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1.
Pathol Oncol Res ; 28: 1610266, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35645620

RESUMO

Background and Aims: Pancreatic ductal adenocarcinoma has one of the worst prognosis of all malignancies. This investigated the relationship between the preoperative serum carbohydrate antigen 19-9 and surgical resectability. Methods: A systematic search was performed in three databases (MEDLINE, EMBASE, and Web of Science) to compare the surgical resectability of pancreatic ductal adenocarcinoma in patients with high and low preoperative serum carbohydrate antigen 19-9 values. The receiving operating characteristic curves were constructed and the weighted mean differences for preoperative serum carbohydrate antigen 19-9 levels of resectable and unresectable groups of patients were calculated. The PROSPERO registration number is CRD42019132522. Results: Results showed that there was a significant difference in resectability between the low and high carbohydrate antigen 19-9 groups. Six out of the eight studies utilised receiver operating characteristic curves in order to find the cut-off preoperative carbohydrate antigen 19-9 levels marking unresectability. The overall result from the pooled area under curve values from the receiver operating characteristic curves was 0.794 (CI: 0.694-0.893), showing that the preoperative carbohydrate antigen 19-9 level is a "fair" marker of resectability. The result of the pooled weighted mean differences was 964 U/ml (p < 0.001) showing that there is a significant carbohydrate antigen 19-9 difference between the resectable and unresectable groups. Based on the results of the I-squared test, the result was 87.4%, accounting for "considerable" heterogeneity within the population. Conclusion: Carbohydrate antigen 19-9 is not a reliable marker of unresectability, it should not be used on its own in surgical decision-making.


Assuntos
Adenocarcinoma , Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Adenocarcinoma/patologia , Antígeno CA-19-9 , Carboidratos , Carcinoma Ductal Pancreático/cirurgia , Humanos , Neoplasias Pancreáticas/patologia , Valor Preditivo dos Testes
2.
Sci Rep ; 12(1): 9819, 2022 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-35701509

RESUMO

Idiopathic inflammatory myopathies (IIM) is a group of heterogeneous autoimmune systemic diseases, which not only involve skeletal muscle but also myocardium. Cardiac involvement in IIM, which eventually develops into heart failure, is difficult to identify by conventional examinations at early stage. The aim of this study was to investigate if multi-parametric cardiac magnetic resonance (CMR) imaging can screen for early cardiac involvement in IIM, compared with clinical score (Myositis Disease Activity Assessment Tool, MDAAT). Forty-nine patients of IIM, and 25 healthy control subjects with comparable age-range and sex-ratio were enrolled in this study. All subjects underwent CMR examination, and multi-slice short-axis and 4-chamber cine MRI were acquired to evaluate biventricular global circumferential strain (GCS) and global longitudinal strain (GLS). Native T1 and T2 mapping were performed, and post-contrast T1 mapping and LGE were acquired after administration of contrast. A CMR score was developed from native T1 mean and T2 mean for the identification of cardiac involvement in the IIM cohort. Using contingency tables MDAAT and CMR were compared and statistically analyzed using McNemar test. McNemar's test revealed no significant difference between CMR score and MDAAT (p = 0.454). CMR score had potential to screen for early cardiac involvement in IIM patients, compared to MDAAT.


Assuntos
Miosite , Estudos de Casos e Controles , Humanos , Imageamento por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Miosite/diagnóstico por imagem , Miosite/patologia , Valor Preditivo dos Testes
3.
J Cardiovasc Magn Reson ; 24(1): 36, 2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-35692049

