Abstract
Background
Transthyretine cardiac amyloidosis (TTR-CA) is an emerging treatable disease in cardiology. Severity of TTR infiltration can be assessed by bone scintigraphy with Perugini score, ...depending on HPD-Tc99M myocardial intensity uptake. Less is known on how Perugini score interplays with routine cardiac structural parameters, especially cardiac mass and voltage.
Aim
To evaluate correlation between Perugini score and myocardial mass and voltage abnormalities in patients with TTR-CA.
Methods
Patients diagnosed with ATTR-CA and addressed to our center for treatment underwent complete evaluation including electrocardiogram (ECG) and transthoracic echocardiography (TTE). Routine electrical and echographic parameters were obtained such as: Sokolow indice (SV1+RV5) in millivolt (mV), PR delay (ms), QRS width (in ms), left ventricular mass (LVM, in grams) and diastolic interventricular septum (dIVS) thickness (in mm). Patients were classified in three categories according to Perugini score: I (cardiac uptake < chest bones), II (cardiac uptake = chest bones) and III (cardiac uptake > bones). Main end-point were LVM and Voltage/Mass ratio (VMR) variations, depending on Perugini score.
Results
Among the 17 patients included, 14 were male (82.4%) and mean age was 82±8 years old. On ECG, 6 patients (35.3%) had permanent atrial fibrillation (AF). Mean voltage according to Sokolow index, mean PR delay and mean QRS width were respectively 1.5±0.5 mV, 212±54 ms and 113±19 ms. On TTE, mean LVM and mean dIVS width were respectively 333±98 g (188±55 g/m2) and 19±4 mm. Mean voltage/mass ratio (VMR) was 0.48±0.26 uV/g (see table). On bone scintigraphy, 3 patients were scored with Perugini I (17.6%), 4 with Perugini II (23.5%) and 10 with Perugini III (58.8%). According to Pearson test, there was a strong correlation between Perrugini score and LVM (r=+0.56, p=0.03) (graph A), and a strong negative correlation between Perrugini score and VMR (r=−0.70, p=0.003) (graph B). There were a trend for correlation between Perugini score and Voltage according to Sokolow (r=−0.46, p=0.07) and between Perugini score and dIVS width (r=0.49, p=0.07).
Conclusion
In TTR-CA patients, Perugini score appears to strongly correlate with left ventricle mass and voltage. Larger scale studies are needed to confirm these results.
Funding Acknowledgement
Type of funding sources: None. ECG and TEE trends according to PeruginiCardiac mass and voltage with Perugini
Abstract
Introduction
Heart failure (HF) burden is characterized by high hospitalizations rates, impairing patients survival and quality of life. Yet, early detection and control of congestion with ...home tele-monitoring (HTM) might help to reduce HF hospitalizations (HFH) (1).
Aim
To report our experience of congestion management with HTM for HF patients in out-hospital setting.
Methods
All HF patients followed with the HTM program of our HF clinic between July 2020 and December 2022 were included. For each patient, HTM consisted in daily body weight and symptoms tele-transmission through a connected device. History of HFH were recorded 18 months before and up to 18 months after inclusion in HTM. Alerts were defined as weight gain (WA) (≥ 3 kgs in 2 days or ≥ 2 kgs in 5 days) and/or new symptoms (SA) onset (≥ 3 in 1 day or identical 3 times in 4 days). Relevants HTM alerts were transmitted by the service provider to the local HF team to be managed within 48 hours : phone contact and/or NT-proBNP dosing and/or physical consultation and/or treatment adaptation.
