Accurate and reliable precipitation data with high spatial and temporal resolution are essential in studying climate variability, water resources management, and hydrological forecasting. A range of ...global precipitation data are available to this end, but how well these capture actual precipitation remains unknown, particularly for mountain regions where ground stations are sparse. We examined the performance of three global high-resolution precipitation products for capturing precipitation over Central Asia, a hotspot of climate change, where reliable precipitation data are particularly scarce. Specifically, we evaluated MSWEP, CHIRPS, and GSMAP against independent gauging stations for the period 1985–2015. Our results show that MSWEP and CHIRPS outperformed GSMAP for wetter periods (i.e., winter and spring) and wetter locations (150–600 mm·year−1), lowlands, and mid-altitudes (0–3,000 m), and regions dominated by winter and spring precipitation. MSWEP performed best in representing temporal precipitation dynamics and CHIRPS excelled in capturing the volume and distribution of precipitation. All precipitation products poorly estimated precipitation at higher elevations (>3,000 m), in drier areas (<150 mm), and in regions characterized by summer precipitation. All products accurately detected dry spells, but their performance decreased for wet spells with increasing precipitation intensity. In sum, we find that CHIRPS and MSWEP provide the most reliable high-resolution precipitation estimates for Central Asia. However, the high spatial and temporal heterogeneity of the performance call for a careful selection of a suitable product for local applications considering the prevailing precipitation dynamics, climatic, and topographic conditions.
Abstract
Aims
There are limited data on coronary obstruction following transcatheter valve-in-valve (ViV) implantation inside failed aortic bioprostheses. The objectives of this study were to ...determine the incidence, predictors, and clinical outcomes of coronary obstruction in transcatheter ViV procedures.
Methods and results
A total of 1612 aortic procedures from the Valve-in-Valve International Data (VIVID) Registry were evaluated. Data were subject to centralized blinded corelab computed tomography (CT) analysis in a subset of patients. The virtual transcatheter valve to coronary ostium distance (VTC) was determined. A total of 37 patients (2.3%) had clinically evident coronary obstruction. Baseline clinical characteristics in the coronary obstruction patients were similar to controls. Coronary obstruction was more common in stented bioprostheses with externally mounted leaflets or stentless bioprostheses than in stented with internally mounted leaflets bioprostheses (6.1% vs. 3.7% vs. 0.8%, respectively; P < 0.001). CT measurements were obtained in 20 (54%) and 90 (5.4%) of patients with and without coronary obstruction, respectively. VTC distance was shorter in coronary obstruction patients in relation to controls (3.24 ± 2.22 vs. 6.30 ± 2.34, respectively; P < 0.001). Using multivariable analysis, the use of a stentless or stented bioprosthesis with externally mounted leaflets odds ratio (OR): 7.67; 95% confidence interval (CI): 3.14–18.7; P < 0.001 associated with coronary obstruction for the global population. In a second model with CT data, a shorter VTC distance predicted this complication (OR: 0.22 per 1 mm increase; 95% CI: 0.09–0.51; P < 0.001), with an optimal cut-off level of 4 mm (area under the curve: 0.943; P < 0.001). Coronary obstruction was associated with a high 30-day mortality (52.9% vs. 3.9% in the controls, respectively; P < 0.001).
Conclusion
Coronary obstruction following aortic ViV procedures is a life-threatening complication that occurred more frequently in patients with prior stentless or stented bioprostheses with externally mounted leaflets and in those with a short VTC.
