Intelligibility listening tests are necessary during development and evaluation of speech processing algorithms, despite the fact that they are expensive and time consuming. In this paper, we propose ...a monaural intelligibility prediction algorithm, which has the potential of replacing some of these listening tests. The proposed algorithm shows similarities to the short-time objective intelligibility (STOI) algorithm, but works for a larger range of input signals. In contrast to STOI, extended STOI (ESTOI) does not assume mutual independence between frequency bands. ESTOI also incorporates spectral correlation by comparing complete 400ms length spectrograms of the noisy/processed speech and the clean speech signals. As a consequence, ESTOI is also able to accurately predict the intelligibility of speech contaminated by temporally highly modulated noise sources in addition to noisy signals processed with time-frequency weighting. We show that ESTOI can be interpreted in terms of an orthogonal decomposition of short-time spectrograms into intelligibility subspaces, i.e., a ranking of spectrogram features according to their importance to intelligibility. A free MATLAB implementation of the algorithm is available for noncommercial use at http://kom.aau.dk/~jje/.
We propose a novel deep learning training criterion, named permutation invariant training (PIT), for speaker independent multi-talker speech separation, commonly known as the cocktail-party problem. ...Different from the multi-class regression technique and the deep clustering (DPCL) technique, our novel approach minimizes the separation error directly. This strategy effectively solves the long-lasting label permutation problem, that has prevented progress on deep learning based techniques for speech separation. We evaluated PIT on the WSJ0 and Danish mixed-speech separation tasks and found that it compares favorably to non-negative matrix factorization (NMF), computational auditory scene analysis (CASA), and DPCL and generalizes well over unseen speakers and languages. Since PIT is simple to implement and can be easily integrated and combined with other advanced techniques, we believe improvements built upon PIT can eventually solve the cocktail-party problem.
The aim of the study was to evaluate the safety and efficacy of left atrial appendage occlusion (LAAO) with the AMPLATZER Cardiac Plug (ACP) or Amulet using aspirin alone (ASA) as post-implantation ...antithrombotic treatment.
This was a single-centre, prospective, non-randomised study on LAAO with the ACP or Amulet in a consecutive cohort (n=110) treated by ASA alone post implantation. The primary outcome was device-related thrombosis, while secondary outcomes were ischaemic stroke or major bleeding. Clinical follow-up was conducted after six weeks and 12 months with TEE and cardiac CT. One hundred and seven patients were included in the analysis. Three patients were excluded due to a mechanical valve prosthesis. CHA2DS2-VASc score was 4.4±1.6 and HAS-BLED 4.1±1.1. Successful implantation was obtained in all patients with a periprocedural complication rate of 4.6%. Median follow-up was 2.3 years, with a total of 265 patient-years. Device-related thrombosis was detected in 2/107 (1.9%) cases. Stroke occurred in 6/107 patients, with an annualised rate of 2.3%, which is a 61% risk reduction compared to the predicted rate. Annual risk of major bleeding was reduced by 57%.
LAAO with the ACP or Amulet was safely performed with ASA monotherapy after implantation without an increased risk of device-related thrombosis or stroke.
Abstract
Aims
Non-invasive assessment of stable chest pain patients is a critical determinant of resource utilization and clinical outcomes. Increasingly coronary computed tomography angiography ...(CCTA) with selective CCTA-derived fractional flow reserve (FFRCT) is being used. The ADVANCE Registry, is a large prospective examination of using a CCTA and FFRCT diagnostic pathway in real-world settings, with the aim of determining the impact of this pathway on decision-making, downstream invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular events (MACE).
