The aim of this study was to define the incidence of left ventricular thrombus (LVT) and its predictors in the contemporary era of primary percutaneous intervention (pPCI) and contrast ...echocardiography. We retrospectively analyzed 1,059 patients presenting with ST-elevation myocardial infarction (STEMI) to our tertiary cardiac center and treated with pPCI. Preprocedural pharmacology and procedural technique (including access route, the use of drug-eluting stents, and thrombectomy) were at the operators' discretion. Transthoracic echocardiography was performed before discharge; echo contrast agent was used when appropriate. LVT was detected in 42 subjects (4%). There were no significant differences in baseline demographics or pre-PCI clinical features between the 2 groups. Post-treatment, mean ejection fraction (EF) in patients with LVT was 35 ± 8.4% and in those without LVT was 47 ± 10%, p <0.001. Thirty-seven patients (88%) in the LVT group presented with an anterior STEMI versus 471 patients (42%) in the without LVT group (p <0.001). Apical akinesis was noted in all patients with LVT irrespective of the principal location of the MI. Multivariate analysis predictors of LVT were reduced EF, anterior site of MI, and the use of platelet glycoprotein IIb/IIIa inhibitors. After diagnosis of LVT, patients were treated with warfarin for 3 to 6 months. No significant difference in mortality was detectable at discharge between the 2 groups. In conclusion, in the contemporary era of pPCI, the incidence of LVT in patients with STEMI is significantly lower than that of the previous (thrombolysis) literature. The early presence of LVT is more likely in patients with anterior STEMI (involving the apex) and reduced EF.
The cost of ASD in the U.S. is estimated using a forecast model that for the first time accounts for the true historical increase in ASD. Model inputs include ASD prevalence, census population ...projections, six cost categories, ten age brackets, inflation projections, and three future prevalence scenarios. Future ASD costs increase dramatically: total base-case costs of $223 (175–271) billion/year are estimated in 2020; $589 billion/year in 2030, $1.36 trillion/year in 2040, and $5.54 (4.29–6.78) trillion/year by 2060, with substantial potential savings through ASD prevention. Rising prevalence, the shift from child to adult-dominated costs, the transfer of costs from parents onto government, and the soaring total costs raise pressing policy questions and demand an urgent focus on prevention strategies.
Abstract Background Transcaval access may enable fully percutaneous transcatheter aortic valve replacement (TAVR) without the hazards and discomfort of transthoracic (transapical or transaortic) ...access. Objectives We performed a prospective, independently-adjudicated, multi-center, single-arm Investigational Device Exemption trial of transcaval access for TAVR in patients ineligible for femoral artery access and high or prohibitive risk of complications from transthoracic access. Methods 100 subjects underwent attempted percutaneous transcaval access to the abdominal aorta by electrifying a caval guidewire and advancing into a prepositioned aortic snare. After exchanging for a rigid guidewire, conventional TAVR was performed through transcaval introducer sheaths. Transcaval access ports were closed with nitinol cardiac occluders. A core lab analyzed pre-discharge and 30-day abdominal CT. The STS predicted risk of mortality was 9.6 ± 6.3%. Results Transcaval access was successful in 99/100 subjects. Device success (access and closure with a nitinol cardiac occluder without death or emergency surgical rescue) was 98/99, except for one closed only with a covered stent. Inpatient survival was 96% and 30-day survival was 92%. VARC2 life-threatening bleeding and modified VARC2 major vascular complications possibly related to transcaval access were 7% and 13%, respectively. Median length of stay was 4 (2-6) days. There were no vascular complications after discharge. Conclusion Transcaval access enabled TAVR in patients who were not good candidates for transthoracic access. Bleeding and vascular complications, using permeable nitinol cardiac occluders to close the access ports, were common but acceptable in this high risk cohort. Transcaval access should be investigated in patients who are eligible for transthoracic access. Purpose-built closure devices are in development that may simplify the procedure and reduce bleeding.
T1 mapping is a robust and highly reproducible application to quantify myocardial relaxation of longitudinal magnetisation. Available T1 mapping methods are presently site and vendor specific, with ...variable accuracy and precision of T1 values between the systems and sequences. We assessed the transferability of a T1 mapping method and determined the reference values of healthy human myocardium in a multicenter setting.
Healthy subjects (n=102; mean age 41 years (range 17-83), male, n=53 (52%)), with no previous medical history, and normotensive low risk subjects (n=113) referred for clinical cardiovascular magnetic resonance (CMR) were examined. Further inclusion criteria for all were absence of regular medication and subsequently normal findings of routine CMR. All subjects underwent T1 mapping using a uniform imaging set-up (modified Look- Locker inversion recovery, MOLLI, using scheme 3(3)3(3)5)) on 1.5 Tesla (T) and 3 T Philips scanners. Native T1-maps were acquired in a single midventricular short axis slice and repeated 20 minutes following gadobutrol. Reference values were obtained for native T1 and gadolinium-based partition coefficients, λ and extracellular volume fraction (ECV) in a core lab using standardized postprocessing.
