Living in segregated areas with concentrated neighbourhood poverty negatively affects the quality of life, including the availability of local jobs, access to services, and supportive social ...relationships. However, even with similar neighbourhood poverty levels, the degree and structure of spatial separation vary markedly between such areas. We expected that the level of spatial segregation aggravates the social exclusion of its inhabitants by negatively affecting their social capital. To test this hypothesis, we identified three low‐income neighbourhoods with high poverty rates (78%) in a medium‐sized town in Hungary, with different levels of integration in the city (based on characteristics such as the degree of spatial separation, infrastructure, and availability of services). The three neighbourhoods were located in two areas of differing degrees of integration in the fabric of the city: fully integrated, semi‐integrated (integrated into the surrounding residential area but isolated from the city), and non‐integrated. 69% of the 394 households in these areas were represented in our sample (one respondent per household). We interviewed respondents regarding the size and composition of their personal networks. Our results, which also distinguished between Roma and non‐Roma inhabitants, showed that those living in the spatially more integrated area not only have the largest and most diverse networks but seem to have a strong, “bonding‐based” cohesive community network as well. Even the non‐Roma who live there have ethnically heterogeneous—in other words—Roma network members. The disintegrated area, on the other hand, is characterised by both spatial and social isolation.
We search for limit cycles in the dynamical model of two-species chemical reactions that contain seven reaction rate coefficients as parameters and at least one third-order reaction step, that is, ...the induced kinetic differential equation of the reaction is a planar cubic differential system. Symbolic calculations were carried out using the Mathematica computer algebra system, and it was also used for the numerical verifications to show the following facts: the kinetic differential equations of these reactions each have two limit cycles surrounding the stationary point of focus type in the positive quadrant. In the case of Model 1, the outer limit cycle is stable and the inner one is unstable, which appears in a supercritical Hopf bifurcation. Moreover, the oscillations in a neighborhood of the outer limit cycle are slow-fast oscillations. In the case of Model 2, the outer limit cycle is unstable and the inner one is stable. With another set of parameters, the outer limit cycle can be made stable and the inner one unstable.
Chrysotile asbestos from different geographic regions was characterized by
57Fe Mössbauer and FT-IR spectroscopies, and FE-SEM coupled with EDS. Mössbauer spectra showed incorporation of Fe(II) and ...Fe(III) into the crystal structure of chrysotile. The Fe(II)/Fe(III) ratios were calculated. The Fe(II) occupied the octahedral Mg(II) positions. Broadening of Mössbauer lines corresponding to the Fe(III) doublet indicated a possible presence of Fe(III) in tetrahedral and octahedral positions. In all samples magnetite (Fe
3−
x
O
4) was found as associated mineral. Changes in the FT-IR spectra of chrysotiles were assigned to structural incorporation of metal ions, such as iron or aluminium ions. The morphology of chrysotile asbestos was inspected by FE-SEM.
Left atrial appendage (LAA) thrombus is the most common source of embolization in atrial fibrillation (AF). Transesophageal echocardiography (TEE) is the gold standard method for LAA thrombus ...exclusion. Our pilot study aimed to compare the efficacy of a new non-contrast-enhanced cardiac magnetic resonance (CMR) sequence (BOOST) with TEE for the detection of LAA thrombus and to evaluate the usefulness of BOOST images for planning radiofrequency catheter ablation (RFCA) compared with left atrial (LA) contrast-enhanced computed tomography (CT). We also attempted to assess the patients' subjective experiences with TEE and CMR.
Patients with AF undergoing either electrical cardioversion or RFCA were enrolled. Participants underwent pre-procedural TEE and CMR scans to evaluate LAA thrombus status and pulmonary vein anatomy. Patient experiences with TEE and CMR were assessed using a questionnaire developed by our team. Some patients scheduled for RFCA also had pre-procedural LA contrast-enhanced CT. In such cases, the operating physician was asked to subjectively define the quality of the CT and CMR scan on a scale of 1-10 (1 = worst, 10 = best) and comment on CMR's usefulness in RFCA planning.
