtained from the medical records. The entire lung volume was segmented on thin-section Digital Imaging and Communication in Medicine images to derive whole-lung radiomics. Data were analyzed using multiple logistic regression with receiver operator characteristic area under the curve (AUC) as the output. RESULTS: Computed tomography radiomics (AUC, 0.99) outperformed clinical variables (AUC, 0.89) for prediction of the extent of pulmonary opacities related to COVID-19 pneumonia. Type of pulmonary opacities could be predicted with CT radiomics (AUC, 0.77) but not with clinical or laboratory data (AUC, <0.56; P > 0.05). Prediction of patient outcome with radiomics (AUC, 0.85) improved to an AUC of 0.90 with the addition of clinical variables (patient age and duration of presenting symptoms before admission). Among clinical variables, the combination of peripheral capillary oxygen saturation on hospital admission, duration of symptoms, platelet counts, and patient age provided an AUC of 0.81 for predicting patient outcomes. CONCLUSIONS: Radiomics from noncontrast CT reliably predict disease severity (AUC, 0.99) and outcome (AUC, 0.85) in patients with COVID-19 pneumonia.

Involvement of nitric oxide in pioglitazone memory improvement in morphine-induced memory impaired mice.

INTRODUCTION: Pioglitazone, a PPAR-γ agonist, which is clinically used in treating diabetic patients, has been recently reported to have crucial roles in improving cognition and memory performance. Since the mechanisms involved in the neuroprotective effect of pioglitazone are not entirely understood, the current study was designed to investigate the possible interaction of pioglitazone with morphine in memory-impaired mice and the probable role of nitric oxide (NO) in this effect. MATERIALS AND METHODS: All the experiments were performed in passive avoidance and Y-maze paradigms. To induce memory impairment, mice were administered morphine (1, 3 and 10mg/kg, s.c.) immediately before the training trial. Pioglitazone (20, 40 and 80mg/kg, p.o.) was gavaged 2h prior to the training trial. Further, an NO synthase inhibitor, L-NAME (10mg/kg, i.p.), or an inducible NO synthase inhibitor, aminoguanidine (100mg/kg, i.p.) was administered 30 min before the training trial to determine the possible involvement of NO in the restorative effect of pioglitazone. RESULTS: 1) Morphine dose dependently impaired the acquisition of spatial memory and passive avoidance task. 2) Treatment with pioglitazone significantly improved the memory performance in morphine-treated mice in both tests. 3) In the passive avoidance task, L-NAME, but not aminoguanidine, altered the effect of pioglitazone on morphine-induced memory impairment. 4) In Y-maze discrimination, the memory improving effect of pioglitazone was reversed by both NO synthase inhibitors, L-NAME and aminoguanidine. DISCUSSION: Our results demonstrate that the pioglitazone improving effect on the morphine-induced impairment of memory acquisition is at least in part through the NO pathway. It is suggested that in short term spatial recognition memory, both inducible and constitutive NO synthases are involved, but in the long term fear memory, only the constitutive NO synthases indicated a prominent role in the anti-amnestic effect of pioglitazone on morphine-induced memory impairment.

Involvement of NMDA receptors in the beneficial effects of pioglitazone on scopolamine-induced memory impairment in mice.

INTRODUCTION: Pioglitazone, a peroxisome proliferator activated receptor γ (PPARγ) agonist, is widely used in clinical medicine as a treatment for type 2 diabetes and is recently proved to have beneficial effects on improving cognition in early stages of Alzheimer's disease (AD). Moreover, it has been shown that pioglitazone reduces N-methyl-D-aspartate (NMDA, a glutamate agonist) mediated calcium currents and transients. Since enhanced calcium transients are present in AD models, we tested the hypothesis whether pioglitazone manifests its acquisition memory enhancement role through glutamatergic pathway. MATERIAL AND METHODS: Memory performance was evaluated in a two-trial recognition Y-maze test and passive avoidance in mice. Pioglitazone (20 or 40 mg/kg, p.o.) was administered 2h before each trial, NMDA (75 mg/kg i.p.), 15 min before pioglitazone, and scopolamine, an M1 (muscarinic) receptor antagonist (0.3 or 1.0 mg/kg i.p.) and MK-801 (dizocilpine) (0.01, 0.03 or 0.1 mg/kg, i.p.), the highly selective, non-competitive NMDA antagonist--30 min beforehand. RESULTS: (1) We induced the memory impairment by scopolamine or MK-801 before trials. (2) Pioglitazone did not improve the memory impairment induced by MK-801. (3) Pioglitazone significantly improved the memory impairment induced by scopolamine. (4) Subeffective dose of MK-801 nullified the beneficial effects of pioglitazone in scopolamine induced memory impaired mice. (5) NMDA promoted the effects of subeffective dose of pioglitazone on memory impaired by scopolamine. DISCUSSION: In conclusion, the present study suggests that glutamatergic pathway is involved in the pioglitazone induced memory performance.