RESUMO

BACKGROUND: The right ventricle (RV) in hypertrophic cardiomyopathy (HCM) tends to be neglected, as previous efforts have predominantly focused on examining the prognostic value of left ventricular (LV) abnormalities. The objectives of this study were to assess RV function in HCM, changes over time, and association with clinical outcomes. METHODS: Two hundred and ninety HCM patients with preserved LV ejection fraction (LVEF ≥ 55%) and 30 age- and sex-matched controls underwent cardiovascular magnetic resonance (CMR). All patients were followed up for clinical events for a median duration of 4.4 years. Sixty-three patients had a follow-up CMR undertaken at a median interval of 5.4 years. Main study measures and outcomes were RV function (RV ejection fraction (RVEF) and RV strain) at baseline, temporal changes in RV function over time and prognostic value of RV dysfunction for predicting cardiovascular outcomes in HCM. RESULTS: When compared to controls, HCM patients exhibited lower RV and LV peak global longitudinal systolic strains on feature-tracking analysis of cine images, while RVEF and LVEF were within the normal range. On follow-up CMR, both RV and LV strain parameters decreased over time. RVEF decreased at follow-up (65 ± 7% to 62 ± 7%, P < 0.001) but the change in LVEF was not significant (68 ± 10% to 66 ± 8%, P = 0.30). On clinical follow up, reduced RVEF was an independent predictor of non-sustained ventricular tachycardia (NSVT) [HR 1.10 (95% CI 1.06-1.15), P < 0.001] and composite cardiovascular events (NSVT, stroke, heart failure hospitalisation and cardiovascular death) [HR 1.07 (95% CI 1.03-1.10), P < 0.001]. RV longitudinal strain was an independent predictor of NSVT [HR 1.05 (95% CI 1.01-1.09), P = 0.029]. Patients with RVEF < 55% showed an increased risk of NSVT and composite cardiovascular events. In contrast, LVEF and LV global longitudinal strain were not predictive of such events on multivariable analysis. CONCLUSIONS: In HCM, RV function, including RV strain, and LV strain decrease over time despite preserved LVEF. Reduction in RV but not LV function is associated with adverse cardiovascular outcomes. Assessing RV function in early HCM disease might have a role in risk stratification to prevent future cardiovascular events.


Assuntos
Cardiomiopatia Hipertrófica , Função Ventricular Direita , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Valor Preditivo dos Testes , Volume Sistólico , Função Ventricular Esquerda
4.
Scanning ; 2022: 2366871, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35692699

RESUMO

In order to explore the value of color Doppler ultrasonography (TVCDS) in the diagnosis and differential diagnosis of adenomyosis. A total of 150 patients with adenomyosis admitted to a hospital from January 2020 to December 2021 were selected, taking transvaginal three-dimensional color Doppler ultrasound and abdominal ultrasound for examination, all results were compared with patient pathology or surgical results, in order to compare the accuracy of the two inspection methods. The positive predictive value of three-dimensional color Doppler ultrasonography was higher than that of abdominal ultrasonography, and the difference was statistically significant (P < 0.05). The coincidence rate, sensitivity, and specificity of three-dimensional color Doppler ultrasonography were higher than those of abdominal ultrasonography, while the misdiagnosis rate was lower than that of abdominal ultrasonography, and the differences were statistically significant (all P < 0.05). The imaging features of vaginal three-dimensional color Doppler ultrasound in patients with adenomyosis are mainly enlarged uterus, slightly stronger echoes in the myometrium with enhanced echogenic spots, and short or short branch blood flow signals in the lesions. After statistical analysis, there was a significant difference in the blood flow changes between benign and malignant endometrial echoes and abnormal echoes in the uterine cavity, P < 0.05. Normal endometrium and benign intrauterine lesions mainly showed no blood flow signal, while malignant lesions in the uterine cavity mostly showed changes in blood flow signal. Compared with abdominal examination, transvaginal color Doppler ultrasonography has obvious advantages in the diagnosis of adenomyosis. According to the characteristics of ultrasound images, blood flow distribution, frequency spectrum, etc., it can provide a more accurate basis for clinical timely, provide the identification points of uterine fibroids, and provide help for clinicians to choose a treatment plan.


Assuntos
Adenomiose , Adenomiose/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Valor Preditivo dos Testes , Ultrassonografia/métodos , Ultrassonografia Doppler em Cores , Útero/diagnóstico por imagem
5.
BMJ Case Rep ; 15(6)2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-35688575

RESUMO

We present a case of angina, where extreme coronary tortuosity affected invasive physiology interpretation. Extreme coronary tortuosity may lower fractional flow reserve and instantaneous wave-free ratio. Therefore, invasive physiology can be misleading in this setting, when used to evaluate stenosis significance, or when used post-percutaneous coronary (PCI) intervention for physiology guided stent optimisation.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Cateterismo Cardíaco , Angiografia Coronária , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Humanos , Valor Preditivo dos Testes , Resultado do Tratamento
6.
Turk Kardiyol Dern Ars ; 50(4): 264-269, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35695362

