Abstract only
Introduction:
Computed tomography (CT) imaging is widely used in the emergency department (ED) setting. Calcifications of the coronary arteries, heart valves, and aorta are common ...incidental findings that may herald clinical or subclinical cardiovascular disease.
Hypothesis:
We sought to determine whether the quantitative burden of cardiovascular calcifications, as measured by a CT-based deep learning pipeline, would be predictive of short-term mortality in a diverse population of ED patients.
Methods:
We conducted a prospective single-center cohort study nested in the Quebec COVID-19 Biobank from March 2020 to September 2021. For the purposes of this study, we enlisted adult patients presenting to the ED with cardiopulmonary symptoms who were tested for COVID-19 and underwent CT imaging of the chest. We used a deep learning model previously developed by our team to automate the quantitative scoring of coronary artery calcification (CAC), aortic valve calcification (AVC), mitral annular calcification (MAC), and thoracic aorta calcification (TAC) from the CT images. These calcium scores were categorized as sex-stratified tertiles plus a zero-score referent category. The primary outcome was all-cause mortality at 30 and 90 days adjusted for age, sex, and COVID-19 status using multivariable logistic regression.
Results:
The study sample consisted of 731 ED visits among 271 unique patients with a mean age of 66 years and 47% females. COVID-19 illness was the main diagnosis in 29% of ED visits. The prevalence of any quantifiable calcification was 51% for CAC, 33% for AVC, 23% for MAC, and 80% for TAC. The statistically significant adjusted odds ratios for mortality were 2.50 (1.08, 5.81) in the highest AVC tertile at 30 days, 2.73 (1.37 5.47) in the highest CAC tertile at 90 days, and 4.42 (1.01, 19.4) in the highest TAC tertile at 90 days. These odds ratio remained similar after further adjustment for past history of myocardial infarction or heart failure.
Conclusions:
High calcium scores in the coronary arteries, aortic valve, and thoracic aorta are associated with heightened 30-day mortality in ED patients. Deep learning quantification of calcium scores from clinical CT scans is an opportunistic approach for risk stratification.
Abstract only
Background:
Calcific valve disease is now understood as a dynamic inflammatory process that alters the tissue’s adaptive response to stress stimuli. Transcatheter aortic valve ...replacement (TAVR) is a minimally invasive treatment for severe aortic stenosis. Manual analysis of calcifications in pre-TAVR CT scans is time-consuming and subjective.
Hypothesis:
Deep learning (DL) models can accurately quantify cardiovascular calcification and predict post-procedural outcomes in TAVR patients. We aimed to develop such a model and investigate its correlation with long-term all-cause mortality in TAVR patients.
Methods:
This post-hoc analysis examined patients from the FRAILTY-AVR trial and the Royal Victoria Hospital TAVR registry. A 3D UNet-based DL pipeline was developed and trained to detect and quantify coronary artery calcification (CAC), aortic valve calcification (AVC), mitral annular calcification (MAC), and thoracic aorta calcification (TAC) based on pre-procedural CT images. Quantification involved segmentation and CT image analysis techniques. Cox regression analysis, adjusting for various covariates, evaluated the primary endpoint of all-cause mortality one year after TAVR.
Results:
The study included 585 TAVR patients (mean age: 82.5 years; 44% females) with a median follow-up of 506 days. At one year, 27.5%(161) reached the primary endpoint of all-cause mortality. Hazard ratios for MAC, AVC, TAC, and CAC were 1.26 (95% CI: 1.06-1.51, P=0.010), 0.99 (95% CI: 0.83-1.18, P=0.91), 1.07 (95% CI: 0.89-1.29, P=0.46), and 0.89 (95% CI: 0.72-1.09, P=0.26), respectively. Adjustments for covariates did not significantly change these hazard ratios. Mean calcification volumes were 770 mm3 (AVC), 737 mm3 (CAC), 3076 mm3 (TAC), and 629 mm3 (MAC). No substantial correlations were observed between the four calcifications or cardiovascular co-morbidities however, each score may yield meaningful information.
