To investigate the mechanisms underlying the SARS-CoV-2 infection severity observed in patients with obesity, we performed a prospective study of 51 patients evaluating the impact of multiple immune ...parameters during 2 weeks after admission, on vital organs' functions according to body mass index (BMI) categories. High-dimensional flow cytometric characterization of immune cell subsets was performed at admission, 30 systemic cytokines/chemokines levels were sequentially measured, thirteen endothelial markers were determined at admission and at the zenith of the cytokines. Computed tomography scans on admission were quantified for lung damage and hepatic steatosis (n = 23). Abnormal BMI (> 25) observed in 72.6% of patients, was associated with a higher rate of intensive care unit hospitalization (p = 0.044). SARS-CoV-2 RNAaemia, peripheral immune cell subsets and cytokines/chemokines were similar among BMI groups. A significant association between inflammatory cytokines and liver, renal, and endothelial dysfunctions was observed only in patients with obesity (BMI > 30). In contrast, early signs of lung damage (ground-glass opacity) correlated with Th1/M1/inflammatory cytokines only in normal weight patients. Later lesions of pulmonary consolidation correlated with BMI but were independent of cytokine levels. Our study reveals distinct physiopathological mechanisms associated with SARS-CoV-2 infection in patients with obesity that may have important clinical implications.
Purpose
To improve knowledge of the tricuspid valve and right atrioventricular junction (RAVJ) coupling, four-dimensional (4D) imaging is mandatory (3D + time). Based on multiphase cardiac-volume ...computed tomography (CT) and innovative 4D analysis, we proposed to assess dynamical features of tricuspid annulus (TA) in relation to the right ventricle (RV) and right atrial (RA) functions.
Methods
Cardiac-volume CT data sets through time were obtained in 30 healthy patients (Male 57%, mean age 57 ± 11 years). Using an in-house software, 3D semi-automated delineation of 18 points around TA perimeter were defined through 10 cardiac phases within RR interval and used to calculate TA features such as 3D/2D areas, perimeters, 360°-diameters and vertical deformation. RV and RA inner contours were also delineated. Bi-dimensional parameters were compared with multiplanar reconstruction (MPR) measurements.
Results
TA was elliptical in horizontal projection with a maximal eccentricity index (EcI
max
) of 0.58 ± 0.12; and saddle-shaped in vertical projection with a horn nearby the antero-septal commissure. This feature remained throughout the cardiac cycle, but TA was more planar and less circular in late diastole (TA-height: 4.53 ± 1.06 mm, EcI
max
= 0.61 ± 0.14) when TA 3D area and perimeter reached a maximum of 7.05 ± 1.23 and 7.48 ± 0.93cm/m
2
, respectively. Correlations between minimal and maximal TA 3D areas and TA Projected 2D areas were excellent (
r
= 0.993 and
r
= 0.995,
p
< 0.001). TA 2D area measurements by MPR overestimated the projected values by 22 to 24%. Correlation between RV concentric strain and TA maximal diameter shortening was
r
= 0.452 (
p
= 0.01).
Conclusions
Cardiac-volume CT improves physiological knowledge of the relationships between the RAVJ components in healthy subjects.
To evaluate right ventricle (RV) diastolic function from phase-contrast MRI (PC-MRI) in aging. 89 healthy individuals (50 men, 43 ± 15 years) underwent cardiac MRI including 2D PC-MRI (1.5T) and ...reference Doppler echocardiography of both ventricles on the same day. Conventional echocardiographic parameters were estimated: early (E, cm/s) and atrial (A) peak velocities as well as myocardial early peak longitudinal velocity (E′). PC-MRI images were analyzed using custom software, providing: E′, E and A waves along with respective peak flow rates (Ef, Af, mL/s) and filling volume (mL), for both ventricles. Intra- and inter-observer reproducibility was studied in 30 subjects and coefficients of variation (CoV) as well as intra-class correlation coefficients (ICC) were provided. RV diastolic function indices derived from PC-MRI data were reproducible (CoV ≤ 21%, ICC ≥ 0.75) and reliable as reflected by significant associations with left ventricular diastolic function indices assessed using both echocardiography (linear regression Pearson correlation coefficient r ≤ 0.59) and PC-MRI (r ≤ 71). Despite the fair associations between RV echocardiography and PC-MRI (r ≤ 0.25), the highest correlation with age was obtained for MRI Ef/Af ratio (r = − 0.64, p < 0.0001 vs. r = − 0.40, p = 0.0001 for echocardiographic E/A). Among PC-MRI E/A ratios, highest correlations with age were observed for flow rate and mean velocity ratios (r = − 0.61, p < 0.0001) as compared to maximal velocity ratios (r = − 0.56, p < 0.0001). Associations with age for E′ were equivalent between PC-MRI (mean velocity: r = − 0.40, p < 0.0001; maximal velocity: r = − 0.36, p = 0.0005) and echocardiography (r = − 0.36, p = 0.0006). Finally, the significant and age-independent associations between RV mass/end-diastolic volume and E′ were stronger for PC-MRI (mean velocity: r = − 0.36, p = 0.0006; maximal velocity: r = − 0.28, p = 0.007) than echocardiography (r = − 0.09, p = 0.38). PC-MRI tricuspid inflow and annulus myocardial velocity parameters were reproducible and able to characterize age-related variations in RV diastolic function.