In healthy controls, mean native T1 values were 950±21 msec at 1.5 T and 1052±23 at 3 T. λ and ECV values were 0.44±0.06 and 0.25±0.04 at 1.5 T, and 0.44±0.07 and 0.26±0.04 at 3 T, respectively. There were no significant differences between healthy controls and low risk subjects in routine CMR parameters and T1 values. The entire cohort showed no correlation between age, gender and native T1. Cross-center comparisons of mean values showed no significant difference for any of the T1 indices at any field strength. There were considerable regional differences in segmental T1 values. λ and ECV were found to be dose dependent. There was excellent inter- and intraobserver reproducibility for measurement of native septal T1.
We show transferability for a unifying T1 mapping methodology in a multicenter setting. We provide reference ranges for T1 values in healthy human myocardium, which can be applied across participating sites.
The lack of detailed life history (LH) information (e.g. age, growth, size at maturity, sex composition etc.) for many species of conservation importance limits the implementation of appropriate ...conservation measures. Typically, LH information is acquired using lethal sampling techniques, which undermines the goal of conservation. This is particularly problematic for many shark species that have low fecundity and slow growth rates. Here we tested the use of non-invasive laser photogrammetry to measure body morphometry in vivo. We used random forest classification models to identify allometric relationships (ratios between body measurements) that discriminated between the sex and stage of sexual maturity of
Scyliorhinus canicula
. We coupled the use of allometric ratios (determined from cadavers) with parallel laser photogrammetry, in order to collect total length (TL) and finer scale morphometrics from 37 free-swimming individuals. TL measurements proved to be accurate (SE = 5.2%) and precise (CV = 1.8%), and did not differ significantly from the known TL of the respective animal (
t
36 = 0.7,
P
= 0.5). Conditional Inference tree model predictions of free-swimming sharks correctly predicted 100% of mature males and 79% of immature males. Our results suggest that when used together, allometric ratios and parallel laser photogrammetry have the potential to be a promising alternative to collect essential life history information from free swimming animals and avoids the need for destructive sampling.
A recent Letter to the Editor by Gennari et al. (2024) contends that methodological issues and data uncertainties may be obscuring declines in abundance of the white shark population in South Africa ...in the analyses of Bowlby et al. (2023). We have addressed their critiques using scientifically accepted analytical understanding to demonstrate why our ecological conclusions remain unchanged: (1) the relative abundance of white sharks has not exhibited systematic increases or declines at a regional level since protection in 1991, and (2) observed data on human-shark incidents are consistent with the hypothesis that white sharks have partially redistributed along the South African coastline. Future long-term, standardized monitoring throughout South Africa would be expected to substantially reduce uncertainty about the population trend and status of white sharks. Ultimately, the lack of abundance increase following protection remains concerning and necessitates continued conservation efforts.
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•Non-traditional monitoring data allow evaluation of abundance and distribution trends.•White sharks’ regional status remains stable despite localized decline.•Human-shark incidents ...demonstrate a shift eastwards from traditional aggregation sites.•Future monitoring would benefit from improved standardization to track population status.•Understanding ecological drivers and mortality sources is crucial.
Unprecedented levels of change in ocean ecosystems bring an ever-increasing need for re-analyses of existing data to explore pressing conservation questions. Substantial declines in white shark (Carcharodon carcharias) presence at two primary aggregation sites have raised concerns about the species’ status throughout South Africa. Using the most comprehensive suite of abundance indices compiled to date, we evaluated temporal trends and the strength of evidence for regional redistribution. Individual indices from all primary aggregation sites in South Africa were highly variable. The overall temporal trend from a log-linear Generalized Additive Model was relatively flat, indicating largely unchanged abundance throughout South Africa since protection in 1991. However, reports of human-shark incidents showed a general shift from the Western to the Eastern Cape. Correlations among individual abundance indices demonstrated that movements were not as simple as animals leaving one site to inhabit another. Further research is needed to explore the effect of movement on monitoring data. Our results reaffirm the need for better standardization in data collection methods to generate abundance indices and to develop long-term monitoring programs on the Eastern Cape. Ideally, environmental or operational factors affecting abundance indices should also be explored in future status assessments at a regional level. Our results provide a baseline for future work, directing research to understand drivers of localized and regional changes and focusing management on reducing anthropogenic sources of mortality within their Southwest Indian Ocean range.
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