Conclusions:
High mitral annular calcification, quantified by our AI pipeline, was independently associated with increased one-year post-TAVR mortality. AI enables efficiency, objectivity, and improved insights, enhancing clinical decision-making and personalized care.
To identify genetic markers associated with late treatment-related skeletal morbidity in survivors of childhood acute lymphoblastic leukemia (ALL).
To this end, we measured the association between ...reduction in bone mineral density or vertebral fractures prevalence and variants from 1039 genes derived through whole exome sequencing in 242 childhood ALL survivors. Top-ranking variants were confirmed through genotyping, and further explored with stratified analyses and multivariable models.
The minor allele of rs1944294 in
gene was associated with bone geometrical parameter, trabecular cross-sectional area (p = 0.001). The association was modulated by radiation therapy (p = 0.001) and post-treatment time (p = 0.0002).
The variant in
gene is a potential novel risk factor of bone morbidity in survivors of childhood ALL.
Although 80% of childhood acute lymphoblastic leukemia (ALL) cases are cured with current treatment protocols, exposure to chemotherapeutics or radiation therapy during a vulnerable period of child ...development has been associated with a high frequency of late adverse effects (LAE). Previous observations suggest important skeletal muscle size, density and function deficits in ALL survivors.
Given that only a fraction of all patients will suffer from this particular complication, we investigated whether it could be predicted by genetic markers.
We analysed associations between skeletal muscle force (Fmax) and power (Pmax) and germline genetic variants from 1039 genes derived through whole-exome sequencing. Top-ranking association signals retained after correction for multiple testing were confirmed through genotyping, and further analysed through stratified analyses and multivariate models.
Our results show that skeletal muscle function deficit is associated with two common single nucleotide polymorphisms (SNPs) (rs2001616
=0.0002 (Pmax) and rs41270041
,
=0.02 (Fmax)) and two rare ones located in the
gene
=0.001 (Pmax)). These associations were further modulated by sex, body mass index and risk groups, which reflected glucocorticoid dose and radiation therapy (
≤0.02).
Occurrence of muscle function deficit in childhood ALL is thus strongly modulated by variations in the
and
genes, which could lead to personalized prevention strategies in childhood ALL survivors.
Background: Although 80% of childhood acute lymphoblastic leukemia (ALL) cases are cured with current treatment protocols, exposure to chemotherapeutics or radiation therapy during a vulnerable ...period of child development has been associated with a high frequency of late adverse effects (LAE). Previous observations suggest important skeletal muscle size, density and function deficits in ALL survivors. Purpose: Given that only a fraction of all patients will suffer from this particular complication, we investigated whether it could be predicted by genetic markers. Patients and methods: We analysed associations between skeletal muscle force (Fmax) and power (Pmax) and germline genetic variants from 1039 genes derived through wholeexome sequencing. Top-ranking association signals retained after correction for multiple testing were confirmed through genotyping, and further analysed through stratified analyses and multivariate models. Results: Our results show that skeletal muscle function deficit is associated with two common single nucleotide polymorphisms (SNPs) (rs2001616DUOX2, P=0.0002 (Pmax) and rs41270041ADAMTS4, P=0.02 (Fmax)) and two rare ones located in the ALOX15 gene (P=0.001 (Pmax)). These associations were further modulated by sex, body mass index and risk groups, which reflected glucocorticoid dose and radiation therapy (P<0.02). Conclusion: Occurrence of muscle function deficit in childhood ALL is thus strongly modulated by variations in the DUOX2, ADAMTS4 and ALOX15 genes, which could lead to personalized prevention strategies in childhood ALL survivors. Keywords: acute lymphoblastic leukemia, late adverse effects, skeletal muscle deficit, genetic association study, whole exome sequencing
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