The aim of this study is to quantify aortic backward flow (BF) using phase-contrast cardiovascular magnetic resonance (PC-CMR) and to study its associations with age, indexes of arterial stiffness, ...and geometry. Although PC-CMR blood flow studies showed a simultaneous presence of BF and forward flow (FF) in the ascending aorta (AA), the relationship between aortic flows and aging as well as arterial stiffness and geometry in healthy volunteers has never been reported. We studied 96 healthy subjects 47 women, 39 ± 15 yr old (19-79 yr). Aortic stiffness arch pulse wave velocity (PWVAO), AA distensibility, geometry (AA diameter and arch length), and parameters related to AA BF and FF (volumes, peaks, and onset times) were estimated from CMR. Applanation tonometry carotid-femoral pulse-wave velocity (PWVCF), carotid augmentation index, and time to return of the reflected pressure wave were assessed. Whereas FF parameters remained unchanged, BF onset time shortened significantly (R(2) = 0.18, P < 0.0001) and BF volume and BF-to-FF peaks ratio increased significantly (R(2) = 0.38 and R(2) = 0.44, respectively, P < 0.0001) with aging. These two latter BF indexes were also related to stiffness indexes (PWVCF, R(2) > 0.30; PWVAO, R(2) > 0.24; and distensibility, R(2) > 0.20, P < 0.001), augmentation index (R(2) > 0.20, P < 0.001), and aortic geometry (AA diameter, R(2) > 0.58; and arch length, R(2) > 0.31, P < 0.001). In multivariate analysis, aortic diameter was the strongest independent correlate of BF beyond age effect. In conclusion, AA BF estimated using PC-CMR increased significantly in terms of magnitude and volume and appeared earlier with aging and was mostly determined by aortic geometry. Thus BF indexes could be relevant markers of subclinical arterial wall alterations.
Background
In the case of breast cancer (BC), radiotherapy (RT) helps reduce locoregional recurrence and BC-related deaths but can lead to cardiotoxicity, resulting in an increased risk of long-term ...major cardiovascular events. It is therefore of primary importance to early detect subclinical left ventricular (LV) dysfunction in BC patients after RT and to determine the dose–response relationships between cardiac doses and these events.
Methods
Within the frame of the MEDIRAD European project (2017–2022), the prospective multicenter EARLY‐HEART study (ClinicalTrials.gov Identifier: NCT03297346) included chemotherapy naïve BC women aged 40–75 years and treated with lumpectomy and adjuvant RT. Myocardial strain analysis was provided using speckle‐tracking echocardiography performed at baseline and 6 months following RT. A global longitudinal strain (GLS) reduction >15% between baseline and follow-up was defined as a GLS-based subclinical LV dysfunction. Individual patient dose distributions were obtained using multi-atlas-based auto-segmentation of the heart. Dose-volume parameters were studied for the whole heart (WH) and left ventricle (LV).
Results
The sample included 186 BC women (57.5 ± 7.9 years, 64% left-sided BC). GLS-based subclinical LV dysfunction was observed in 22 patients (14.4%). These patients had significantly higher cardiac exposure regarding WH and LV doses compared to patients without LV dysfunction (for mean WH dose: 2.66 ± 1.75 Gy versus 1.64 ± 0.96 Gy,
p
= 0.01). A significantly increased risk of subclinical LV dysfunction was observed with the increase in the dose received to the WH ORs from 1.13 (V
5
) to 1.74 (D
mean
);
p <
0.01 and to the LV ORs from 1.10 (V
5
) to 1.46 (D
mean
);
p <
0.01. Based on ROC analysis, the LV-V
5
parameter may be the best predictor of the short-term onset of subclinical LV dysfunction.
