Trajectories of functional and structural myocardial parameters in post-COVID-19 syndrome-insights from mid-term follow-up by cardiovascular magnetic resonance.

Introduction: Myocardial tissue alterations in patients with post-Coronavirus disease 2019 syndrome (PCS) are often subtle and mild. Reports vary in the prevalence of non-ischemic and ischemic injuries as well as the extent of ongoing myocardial inflammation. The exact relevance of these myocardial alterations is not fully understood. This study aimed at describing the trajectories of myocardial alterations in PCS patients by mid-term follow-up with cardiovascular magnetic resonance (CMR). Methods: This study entails a retrospective analysis of symptomatic PCS patients referred for follow-up CMR between August 2020 and May 2023 due to mildly affected or reduced left or right ventricular function (LV and RV, respectively) and structural myocardial alterations, e.g., focal and diffuse fibrosis, on baseline scans. Follow-up CMR protocol consisted of cine images and full coverage native T1 and T2 mapping. Baseline and follow-up scans were compared using t-tests or Wilcoxon tests. Post-hoc analysis was carried out in a subgroup based on the change of LV stroke volume (SV) between scans. Results: In total, 43 patients [median age (interquartile range) 46 (37-56) years, 33 women] received follow-ups 347 (167-651) days after initial diagnosis. A decrease in symptoms was recorded on follow-ups (p < 0.03) with 23 patients being asymptomatic at follow-ups [symptomatic at baseline 43/43 (100%) vs. symptomatic at follow-up 21/43 (49%), p < 0.001]. Functional improvement was noted for LV-SV [83.3 (72.7-95.0) vs. 84.0 (77.0-100.3) ml; p = 0.045], global radial [25.3% (23.4%-27.9%) vs. 27.4% (24.4%-33.1%); p < 0.001], and circumferential strains [-16.5% (-17.5% to -15.6%) vs. -17.2% (-19.5% to -16.1%); p < 0.001]. In total, 17 patients had an LV-SV change >10% on follow-up scans (5 with a decrease and 12 with an increase), with LV-SV, RV-SV, and global longitudinal strain being discriminatory variables on baseline scans (p = 0.01, 0.02, and 0.04, respectively). T1- or T2-analysis revealed no changes, remaining within normal limits. Conclusion: Symptomatic load as well as blood pressures decreased on follow-up. CMR did not detect significant changes in tissue parameters; however, volumetric, specifically LV-SV, and deformation indexes improved during mid-term follow-up.

Sex-specific structural and functional cardiac remodeling during healthy aging assessed by cardiovascular magnetic resonance.

BACKGROUND: Aging as a major non-modifiable cardiac risk factor challenges future cardiovascular medicine and economic demands, which requires further assessments addressing physiological age-associated cardiac changes. OBJECTIVES: Using cardiovascular magnetic resonance (CMR), this study aims to characterize sex-specific ventricular adaptations during healthy aging. METHODS: The population included healthy volunteers who underwent CMR at 1.5 or 3 Tesla scanners applying cine-imaging with a short-axis coverage of the left (LV) and right (RV) ventricle. The cohort was divided by sex (female and male) and age (subgroups in years): 1 (19-29), 2 (30-39), 3 (40-49), and 4 (≥50). Cardiac adaptations were quantitatively assessed by CMR indices. RESULTS: After the exclusion of missing or poor-quality CMR datasets or diagnosed disease, 140 of 203 volunteers were part of the final analysis. Women generally had smaller ventricular dimensions and LV mass, but higher biventricular systolic function. There was a significant age-associated decrease in ventricular dimensions as well as a significant increase in LV mass-to-volume ratio (LV-MVR, concentricity) in both sexes (LV-MVR in g/ml: age group 1 vs. 4: females 0.50 vs. 0.57, p=0.016, males 0.56 vs. 0.67, p=0.024). LV stroke volume index decreased significantly with age in both sexes, but stronger for men than for women (in ml/m2: age group 1 vs. 4: females 51.76 vs. 41.94, p<0.001, males 55.31 vs. 40.78, p<0.001). Ventricular proportions (RV-to-LV-volume ratio) were constant between the age groups in both sexes. CONCLUSIONS: In both sexes, healthy aging was associated with an increase in concentricity and a decline in ventricular dimensions. Furthermore, relevant age-related sex differences in systolic LV performance were observed.

[Clinical application of large language models : Does ChatGPT replace medical report formulation? An experience report]. / Anwendung von "large language models" in der Klinik : Ersetzt ChatGPT die Arztbrieferstellung? Ein Erfahrungsbericht.

Artificial intelligence (AI)-based language models, such as ChatGPT offer an enormous potential for research and medical care but also for clinical workflow optimization by making medical documentation easier and more efficient in taking over standardized routine tasks. With their ability to guess a text's content using word statistics and thus outputting contextually relevant results in chat dialogues, large language models (LLM) can provide appropriate summaries of medical documentation for different target groups. For instance, text generation in easy to understand language could potentially contribute to an increase in patients' health literacy and, consequently, to increased adherence to treatment. Subsequent, the function of AI-based chatbot models to improve user experiences and enhance competence in the use of AI-based language models will be adressed. Current limitations and chances in creating epicrises are presented as an experience report. In the future, the implementation of local LLMs in medical management systems (hospital information systems, HIS and practice administration systems, PAS) and in conjunction with the electronic patient records (ePA) can fundamentally change clinical and outpatient care.