RESUMO

OBJECTIVE: For fractional flow reserve measurement, contrast media can be used as an alterna- tive for adenosine. However, contrast media with different physical characteristics (e.g., osmo- lality and viscosity) may have different effects on hyperemia. This study aimed to determine if the diagnostic accuracy of contrast fractional flow reserve was influenced by 2 commonly used contrast media (Visipaque and Ultravist). METHODS: In this diagnostic study, candidates for coronary angiography with intermediate cor- onary lesion were enrolled and randomized to receive either an iso-osmolar contrast media (Visipaque) or a low osmolar contrast media (Ultravist) for fractional flow reserve measure- ment. The gold standard was fractional flow reserve measured by adenosine fractional flow reserve. Then cFFR and adenosine fractional flow reserve were compared between the groups, and the diagnostic values of both contrasts were calculated. Finally, the cut-point for diagnos- ing adenosine fractional flow reserve ≤ 0.8 was calculated for cFFR in both groups. RESULTS: In this study, 46 patients were studied (24 patients received Ultravist and 22 patients received Visipaque). There was no significant difference between the groups in adenosine frac- tional flow reserve. Also, the mean cFFR was not different from the mean adenosine fractional flow reserve in both groups. There was a strong correlation between cFFR and adenosine frac- tional flow reserve for each of the contrasts (r = 0.937 for Ultravist and r = 0.927 for Visipaque). Both contrasts had high specificity to diagnose fractional flow reserve ≤ 0.8 (specificity = 1), and the sensitivities of cFFR for Ultravist and Visipaque were 83.3% and 94.7%. The cut-point to predict adenosine fractional flow reserve ≤ 0.80 was 0.845 for Ultravist and 0.835 for Visipaque. CONCLUSIONS: Both iso-osmolar or low osmolar contrast media have an acceptable diagnostic accuracy in measuring cFFR.


Assuntos
Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Adenosina , Meios de Contraste , Angiografia Coronária , Humanos , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Vasodilatadores
7.
PLoS One ; 17(6): e0269807, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35696411

RESUMO

BACKGROUND: While patients with cardiac transthyretin amyloidosis are easily diagnosed with bone scintigraphy, the detection of cardiac light chain (AL) amyloidosis is challenging. Cardiac magnetic resonance (CMR) analyses play an essential role in the differential diagnosis of cardiomyopathies; however, limited data are available from cardiac AL-Amyloidosis. Hence, the purpose of the present study was to analyze the potential role of CMR in the detection of cardiac AL-amyloidosis. METHODS: We included 35 patients with proved cardiac AL-amyloidosis and two control groups constituted by 330 patients with hypertrophic cardiomyopathy (HCM) and 70 patients with arterial hypertension (HT), who underwent CMR examination. The phenotype and degree of left ventricular (LV) hypertrophy and the amount and pattern of late gadolinium enhancement (LGE) were evaluated. In addition, global and regional LV strain parameters were also analyzed using feature-tracking techniques. Sensitivity and specificity of several CMR parameters were analyzed in diagnosing cardiac AL-amyloidosis. RESULTS: The sensitivity and specificity of diffuse septal subendocardial LGE in diagnosing cardiac AL-amyloidosis was 88% and 100%, respectively. Likewise, the sensitivity and specificity of septal myocardial nulling prior to blood pool was 71% and 100%, respectively. In addition, a LV end-diastolic septal wall thickness ≥ 15 mm had an optimal diagnostic performance to differentiate cardiac AL-amyloidosis from HT (sensitivity 91%, specificity 89%). On the other hand, a reduced global LV longitudinal strain (< 15%) plus apical sparing (apex-to-base longitudinal strain > 2) had a very low sensitivity (6%) in detecting AL-Amyloidosis, but with very high specificity (100%). CONCLUSIONS: The findings from this study suggest that CMR could have an optimal diagnostic performance in the diagnosis of cardiac AL-amyloidosis. Hence, further larger studies are warranted to validate the findings from this study.