Seventy-one patients were enrolled. In 94.4%, both TEE and CMR excluded, and in 1 patient, both modalities reported the presence of LAA thrombus. In 1 patient, TEE was inconclusive, but CMR excluded LAA thrombus. In 2 patients, CMR could not exclude the presence of thrombus, but in 1 of those cases, TEE was also indecisive. During TEE, 67%, during CMR, only 1.9% of patients reported pain (
< 0.0001), and 89% would prefer CMR in case of a repeat examination. The quality of the left atrial contrast-enhanced CT scans was better compared with the image quality of the CMR BOOST sequence 8 (7-9) vs. 6 (5-7),
< 0.0001. Still, the CMR images were useful for procedural planning in 91% of cases.
The new CMR BOOST sequence provides appropriate image quality for ablation planning. The sequence might be useful for excluding larger LAA thrombi; however, its accuracy in detecting smaller thrombi is limited. Most patients preferred CMR over TEE in this indication.
Background: Cardiac amyloidosis (CA) is a rare, progressive, infiltrative cardiac disease. Light chain (AL) and transthyretin (ATTR) amyloidosis are in the background in almost all cases. New, easily ...available diagnostic tools and recently introduced novel therapies for both types of CA put this disease into the field of interest. Increased left ventricular wall thickness (IWT) detected by echocardiography is generally thought to be a necessary part of the diagnosis. We aimed to determine the proportion of CA patients without IWT, and to define the clinical characteristics of this cohort. Methods: In an academic tertiary center for CA, we identified patients diagnosed and treated for CA between January 2009 and February 2022. In a retrospective analysis we defined the proportion of patients with (≥12 mm) and without (<12 mm) IWT, and described their clinical features. Results: We identified 98 patients suitable for the analysis. In total, 70 had AL and 27 ATTR CA; 89 patients had CA with IWT and 9 patients (9%) had CA without IWT. All non-IWT patients had AL type CA. Both group of patients had clinically significant disease, which is supported by the relevant elevation in cardiac biomarker levels. There was no difference between the outcome of the two groups. Conclusion: Patients without IWT form a relevant subgroup among those with CA. Our results suggest that diagnostic algorithms and criteria should take these individuals into consideration, and, therefore, give them access to effective treatments.
Aims
To evaluate the patient- and procedure-related predictors of transcatheter aortic-valve implantation (TAVI)-associated ischemic brain lesions and to assess the effect of silent cerebral ischemic ...lesions (SCIL) on neurocognitive function.
Methods and results
We investigated 113 consecutive patients with severe aortic stenosis who underwent brain magnetic resonance imaging (MRI) within a week following TAVI. To assess periprocedural cerebral ischemic lesions, diffusion-weighted MRI was utilized. We used multivariate linear regression to identify the independent predictors of TAVI-related ischemic lesion volume (ILV) and periprocedural stroke. Neurocognitive evaluation was performed before and following TAVI at 6-month and one-year follow-up. Following TAVI, a total of 944 new cerebral ischemic lesions were detected in 104 patients (92%). The median ILV was 257 μl (interquartile range IQR:97.1–718.8μl) with a median lesion number of 6/patient IQR:2–10. The majority of ischemic lesions were clinically silent (95%), while 5% of the lesions induced a stroke, which was confirmed by MRI. Predilatation (β = 1.1395%CI:0.32–1.93,
p
= 0.01) and the number of valve positioning attempts during implantation (β = 0.2895%CI:0.06–0.50,
p
= 0.02) increased the log-transformed total ILV. Predilatation (OR = 12.0495%CI:1.46–99.07,
p
= 0.02) and alternative access routes (OR = 7.8495%CI:1.01–61.07,
p
= 0.02) were associated with stroke after adjustments for comorbidities and periprocedural factors. The presence of SCILs were not associated with a change in neurocognitive function that remained stable during the one-year follow-up.