Methods and results
A total of 5083 patients with symptoms concerning for coronary artery disease (CAD) and atherosclerosis on CCTA were enrolled at 38 international sites from 15 July 2015 to 20 October 2017. Demographics, symptom status, CCTA and FFRCT findings, treatment plans, and 90 days outcomes were recorded. The primary endpoint of reclassification between core lab CCTA alone and CCTA plus FFRCT-based management plans occurred in 66.9% confidence interval (CI): 64.8–67.6 of patients. Non-obstructive coronary disease was significantly lower in ICA patients with FFRCT ≤0.80 (14.4%) compared to patients with FFRCT >0.80 (43.8%, odds ratio 0.19, CI: 0.15–0.25, P < 0.001). In total, 72.3% of subjects undergoing ICA with FFRCT ≤0.80 were revascularized. No death/myocardial infarction (MI) occurred within 90 days in patients with FFRCT >0.80 (n = 1529), whereas 19 (0.6%) MACE hazard ratio (HR) 19.75, CI: 1.19–326, P = 0.0008 and 14 (0.3%) death/MI (HR 14.68, CI 0.88–246, P = 0.039) occurred in subjects with an FFRCT ≤0.80.
Conclusions
In a large international multicentre population, FFRCT modified treatment recommendation in two-thirds of subjects as compared to CCTA alone, was associated with less negative ICA, predicted revascularization, and identified subjects at low risk of adverse events through 90 days.
The aim of this study was to compare the efficacy and safety of intracardiac echocardiography (ICE) from the left atrium (LA) with transesophageal echocardiography (TEE) for procedural guidance of ...transcatheter left atrial appendage occlusion (LAAO).
TEE with general anesthesia is the current gold standard to guide LAAO. By the use of ICE from the LA, LAAO can be performed in local anesthesia and may potentially have advantages over TEE.
A single-center, cohort study of patients undergoing LAAO with the Amplatzer Cardiac Plug or Amulet (St. Jude Medical, St. Paul, Minnesota). Procedures were guided by ICE from the LA with local anesthesia (n = 109) or TEE using general anesthesia (n = 107). All patients had pre-procedural cardiac computed tomography. Efficacy outcomes were technical success, procedural success, and peridevice leakage at TEE 8 weeks after LAAO. Safety outcome was a composite of periprocedural complications.
Technical success was achieved in 99% of both the TEE and ICE group. Procedural success was similar between groups: 94.4% success rate in the TEE-guided group, and 94.5% in the ICE-guided group. Major periprocedural complications occurred in 4.7% of the TEE group and 1.8% of the ICE group. Rate and degree of peridevice leak did not differ between groups at follow-up. Turnover time in the catheter laboratory, and contrast use were reduced with ICE.
LA ICE to guide LAAO as compared with TEE appears to be effective and safe, without increased procedure-related complications. The rate of peridevice leak is low and similar to TEE-guided procedures. Time spent in the catheterization room may decrease substantially.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Coronary plaque characteristics are associated with ischaemia. Differences in plaque volumes and composition may explain the discordance between coronary stenosis severity and ischaemia. We evaluated ...the association between coronary stenosis severity, plaque characteristics, coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT), and lesion-specific ischaemia identified by FFR in a substudy of the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps).
Coronary CTA stenosis, plaque volumes, FFRCT, and FFR were assessed in 484 vessels from 254 patients. Stenosis >50% was considered obstructive. Plaque volumes (non-calcified plaque NCP, low-density NCP LD-NCP, and calcified plaque CP) were quantified using semi-automated software. Optimal thresholds of quantitative plaque variables were defined by area under the receiver-operating characteristics curve (AUC) analysis. Ischaemia was defined by FFR or FFRCT ≤0.80. Plaque volumes were inversely related to FFR irrespective of stenosis severity. Relative risk (95% confidence interval) for prediction of ischaemia for stenosis >50%, NCP ≥185 mm(3), LD-NCP ≥30 mm(3), CP ≥9 mm(3), and FFRCT ≤0.80 were 5.0 (3.0-8.3), 3.7 (2.4-5.6), 4.6 (2.9-7.4), 1.4 (1.0-2.0), and 13.6 (8.4-21.9), respectively. Low-density NCP predicted ischaemia independent of other plaque characteristics. Low-density NCP and FFRCT yielded diagnostic improvement over stenosis assessment with AUCs increasing from 0.71 by stenosis >50% to 0.79 and 0.90 when adding LD-NCP ≥30 mm(3) and LD-NCP ≥30 mm(3) + FFRCT ≤0.80, respectively.