Assuntos
Neuropatias Amiloides Familiares , Cardiomiopatias , Amiloidose de Cadeia Leve de Imunoglobulina , Neuropatias Amiloides Familiares/patologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Meios de Contraste , Gadolínio , Humanos , Hipertrofia Ventricular Esquerda/patologia , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Miocárdio/patologia , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X
8.
Medicina (Kaunas) ; 58(6)2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35744050

RESUMO

Acute pancreatitis has a diverse etiology and natural history, and some patients have severe complications with a high risk of mortality. The prediction of the severity of acute pancreatitis should be achieved by a careful ongoing clinical assessment coupled with the use of a multiple-factor scoring system and imaging studies. Over the past 40 years, various scoring systems have been suggested to predict the severity of acute pancreatitis. However, there is no definite and ideal scoring system with a high sensitivity and specificity. The interest in new biological markers and predictive models for identifying severe acute pancreatitis testifies to the continued clinical importance of early severity prediction. Although contrast-enhanced computed tomography (CT) is considered the gold standard for diagnosing pancreatic necrosis, early scanning for the prediction of severity is limited because the full extent of pancreatic necrosis may not develop within the first 48 h of presentation. This article provides an overview of the available scoring systems and biochemical markers for predicting severe acute pancreatitis, with a focus on their characteristics and limitations.


Assuntos
Pancreatite Necrosante Aguda , Doença Aguda , Biomarcadores , Humanos , Pancreatite Necrosante Aguda/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
9.
J Cardiovasc Magn Reson ; 24(1): 40, 2022 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-35761339

RESUMO

BACKGROUND: Myocardial scar burden quantified using late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR), has important prognostic value in hypertrophic cardiomyopathy (HCM). However, nearly 50% of HCM patients have no scar but undergo repeated gadolinium-based CMR over their life span. We sought to develop an artificial intelligence (AI)-based screening model using radiomics and deep learning (DL) features extracted from balanced steady state free precession (bSSFP) cine sequences to identify HCM patients without scar. METHODS: We evaluated three AI-based screening models using bSSFP cine image features extracted by radiomics, DL, or combined DL-Radiomics. Images for 759 HCM patients (50 ± 16 years, 66% men) in a multi-center/vendor study were used to develop and test model performance. An external dataset of 100 HCM patients (53 ± 14 years, 70% men) was used to assess model generalizability. Model performance was evaluated using area-under-receiver-operating curve (AUC). RESULTS: The DL-Radiomics model demonstrated higher AUC compared to DL and Radiomics in the internal (0.83 vs 0.77, p = 0.006 and 0.78, p = 0.05; n = 159) and external (0.74 vs 0.64, p = 0.006 and 0.71, p = 0.27; n = 100) datasets. The DL-Radiomics model correctly identified 43% and 28% of patients without scar in the internal and external datasets compared to 42% and 16% by Radiomics model and 42% and 23% by DL model, respectively. CONCLUSIONS: A DL-Radiomics AI model using bSSFP cine images outperforms DL or Radiomics models alone as a scar screening tool prior to gadolinium administration. Despite its potential, the clinical utility of the model remains limited and further investigation is needed to improve the accuracy and generalizability.


Assuntos
Cardiomiopatia Hipertrófica , Aprendizado Profundo , Inteligência Artificial , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cicatriz/diagnóstico por imagem , Cicatriz/etiologia , Cicatriz/patologia , Meios de Contraste , Feminino , Gadolínio , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Valor Preditivo dos Testes
10.
J Cardiovasc Magn Reson ; 24(1): 39, 2022 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-35754040