Conclusion
While periprocedural ischemic lesions are frequent, most of them are clinically silent and might not impact the patients' neurocognitive function. The number of valve positioning attempts, predilatation, and alternative access routes should be taken into consideration during TAVI to reduce the ILV and risk for stroke.
Transcatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and survival. Data on the predictive value of left atrial (LA) strain following TAVI are scarce. We aimed to ...evaluate the association of LA strain measured shortly post-TAVI with functional and anatomical reverse remodeling of the LA and LV, and its association with mortality.
We prospectively investigated 90 patients who underwent TAVI. Transthoracic echocardiography including strain analysis was performed shortly after TAVI and repeated 6 months later. CT angiography (CTA) was performed for pre-TAVI planning and 6 months post-TAVI. Speckle tracking echocardiography was used to determine LA peak reservoir strain (LASr) and LV global longitudinal strain (LV-GL), LA volume index (LAVi) was measured by TTE. LV mass index (LVMi) was calculated using CTA images. LA reverse remodeling was based on LASr and LAVi changes, whereas LV reverse remodeling was defined as an improvement in LV-GLS or a reduction of LVMi. The association of severely reduced LASr (<20%) at baseline with changes (Δ) in LASr, LAVi, LV-GLS and LVMi were analyzed using linear regression, and Cox proportional hazard model for mortality.
Mean LASr and LV-GLS were 17.7 ± 8.4 and -15.3 ± 3.4% at baseline and 20.2 ± 10.2 and -16.6 ± 4.0% at follow-up (
= 0.024 and
< 0.001, respectively). Severely reduced LASr at baseline was associated with more pronounced ΔLASr (β = 5.24,
= 0.025) and LVMi reduction on follow-up (β = 5.78,
= 0.036), however, the majority of the patients had <20% LASr on follow-up (44.4%). Also, ΔLASr was associated with ΔLV-GLS (adjusted β = 2.10,
< 0.001). No significant difference in survival was found between patients with baseline severely reduced LASr (<20%) and higher LASr (≥20%) (
= 0.054).
LV reverse remodeling based on LVMi was present even in patients with severely reduced LASr following TAVI, although extensive LA damage based on LA strain was demonstrated by its limited improvement over time.
(ClinicalTrials.gov number: NCT02826200).
Aims
A substantial shift in the field of pulmonary hypertension (PH) is ongoing, as the previous practice of mean pulmonary arterial wedge pressure (PAWPM) is no longer supported. Instead, aiming for ...a better estimate of end‐diastolic pressures (EDP), instantaneous PAWP at mid‐A‐wave (PAWPmid‐A) or, in the absence of an A‐wave, at 130–160 ms following QRS onset has recently been recommended. Electrocardiogram‐gated PAWP (PAWPQRS) has also been proposed. The quantitative differences as well as the diagnostic and prognostic utility of these novel PAWP measurements have not been evaluated. We set out to address these issues.
Methods and results
Pressure tracings of 141 patients with PH due to left heart disease (PH‐LHD) and 43 with primary pulmonary arterial hypertension (PAH) were analysed. PAWP was measured as follows: (i) mean pressure (PAWPM); (ii) per the latest consensus approach PAWPmid‐A, or in atrial fibrillation 130, 140, 150, and 160 ms following QRS onset (PAWP130–160); (iii) at QRS onset (PAWPQRS); and (iv) Z‐point (PAWPZ). For each PAWP, the corresponding pulmonary vascular resistance (PVR) and diastolic pressure gradient were calculated. The cohort comprised 45% female. Mean age was 66 ± 15. PAWPmid‐A was in good agreement with PAWPZ (17.3 14.5 to 21.2 vs. 17.6 14.2 to 21.6 mmHg, P = 0.63), whereas PAWPQRS provided significantly lower values (15.3 12.5 to 19.2 mmHg, P < 0.001). In atrial fibrillation, PAWP130 and PAWPQRS yielded the optimal temporal and quantitative analyses of EDPs. The ability to differentiate PAH from PH‐LHD was similar for the various PAWP measurements PAWPM: area under the curve (AUC) 0.98, confidence interval (CI) 0.96–0.99; PAWPmid‐A/130: AUC 0.94, CI 0.91–0.98; PAWPQRS: AUC 0.96, CI 0.94–0.99, P < 0.001 for all. PVR based on instantaneous PAWP measurements failed to provide superior prognostic information in PH‐LHD as compared with conventional PVR.