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes ...affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
Objectives This study describes the first use of caval-aortic access and closure to enable transcatheter aortic valve replacement (TAVR) in patients who lacked other access options. Caval-aortic ...access refers to percutaneous entry into the abdominal aorta from the femoral vein through the adjoining inferior vena cava. Background TAVR is attractive in high-risk or inoperable patients with severe aortic stenosis. Available transcatheter valves require large introducer sheaths, which are a risk for major vascular complications or preclude TAVR altogether. Caval-aortic access has been successful in animals. Methods We performed a single-center retrospective review of procedural and 30-day outcomes of prohibitive-risk patients who underwent TAVR via caval-aortic access. Results Between July 2013 and January 2014, 19 patients underwent TAVR via caval-aortic access; 79% were women. Caval-aortic access and tract closure were successful in all 19 patients; TAVR was successful in 17 patients. Six patients experienced modified VARC-2 major vascular complications, 2 (11%) of whom required intervention. Most (79%) required blood transfusion. There were no deaths attributable to caval-aortic access. Throughout the 111 (range 39 to 229) days of follow up, there were no post-discharge complications related to tract creation or closure. All patients had persistent aorto-caval flow immediately post-procedure. Of the 16 patients who underwent repeat imaging after the first week, 15 (94%) had complete closure of the residual aorto-caval tract. Conclusions Percutaneous transcaval venous access to the aorta allows TAVR in otherwise ineligible patients, and may offer a new access strategy for other applications requiring large transcatheter implants.
This study describes the first use of caval-aortic access and closure to enable transcatheter aortic valve replacement (TAVR) in patients who lacked other access options. Caval-aortic access refers ...to percutaneous entry into the abdominal aorta from the femoral vein through the adjoining inferior vena cava.
TAVR is attractive in high-risk or inoperable patients with severe aortic stenosis. Available transcatheter valves require large introducer sheaths, which are a risk for major vascular complications or preclude TAVR altogether. Caval-aortic access has been successful in animals.
We performed a single-center retrospective review of procedural and 30-day outcomes of prohibitive-risk patients who underwent TAVR via caval-aortic access.
Between July 2013 and January 2014, 19 patients underwent TAVR via caval-aortic access; 79% were women. Caval-aortic access and tract closure were successful in all 19 patients; TAVR was successful in 17 patients. Six patients experienced modified VARC-2 major vascular complications, 2 (11%) of whom required intervention. Most (79%) required blood transfusion. There were no deaths attributable to caval-aortic access. Throughout the 111 (range 39 to 229) days of follow up, there were no post-discharge complications related to tract creation or closure. All patients had persistent aorto-caval flow immediately post-procedure. Of the 16 patients who underwent repeat imaging after the first week, 15 (94%) had complete closure of the residual aorto-caval tract.
Percutaneous transcaval venous access to the aorta allows TAVR in otherwise ineligible patients, and may offer a new access strategy for other applications requiring large transcatheter implants.
Mountains play a critical role in water cycles in semiarid regions by providing for the majority of the total runoff. However, hydroclimatic conditions in mountainous regions vary considerably in ...space and time, with high interannual fluctuations driven by large-scale climate oscillations. Here, we investigated teleconnections between global climate oscillations and the peak precipitation season from February to June in the Tian-Shan and Pamir Mountains of Central Asia. Using hierarchical climate regionalization, we identified seven subregions with distinct precipitation patterns, and assessed correlations with selected climate oscillations at different time lags. We then simulated the seasonal precipitation in each subregion from 1979 to 2020 using the most prevalent teleconnections as predictors with support vector regression (SVR). Our findings indicate that the El Niño–Southern Oscillation, the Pacific Decadal Oscillation, and the Eastern Atlantic/West Russia pattern are among the major determinants of the seasonal precipitation. The dominant lead-lag times of these oscillations make them reliable predictors ahead of the season. We detected notable teleconnections with the North Atlantic Oscillation and Scandinavian Pattern, with their strongest associations emerging after onset of the season. While the SVR-based models exhibit robust prediction skills, they tend to underestimate precipitation in extremely wet seasons. Overall, our study highlights the value of appropriate spatial and temporal aggregations for exploring the impacts of climate teleconnections on precipitation in complex terrains.