RESUMO

BACKGROUND: Coronary cardiovascular magnetic resonance angiography (CCMRA) of congenital heart disease (CHD) in pediatric patients requires accurate planning, adequate sequence parameter adjustments, lengthy scanning sessions, and significant involvement from highly trained personnel. Anesthesia and intubation are commonplace to minimize movements and control respiration in younger subjects. To address the above concerns and provide a single-click imaging solution, we applied our free-running framework for fully self-gated (SG) free-breathing 5D whole-heart CCMRA to CHD patients after ferumoxytol injection. We tested the hypothesis that spatial and motion resolution suffice to visualize coronary artery ostia in a cohort of CHD subjects, both for intubated and free-breathing acquisitions. METHODS: In 18 pediatric CHD patients, non-electrocardiogram (ECG) triggered 5D free-running gradient echo CCMRA with whole-heart 1 mm3 isotropic spatial resolution was performed in seven minutes on a 1.5T CMR scanner. Eleven patients were anesthetized and intubated, while seven were breathing freely without anesthesia. All patients were slowly injected with ferumoxytol (4 mg/kg) over 15 minutes. Cardiac and respiratory motion-resolved 5D images were reconstructed with a fully SG approach. To evaluate the performance of motion resolution, visibility of coronary artery origins was assessed. Intubated and free-breathing patient sub-groups were compared for image quality using coronary artery length and conspicuity as well as lung-liver interface sharpness. RESULTS: Data collection using the free-running framework was successful in all patients in less than 8 min; scan planning was very simple without the need for parameter adjustments, while no ECG lead placement and triggering was required. From the resulting SG 5D motion-resolved reconstructed images, coronary artery origins could be retrospectively extracted in 90% of the cases. These general findings applied to both intubated and free-breathing pediatric patients (no difference in terms of lung-liver interface sharpness), while image quality and coronary conspicuity between both cohorts was very similar. CONCLUSIONS: A simple-to-use push-button framework for 5D whole-heart CCMRA was successfully employed in pediatric CHD patients with ferumoxytol injection. This approach, working without any external gating and for a wide range of heart rates and body sizes provided excellent definition of cardiac anatomy for both intubated and free-breathing patients.


Assuntos
Cardiopatias Congênitas , Angiografia por Ressonância Magnética , Criança , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Óxido Ferroso-Férrico , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/patologia , Humanos , Imageamento Tridimensional/métodos , Pulmão , Angiografia por Ressonância Magnética/métodos , Valor Preditivo dos Testes , Respiração , Estudos Retrospectivos
11.
Mol Med ; 28(1): 67, 2022 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-35715741

RESUMO

BACKGROUND: Approximately 25% of patients with early-stage breast cancer experience cancer progression throughout the disease course. Alterations in TMEM240 in breast cancer were identified and investigated to monitor treatment response and disease progression. METHODS: Circulating methylated TMEM240 in the plasma of breast cancer patients was used to monitor treatment response and disease progression. The Cancer Genome Atlas (TCGA) data in Western countries and Illumina methylation arrays in Taiwanese breast cancer patients were used to identify novel hypermethylated CpG sites and genes related to poor hormone therapy response. Quantitative methylation-specific PCR (QMSP), real-time reverse transcription PCR, and immunohistochemical analyses were performed to measure DNA methylation and mRNA and protein expression levels in 394 samples from Taiwanese and Korean breast cancer patients. TMEM240 gene manipulation, viability, migration assays, RNA-seq, and MetaCore were performed to determine its biological functions and relationship to hormone drug treatment response in breast cancer cells. RESULTS: Aberrant methylated TMEM240 was identified in breast cancer patients with poor hormone therapy response using genome-wide methylation analysis in the Taiwan and TCGA breast cancer cohorts. A cell model showed that TMEM240, which is localized to the cell membrane and cytoplasm, represses breast cancer cell proliferation and migration and regulates the expression levels of enzymes involved in estrone and estradiol metabolism. TMEM240 protein expression was observed in normal breast tissues but was not detected in 88.2% (67/76) of breast tumors and in 90.0% (9/10) of metastatic tumors from breast cancer patients. QMSP revealed that in 54.5% (55/101) of Taiwanese breast cancer patients, the methylation level of TMEM240 was at least twofold higher in tumor tissues than in matched normal breast tissues. Patients with hypermethylation of TMEM240 had poor 10-year overall survival (p = 0.003) and poor treatment response, especially hormone therapy response (p < 0.001). Circulating methylated TMEM240 dramatically and gradually decreased and then diminished in patients without disease progression, whereas it returned and its levels in plasma rose again in patients with disease progression. Prediction of disease progression based on circulating methylated TMEM240 was found to have 87.5% sensitivity, 93.1% specificity, and 90.2% accuracy. CONCLUSIONS: Hypermethylation of TMEM240 is a potential biomarker for treatment response and disease progression monitoring in breast cancer.