Conclusions
Although instantaneous PAWP measurement might better represent EDP, they nevertheless fail to yield incremental diagnostic or prognostic information in PH‐LHD as compared with conventional measurements.
Background
Isolated post-capillary pulmonary hypertension (Ipc-PH) is characterized by elevated left atrial pressures that are passively transmitted upstream, whereas combined pre- and post-capillary ...PH (Cpc-PH) demonstrates additional reactive changes in pulmonary vasculature. The increased load imposed on the right ventricle (RV) influences left ventricular (LV) mechanics by means of interventricular interaction. However, there is lack of evidence to substantiate the effect of possible additional alterations in the arterio-ventricular (AV) coupling and their effect on LV function. Considering the discrepant RV load in Cpc-PH and Ipc-PH, we sought to investigate whether these two conditions are also characterized by differential alterations in AV coupling.
Methods and results
Invasive hemodynamic and echocardiographic data of 120 patients with PH due to severe rheumatic mitral stenosis before and immediately after percutaneous valvulotomy, along with 40 age-matched healthy controls, were analyzed. Effective arterial (
E
a
) and ventricular elastance (
E
es
) were measured. PH patients demonstrated elevated LV afterload (
E
a
) along with AV uncoupling, and these derangements were more evident in the Cpc-PH group
E
a
: 3.3 (2.3–5.4) vs 2.6 (2.1–3.5) mmHg/mL,
E
a
/
E
es
: 0.73 (0.6–0.9) vs 0.88 (0.7–1.2),
p
< 0.05. In addition, PH was associated with reduced LV deformation, which was mainly determined by elevated
E
a
, while the effect of interventricular interaction was limited to the septal wall.
Conclusions
Our results suggest that in addition to the interventricular interaction, an abnormal AV coupling contributes to the altered LV mechanics that has been associated with adverse prognosis in Cpc-PH.
Rheumatoid arthritis (RA) patients have a shorter life expectancy than the general population primarily due to cardiovascular comorbidities.
To characterize arterial aging in RA.
Coronary calcium ...score (CCS) were available from 112 RA patients; out of these patients, follow-up CCS were measured for 54 randomly selected individuals. Control CCS were obtained from the MESA database (includes 6,000 < participants); arterial age was calculated from CCS.
RA patients were significantly older (10.45 ± 18.45 years,
< 0.001) in terms of the arterial age than the age-, gender-, and race-matched controls. The proportion of RA patients who had zero CCS was significantly less (
< 0.01) than that of those in the MESA reference group. Each disease year contributed an extra 0.395 years (
< 0.01) on the top of the normal aging process. However, the rate of the accelerated aging is not uniform, in the first years of the disease it is apparently faster. Smoking (
< 0.05), previous cardiovascular events (
< 0.05), and high blood pressure (
< 0.05) had additional significant effect on the aging process. In the follow-up study, inflammatory disease activity (CRP > 5 mg/L,
< 0.05) especially in smokers and shorter than 10 years of disease duration (
= 0.05) had the largest impact.
Arterial aging is faster in RA patients than in control subjects, particularly in the first 10 years of the disease. Inflammation, previous cardiovascular events, and smoking are additional contributing factors to the intensified coronary atherosclerosis progression. These data support that optimal control of inflammation is essential to attenuate the cardiovascular risk in RA.
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