Results
Among the 147 patients included, mean age was 60±12 years, 110 (75%) were males. Mean left ventricle ejection fraction (LVEF) was 34±11%, and 112 (76%) had HF-rEF, 19 (13%) HF-mrEF and 16 (11%) HF-pEF. Other baselines characteristics are resumed in Table1. Mean HTM duration was 391±250 days and mean device observance was 74±21%. During HTM, 85 (59%) alerts were managed by the HF team in a mean delay of 98±114 days after inclusion : 47 (32%) WA, 34 (23%) SA and 4 (3%) W+SA. After Student-paired test compared to D0 (day of alert transmission), mean weight (kgs) at D2, D5, D10, D21 and D30 were significantly lower (all p<10E-3), respectively 91±17 versus 90±17, 89±17, 89±16, 88±16 and 89±17 kgs (Fig.1A). After Wilcoxon paired-test, the same difference was observed for symptoms (all p<10E-3) : 3±2 (D0) versus 1±1 (D2), 0.7±1 (D5), 0.4±0.8 (D10), 0.5±0.7 (D21) and 0.5±0.9 (D30) (Fig.1B). Patients HFH rates were significantly lower after HTM inclusion : 19 HFH (13%) after HTM versus 70 (48%) before, according to McNemar's X2 test (p<10E-11) (Fig.1C). Notably, post-HTM observed HFH rates (13%) also differed significantly from the 20% expected in a general HF population (2). For the 15 patients (10%) with history of HFH both before and after HTM implementation, mean lengths of stay (LOS) were significantly lower when HFH occurs after HTM inclusion according to Wilcoxon signed rank test : 10±12 vs 22±19 days (-12±17 days, p=0.02) (Fig.1D).
Conclusion
In our experience, HTM is a efficient to help controling congestion and symptoms of HF patients in out-hospital setting, and can help to reduce HFH, providing that each alerts is being timely and appropriately addressed by the HF team. Prospective studies are needed to confirm these results.Impact of HTM on congestion and HFHTable 1.Patients characteristics.
Suppression of the J/ψ nuclear-modification factor has been seen as a trademark signature of final-state effects in large collision systems for decades. In small systems, the nuclear modification was ...attributed to cold-nuclear-matter effects until the observation of strong differential suppression of the ψ(2S) state in p+A and d+A collisions suggested the presence of final-state effects. Results of J/ψ and ψ(2S) measurements in the dimuon decay channel are presented here for p+p, p+Al, and p+Au collision systems at sNN=200GeV. The results are predominantly shown in the form of the nuclear-modification factor, RpA, the ratio of the ψ(2S) invariant yield per nucleon-nucleon collision in collisions of proton on target nucleus to that in p+p collisions. Measurements of the J/ψ and ψ(2S) nuclear-modification factor are compared with shadowing and transport-model predictions, as well as to complementary measurements at Large Hadron Collider energies.
Small nuclear collisions are mainly sensitive to cold-nuclear-matter effects; however, the collective behavior observed in these collisions shows a hint of hot-nuclear-matter effects. The ...identified-particle spectra, especially the ϕ mesons which contain strange and antistrange quarks and have a relatively small hadronic-interaction cross section, are a good tool to study these effects. The PHENIX experiment has measured ϕ mesons in a specific set of small collision systems p+Al, p+Au, and 3He+Au, as well as d+Au Adare et al., Phys. Rev. C 83, 024909 (2011), at √sNN=200 GeV. The transverse-momentum spectra and nuclear-modification factors are presented and compared to theoretical-model predictions. The comparisons with different calculations suggest that quark-gluon plasma may be formed in these small collision systems at √sNN=200 GeV. However, the volume and the lifetime of the produced medium may be insufficient for observing strangeness-enhancement and jet-quenching effects. The comparison with calculations suggests that the main production mechanisms of ϕ mesons at midrapidity may be different in p+Al versus p/d/3He+Au collisions at √sNN=200 GeV. While thermal quark recombination seems to dominate in p/d/3He+Au collisions, fragmentation seems to be the main production mechanism in p+Al collisions.
We present a measurement of the transverse single-spin asymmetry for π0 and η mesons in p↑+ p collisions in the pseudorapidity range |η| < 0.35 and at a center-of-mass energy of 200 GeV with the ...PHENIX detector at the Relativistic Heavy Ion Collider. In comparison with previous measurements in this kinematic region, these results have factor-of-3-smaller uncertainties. As hadrons, π0 and η mesons are sensitive to both initial- and final-state nonperturbative effects for a mix of parton flavors. Comparisons of the differences in their transverse single-spin asymmetries have the potential to disentangle the possible effects of strangeness, isospin, or mass. These results can constrain the twist-3 trigluon collinear correlation function as well as the gluon Sivers function.
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