Assuntos
Antineoplásicos Hormonais , Neoplasias da Mama , Metilação de DNA , Proteínas de Membrana , Antineoplásicos Hormonais/uso terapêutico , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/genética , Neoplasias da Mama/sangue , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Ilhas de CpG , Progressão da Doença , Feminino , Hormônios , Humanos , Proteínas de Membrana/biossíntese , Proteínas de Membrana/sangue , Proteínas de Membrana/genética , Valor Preditivo dos Testes
12.
J Biomed Inform ; 131: 104112, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35680073

RESUMO

Extended endocrine therapy beyond 5 years is of major concern to ER + breast cancer survivors. However, it might be unsuitable to apply routinely used genomic tests designed for early recurrence risks to distant recurrence within 10 years in extended treatment context. These tests initially aim at high sensitivities with Type I errors much higher than Type II. Having lower positive predictive values (PPVs), these tests can bring many false positives who might not need further treatment options to avoid adversely affecting quality of life. Alternatively, we proposed a top-down approach to the raised issues. We built 149 targeted genes from four genomic tests upon 381 ER-positive node-negative patients with either metastasis free beyond 10 years (n = 202) or metastasis within 10 years (n = 179). By a basket of SVM-wrapped length-constraint feature selection (LCFS), we discovered four genomic SVMs that traded off Type I against Type II errors. Two independent cohorts were used to validate disease outcome predictions. A 36-gene SVM balanced sensitivities with PPVs at good levels: 74% vs 76% on 10-fold cross validation (n = 347) and 75% vs 71% on a test set (n = 34). Neither Oncotype DX RS (cutoff = 18, 31, 60.97) nor PAM50 ROR-S (cutoff = 29, 53, 61.18) could. Independent cohorts showed the 36-gene SVM predicted disease free survival (n = 136, HR = 2.59; 95% CI, 1.4-4.8) and disease specific survival (n = 127, HR = 4.06; 95% CI, 1.63-10.11) better than RS (DFS, HR = 2.15; DSS, HR = 3.86) and ROR-S (DFS, HR = 2.29; DSS, HR = 2.76). The case study demonstrated how we identified a genomic test to balance Type I against Type II errors for risk stratification. The top-down approach centered around the LCFS-metaheuristics basket is a generic methodology for clinical decision-making and quality of life using targeted profiling data where the number of dimensions (p) is smaller than the number of samples (n).


Assuntos
Neoplasias da Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Feminino , Humanos , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/patologia , Valor Preditivo dos Testes , Prognóstico , Qualidade de Vida
14.
BMJ Open ; 12(6): e054881, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35725256

RESUMO

INTRODUCTION: Coronary artery disease (CAD) is the leading cause of death worldwide. More than a quarter of cardiovascular events are unexplained by current absolute cardiovascular disease risk calculators, and individuals without clinical risk factors have been shown to have worse outcomes. The 'anatomy of risk' hypothesis recognises that adverse anatomical features of coronary arteries enhance atherogenic haemodynamics, which in turn mediate the localisation and progression of plaques. We propose a new risk prediction method predicated on CT coronary angiography (CTCA) data and state-of-the-art machine learning methods based on a better understanding of anatomical risk for CAD. This may open new pathways in the early implementation of personalised preventive therapies in susceptible individuals as a potential key in addressing the growing burden of CAD. METHODS AND ANALYSIS: GeoCAD is a retrospective cohort study in 1000 adult patients who have undergone CTCA for investigation of suspected CAD. It is a proof-of-concept study to test the hypothesis that advanced image-derived patient-specific data can accurately predict long-term cardiovascular events. The objectives are to (1) profile CTCA images with respect to variations in anatomical shape and associated haemodynamic risk expressing, at least in part, an individual's CAD risk, (2) develop a machine-learning algorithm for the rapid assessment of anatomical risk directly from unprocessed CTCA images and (3) to build a novel CAD risk model combining traditional risk factors with these novel anatomical biomarkers to provide a higher accuracy CAD risk prediction tool. ETHICS AND DISSEMINATION: The study protocol has been approved by the St Vincent's Hospital Human Research Ethics Committee, Sydney-2020/ETH02127 and the NSW Population and Health Service Research Ethics Committee-2021/ETH00990. The project outcomes will be published in peer-reviewed and biomedical journals, scientific conferences and as a higher degree research thesis.