Stenosis severity, plaque characteristics, and FFRCT predict lesion-specific ischaemia. Plaque assessment and FFRCT provide improved discrimination of ischaemia compared with stenosis assessment alone.
In the development process of noise-reduction algorithms, an objective machine-driven intelligibility measure which shows high correlation with speech intelligibility is of great interest. Besides ...reducing time and costs compared to real listening experiments, an objective intelligibility measure could also help provide answers on how to improve the intelligibility of noisy unprocessed speech. In this paper, a short-time objective intelligibility measure (STOI) is presented, which shows high correlation with the intelligibility of noisy and time-frequency weighted noisy speech (e.g., resulting from noise reduction) of three different listening experiments. In general, STOI showed better correlation with speech intelligibility compared to five other reference objective intelligibility models. In contrast to other conventional intelligibility models which tend to rely on global statistics across entire sentences, STOI is based on shorter time segments (386 ms). Experiments indeed show that it is beneficial to take segment lengths of this order into account. In addition, a free Matlab implementation is provided.
Patients with obstructive coronary artery disease (CAD) are at high risk for cardiovascular disease (CVD) events. However, it remains unclear whether the high risk is due to high atherosclerotic ...disease burden or if presence of stenosis has independent predictive value.
The purpose of this study was to evaluate if obstructive CAD provides predictive value beyond its association with total calcified atherosclerotic plaque burden as assessed by coronary artery calcium (CAC).
Among 23,759 symptomatic patients from the Western Denmark Heart Registry who underwent diagnostic computed tomography angiography (CTA), we assessed the risk of major CVD (myocardial infarction, stroke, and all-cause death) stratified by CAC burden and number of vessels with obstructive disease.
During a median follow-up of 4.3 years, 1,054 patients experienced a first major CVD event. The event rate increased stepwise with both higher CAC scores and number of vessels with obstructive disease (by CAC scores: 6.2 per 1,000 person-years (PY) for CAC = 0 to 42.3 per 1,000 PY for CAC >1,000; by number of vessels with obstructive disease: 6.1 per 1,000 PY for no CAD to 34.7 per 1,000 PY for 3-vessel disease). When stratified by 5 groups of CAC scores (0, 1 to 99, 100 to 399, 400 to 1,000, and >1,000), the presence of obstructive CAD was not associated with higher risk than presence of nonobstructive CAD.
Plaque burden, not stenosis per se, is the main predictor of risk for CVD events and death. Thus, patients with a comparable calcified atherosclerosis burden generally carry a similar risk for CVD events regardless of whether they have nonobstructive or obstructive CAD.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Transcatheter left atrial appendage occlusion is an increasingly used alternative to oral anticoagulation in selected patients with atrial fibrillation. Pre-procedural imaging is a prerequisite to a ...successful intervention, with transesophageal echocardiography as the current gold standard. However, cardiac computed tomography offers improved imaging with high-quality multiplanar and 3-dimensional reconstructed images. Nevertheless, the lack of a standardized imaging protocol has slowed the adoption of cardiac computed tomography into clinical practice. On the basis of current research and expert consensus, this paper provides a protocol for the preparation, acquisition, and interpretation of cardiac computed tomographic imaging in pre-procedural planning of left atrial appendage occlusion.
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•Cardiac CT is increasingly used to plan transcatheter LAAO.•High-quality multiplanar and 3D imaging allow accurate device sizing and efficient LAAO.•A standardized protocol for cardiac CT is paramount for a high-quality result.•Pre-procedural cardiac CT may improve the accuracy, efficacy, and safety of LAAO.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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