Conclusion
These results highlighted that all cardiac doses were strongly associated with the occurrence of subclinical LV dysfunction arising 6 months after BC RT. Whether measurements of GLS at baseline and 6 months after RT combined with cardiac doses can early predict efficiently subclinical events occurring 24 months after RT remains to be investigated.
Background Hypertension occurs in 20% to 40% of survivors of anatomically successful repair of aortic coarctation (CoA). The aim of the present study was to examine the role of central aortic ...function in this setting. Methods Forty normotensive asymptomatic subjects with successful CoA repair (age 12 ± 8 years) and 20 age- and sex-matched control subjects underwent detailed magnetic resonance imaging investigation of the thoracic aorta and left ventricle. Aortic distensibility, compliance, and stiffness β index were calculated in the central (precoarctation) and descending (postcoarctation) aorta. Aortic pulse wave velocity was measured and left ventricular mass was calculated. Results Compared to control subjects, CoA subjects had markedly decreased central aortic distensibility (2.8 ± 0.7 vs 4.2 ± 0.5 mm Hg−1· 10−3 , P < .001) and compliance (1.7 ± 0.3 vs 2.5 ± 0.6 mm2 mm Hg−1 , P < .001) and increased stiffness β index (5.2 ± 1 vs 2.5 ± 0.6, P < .001). Pulse wave velocity was also significantly increased in the CoA subjects (4.7 ± 1.3 vs 3.3 ± 0.6 m/sec, P < .001). Left ventricular mass index was higher in the CoA subjects (84 ±11 vs 73 ±10 g/m2 , P = .01) and correlated significantly with aortic stiffness β index ( r2 = 0.8, P < .0001). By contrast, descending aortic characteristics were similar in the CoA and control subjects. Conclusion Central aortic stiffness is markedly increased and associated with increased left ventricular mass in normotensive young subjects after successful early repair of CoA.
•A three-dimensional (3D) deep learning-based model can be trained effectively to compute automatically the coronary artery calcium score from a CT examination.•The proposed model is based on a U-Net ...architecture designed for 3D segmentation of coronary artery calcifications.•It would be useful to test and validate this method on a wider range of CT acquisitions, including non-ECG-gated ones, performed for routine examinations for lung disease.
The purpose of this study was to develop and evaluate an algorithm that can automatically estimate the amount of coronary artery calcium (CAC) from unenhanced electrocardiography (ECG)-gated computed tomography (CT) cardiac volume acquisitions by using convolutional neural networks (CNN).
The method used a set of five CNN with three-dimensional (3D) U-Net architecture trained on a database of 783 CT examinations to detect and segment coronary artery calcifications in a 3D volume. The Agatston score, the conventional CAC scoring, was then computed slice by slice from the resulting segmentation mask and compared to the ground truth manually estimated by radiologists. The quality of the estimation was assessed with the concordance index (C-index) on CAC risk category on a separate testing set of 98 independent CT examinations.
The final model yielded a C-index of 0.951 on the testing set. The remaining errors of the method were mainly observed on small-size and/or low-density calcifications, or calcifications located near the mitral valve or ring.
The deep learning-based method proposed here to compute automatically the CAC score from unenhanced-ECG-gated cardiac CT is fast, robust and yields accuracy similar to those of other artificial intelligence methods, which could improve workflow efficiency, eliminating the time spent on manually selecting coronary calcifications to compute the Agatston score.
Fibromuscular dysplasia is an uncommon, segmental, nonatherosclerotic arterial disease of unknown aetiology. The disease primarily affects women and involves intermediate-sized arteries in many areas ...of the body, including cervical and intracranial arteries. Although often asymptomatic, fibromuscular dysplasia can also be associated with spontaneous dissection, severe stenosis that compromises the distal circulation, or intracranial aneurysm, and is therefore responsible for cerebral ischaemia or subarachnoid haemorrhage. Fibro-muscular dysplasia affects middle and distal portions of the internal carotid and vertebral arteries, and occasionally, intracranial arteries. Several pathological and angiographic patterns exist. The most frequent pathological type is medial fibromuscular dysplasia, which is associated with the ‘string of beads' angiographic pattern. Unifocal lesions are less common and can be associated with several pathological subtypes. The pathophysiology of the disease is widely unknown. Fibromuscular dysplasia may in fact result from various causes and reflect a non-specific response to different insults. The poor knowledge of the natural history and the lack of randomised trials that compared the different treatment options do not allow any satisfactory judgement to be made regarding the need for or the efficacy of any treatment.
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