Assuntos
Doença da Artéria Coronariana , Adulto , Estudos de Coortes , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos
15.
J Cardiovasc Magn Reson ; 24(1): 37, 2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-35725473

RESUMO

Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.


Assuntos
Cardiologia , Cardiopatias , Radiologia , American Heart Association , Criança , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Humanos , Espectroscopia de Ressonância Magnética , América do Norte , Valor Preditivo dos Testes , Estados Unidos
16.
J Cardiovasc Magn Reson ; 24(1): 38, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35725565

RESUMO

The 25th Society for Cardiovascular Magnetic Resonance (SCMR) Annual Scientific Sessions saw 1524 registered participants from more than 50 countries attending the meeting virtually. Supporting the theme "CMR: Improving Cardiovascular Care Around the World", the meeting included 179 invited talks, 52 sessions including 3 plenary sessions, 2 keynote talks, and a total of 93 cases and 416 posters. The sessions were designed so as to showcase the multifaceted role of cardiovascular magnetic resonance (CMR) in identifying and prognosticating various myocardial pathologies. Additionally, various social networking sessions as well as fun activities were organized. The major areas of focus for the future are likely to be rapid efficient and high value CMR exams, automated and quantitative acquisition and post-processing using artificial intelligence and machine learning, multi-contrast imaging and advanced vascular imaging including 4D flow.


Assuntos
Inteligência Artificial , Sistema Cardiovascular , Humanos , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Valor Preditivo dos Testes
17.
J Am Heart Assoc ; 11(11): e024903, 2022 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-35656982

RESUMO

Background Coronary diffuse disease associates with poor outcomes, but little is known about its role after percutaneous coronary intervention (PCI). We aimed to investigate the prognostic implication of pre-PCI focal or diffuse disease patterns combined with post-PCI quantitative flow ratio (QFR). Methods and Results Pre-PCI QFR derived pullback pressure gradient (PPG) (QFR-PPG) was measured to assess physiological disease patterns for 1685 included vessels; the vessels were classified according to dichotomous pre-PCI QFR-PPG and post-PCI QFR. Vessel-oriented composite outcome, a composite of vessel-related ischemia-driven revascularization, vessel-related myocardial infarction, or cardiac death at 2 years was compared among these groups. Vessels with low pre-PCI PPG (3.9% versus 2.0%, hazard ratio [HR], 1.93; 95% CI, 1.08-3.44; P=0.02) or low post-PCI QFR (9.8% versus 2.7%, HR, 3.78; 95% CI, 1.61-8.87; P=0.001) demonstrated higher vessel-oriented composite outcome risk after stent implantation. Of note, despite high post-PCI QFR achieved, vessels with low pre-PCI QFR-PPG presented higher risk of vessel-oriented composite outcome than those with high pre-PCI QFR-PPG (3.7% versus 1.8%, HR, 2.03; 95% CI, 1.09-3.76; P=0.03) and pre-PCI QFR-PPG demonstrated direct prognostic effect not mediated by post-PCI QFR. Integration of groups classified by pre-PCI QFR-PPG and post-PCI QFR showed significantly higher discriminant and reclassification abilities than clinical factors (C-index 0.77 versus 0.72, P=0.03; integrated discrimination improvement 0.93%, P=0.04; net reclassification index 0.33, P=0.02). Conclusions Prognostic value of pre-PCI focal or diffuse disease patterns assessed by QFR-PPG index was retained even after successful PCI, which is mostly explained by its direct effect that was not mediated by post-PCI QFR. Integration of both pre-PCI and post-PCI physiological information can provide better risk stratification in vessels with stent implantation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05104580.


Assuntos
Doença da Artéria Coronariana , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Valor Preditivo dos Testes , Prognóstico , Resultado do Tratamento
18.
BMJ Open ; 12(6): e055481, 2022 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-35738652