Water withdrawals for irrigated crop production constitute the largest source of freshwater consumption on Earth. Monitoring the dynamics of irrigated crop cultivation is crucial for tracking crop ...water consumption, particularly in water-scarce areas. We analyzed changes in water-dependent crop cultivation for 650 000 km 2 of Central Asian drylands, including the entire basin of the Amu Darya river, once the largest tributary to the Aral Sea before large-scale irrigation projects grossly reduced the amount of water reaching the river delta. We used Landsat time series to map overall cropland extent, dry season cropping, and cropping frequency in irrigated croplands annually from 1987 to 2019. We scrutinized the emblematic change processes of six localities to discern the underlying causes of these changes. Our unbiased area estimates reveal that between 1988 and 2019, irrigated dry season cropping declined by 1.34 million hectares (Mha), while wet season and double cropping increased by 0.64 Mha and 0.83 Mha, respectively. These results show that the overall extent of cropland in the region remained stable, while higher cropping frequency increased harvested area. The observed changes’ overall effect on water resource use remains elusive: Following the collapse of the Soviet Union, declining dry season cultivation reduced crop water demand while, more recently, increasing cropping frequency raised water consumption. Our analysis provides the first fine-scale analysis of post-Soviet changes in cropping practices of the irrigated areas of Central Asia. Our maps are openly available and can support future assessments of land-system trajectories and, coupled with evapotranspiration estimates, changes in crop water consumption.
The MITRAL (Mitral Implantation of Transcatheter Valves) trial is the first prospective study for valve-in-mitral annular calcification (ViMAC), mitral valve-in-ring (MViR), and mitral valve-in-valve ...(MViV) using balloon-expandable aortic transcatheter heart valves. Procedural outcomes beyond 1 year are not well described.
This study evaluated 2-year outcomes in ViMAC, MViR, and MViV in the MITRAL trial.
This multicenter prospective study enrolled patients with severe MAC, prior failed mitral annuloplasty ring repair, or prior failed bioprosthetic MV replacement who were at high surgical risk at 13 U.S. sites.
Between February 1, 2015, and December 31, 2017, 91 patients were enrolled (31 with ViMAC, 30 with MViR, and 30 with MViV). In the ViMAC group, 2-year all-cause mortality was 39.3%, 66.7% were New York Heart Association (NYHA) functional class I-II, and mean MV gradient was 5.6 ± 2.0 mm Hg. In the MViR group, 2-year all-cause mortality was 50%, 65% were NYHA functional class I-II, and mean MV gradient was 6.5 ± 2.7 mm Hg. In the MViV group, 2-year all-cause mortality was 6.7%, 85% were NYHA functional class I-II, and mean MV gradient was 6.9 ± 2.4 mm Hg. At 2 years, all patients had ≤mild mitral regurgitation and survivors in all 3 arms showed sustained improvement in Kansas City Cardiomyopathy Questionnaire scores compared to baseline.
Use of balloon-expandable aortic transcatheter heart valves in selected patients with severe MAC, failed annuloplasty ring, and bioprosthetic MV dysfunction is associated with improvements in symptoms, quality of life, and stable prosthesis function at 2-year follow-up. Between 1 and 2 years, the MViR group experienced higher mortality rates than the MViV and ViMAC groups.
Mitral valve replacement in the setting of severe mitral annular calcification remains a surgical challenge. Transcatheter mitral valve replacement (TMVR) using an aortic balloon-expandable ...transcatheter heart valve is emerging as a potential treatment option for high surgical risk patients. Transseptal, transapical, or transatrial access is not always feasible, so an understanding of alternative implantation techniques is important.
The authors sought to present a step-by-step description of a contemporary transatrial TMVR technique using balloon-expandable aortic transcatheter heart valves. This procedure has evolved over time to address valve migration, left ventricular outflow tract obstruction, and paravalvular leak. The authors present a refined technique that has been associated with the most reproducible outcomes.
A step-by-step description of the TMVR technique and outcomes of 8 patients treated using this technique are described. Baseline patient clinical and echocardiographic characteristics and 30-day post-TMVR outcomes are presented.
Eight patients underwent transatrial TMVR at a single institution. Five had previous cardiac surgery. Mean STS score was 8%. Technical success by MVARC (Mitral Valve Academic Research Consortium) criteria was 100%. There was zero in-hospital and 30-day mortality. Procedural success by MVARC criteria at 30 days was 100%. Paravalvular leak immediately post-implant was none or trace in 6 and mild in 1.
The technique described is reproducible and was associated with favorable outcomes in this early experience. It represents a useful technique for the treatment of mitral valve disease in the setting of severe annular calcification. A structured and defined implantation technique is critical to investigators as this field evolves.
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