RESUMO

INTRODUCTION: Coronary CT angiography (CCTA)-derived quantitative flow ratio (CT-QFR) is a novel non-invasive technology to assess the physiological significance of coronary stenoses, which enables fast and on-site computation of fractional flow reserve (FFR) from CCTA images. The objective of this investigator-initiated, prospective, single-centre clinical trial is to evaluate the diagnostic performance of CT-QFR with respect to angiography-derived QFR, using FFR as the reference standard. METHODS AND ANALYSIS: A total of 216 patients who have at least one lesion with a diameter stenosis of 30%-90% in an artery with ≥2.0 mm reference diameter will be enrolled in the study. FFR will be measured during invasive coronary angiography. CT-QFR and QFR will be assessed in two independent core laboratories in a blinded fashion. The primary endpoint is the diagnostic accuracy of CT-QFR in identifying haemodynamically significant coronary stenosis with FFR as the reference standard. The major secondary endpoint is the non-inferiority of CT-QFR compared with QFR in the patients without extensively calcified lesions. ETHICS AND DISSEMINATION: The study was approved by the Ethics Committee of Huadong Hospital Affiliated to Fudan University (2020K192). Outcomes will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER: NCT04665817.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Vasos Coronários , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
19.
JACC Clin Electrophysiol ; 8(6): 782-791, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35738855

RESUMO

BACKGROUND: Smart watches and wearable technology capable of heart rhythm assessment have increased in use in the general population. The Apple Watch Series 4 (AW4) and KardiaBand (KB) are devices capable of obtaining single-lead electrocardiographic recordings, presenting a novel opportunity for the detection of paroxysmal arrhythmias. OBJECTIVES: The aim of this study was to assess the diagnostic utility of the AW4 and KB in an elderly outpatient population. METHODS: Consecutive recordings were taken from patients attending cardiology outpatient clinic from the AW4 and KB concurrently with 12-lead electrocardiography. Automated diagnoses and blinded single-lead electrocardiographic tracing interpretations by 2 cardiologists were analyzed. Analysis was also conducted to assess the effect of combined device and clinician interpretation. RESULTS: One hundred twenty-five patients were prospectively recruited (mean age 76 ± 7 years, 62% men). The accuracy of the automated rhythm assessment was higher with the KB than the AW4 (74% vs 65%). For the detection of atrial fibrillation, the sensitivity and negative predictive value of the KB were 89% and 97%, respectively, and of the AW4 were 19% and 82%, respectively. Using hybrid automated and clinician interpretation, the overall accuracy of the KB and AW4 was 91% and 87%, respectively. CONCLUSIONS: The KB automated algorithm outperformed the AW4 in its accuracy and sensitivity for detecting atrial fibrillation in the outpatient setting. Clinician assessment of the single-lead electrocardiogram improved accuracy. These findings suggest that although these devices' tracings are of sufficient quality, automated diagnosis alone is not sufficient for making clinical decisions about atrial fibrillation diagnosis and management.


Assuntos
Fibrilação Atrial , Dispositivos Eletrônicos Vestíveis , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes
20.
Artigo em Inglês | MEDLINE | ID: mdl-35742524

RESUMO

Atrial fibrillation (AF)-whether paroxysmal or sustained-increases the risk of stroke. We developed and validated a risk score for identifying patients at risk of paroxysmal atrial fibrillation (pAF) after acute ischemic stroke (AIS). A total of 6033 patients with AIS who received 24 h Holter monitoring were identified in the Chang Gung Research Database. Among the identified patients, 5290 with pAF and without AF were included in the multivariable logistic regression analysis to develop the pAF prediction model. The ABCD-SD score (Age, Systolic Blood pressure, Coronary artery disease, Dyslipidemia, and Standard Deviation of heart rate) comprises age (+2 points for every 10 years), systolic blood pressure (-1 point for every 20 mmHg), coronary artery disease (+2 points), dyslipidemia (-2 points), and standard deviation of heart rate (+2 points for every 3 beats per minute). Overall, 5.2% (274/5290) of patients had pAF. The pAF risk ranged from 0.8% (ABCD-SD score ≤ 7) to 18.3% (ABCD-SD score ≥ 15). The model achieved an area under the receiver operating characteristic curve (AUROCC) of 0.767 in the model development group. The ABCD-SD score could aid clinicians in identifying patients with AIS at risk of pAF for advanced cardiac monitoring.


Assuntos
Fibrilação Atrial , Doença da Artéria Coronariana , AVC Isquêmico , Acidente Vascular Cerebral , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Criança , Eletrocardiografia Ambulatorial , Humanos , Valor Preditivo dos Testes , Fatores de Risco
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