Publications by authors named "Eric Larose"

188 Publications

Left ventricular asymmetric remodeling and subclinical left ventricular dysfunction in patients with calcific aortic valve stenosis - Results from a subanalysis of the PROGRESSA study.

Int J Cardiol 2021 Jun 13;332:148-156. Epub 2021 Mar 13.

Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address:

Background: LV asymmetric remodeling (LVAR) is a feature commonly found in AS patients and it is presumed to be mainly related to the severity of valve stenosis. The aim of this study was to determine the associated factors and impact on left ventricular (LV) systolic function of LVAR in patients with mild and moderate aortic valve stenosis (AS).

Methods: Clinical, Doppler-echocardiographic and computed-tomographic data of 155 AS patients with preserved LV ejection fraction (≥50%) prospectively recruited in the PROGRESSA study (NCT01679431) were analyzed. LVAR was defined as a septal wall thickness ≥ 13 mm and a ratio of septal/posterior wall thickness > 1.5. LV global longitudinal strain (LV-GLS) was available in 129 patients. Plasma levels of N-terminal natriuretic B-type peptides (Nt-proBNP) were also measured.

Results: Mean age was 63 ± 15 years (70% men). LVAR was present in 21% (n = 33) of patients. A series of nested multivariate analysis revealed that age was the only factor associated with LVAR (all p ≤ 0.03). Additionally, these patients had higher baseline Nt-proBNP ratio (median [25-75 percentiles]: 1.04 [0.66-2.41] vs. 0.65 [0.33-1.19], p = 0.02), and significantly reduced LV-GLS (17.9[16.6-19.5] vs. 19.3[17.4-20.7] |%|, p = 0.04). A 1:1 matched analysis showed a significant association of LVAR with reduced LV-GLS (17.9[16.6-19.5] vs. 19.8[18.1-20.7] |%|, p = 0.02) and elevated Nt-proBNP (134[86-348] vs. 83[50-179]pg/ml, p = 0.03). Multivariable analysis also revealed that LVAR remains significantly associated with reduced LV-GLS (p = 0.03) and elevated Nt-proBNP (p = 0.001). LVAR was significantly associated with increased risk of major adverse cardiac events and death (Hazard ratio [95% confidence interval]: 2.32[1.28-4.22], p = 0.006).

Conclusions: LVAR was found in ~20% of patients with mild or moderate AS and was not related to the degree of AS severity or concomitant comorbidities, but rather to older age. LVAR was significantly associated with reduced LV longitudinal systolic function, increased Nt-proBNP levels, and higher risk of major adverse events and death. These findings provide support for closer clinical and echocardiographic surveillance of patients harboring this adverse LV remodeling feature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2021.03.017DOI Listing
June 2021

Correlates of Coronary Artery Calcification Prevalence and Severity in Patients With Heterozygous Familial Hypercholesterolemia.

CJC Open 2021 Jan 16;3(1):62-70. Epub 2020 Sep 16.

Nutrition, health and society (NUTRISS) Research Center, Institute on Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada.

Background: Determinants of coronary artery calcification (CAC) prevalence and severity in heterozygous familial hypercholesterolemia (HeFH) remain understudied. The objective of this cross-sectional study was to investigate correlates of CAC in patients with HeFH.

Methods: A CAC score was calculated by a noncontrast computed tomography scan in women (n = 68) and men (n = 78) with genetically defined HeFH. We classified CAC prevalence and severity using 3 categories: CAC score = 0 Agatston Unit (AU), CAC score = 1-100 AU, and CAC score > 100 AU. Information on potential correlates of CAC including familial and personal health history, cardiovascular risk factors, lipid-lowering medication, and lifestyle habits was collected.

Results: A total of 95 patients had prevalent CAC. Independent correlates of CAC prevalence and severity included age (odds ratio [OR] per 10 years: 5.06, 95% confidence interval [CI]: 3.19, 7.93, < 0.0001), family history of premature cardiovascular disease (OR: 3.88, 95% CI: 1.71, 8.81,  = 0.001), male sex (OR: 3.40, 95% CI: 1.49, 7.78,  = 0.004), statin use (OR: 15.5, 95% CI: 1.89, 126,  = 0.01), diet quality assessed with the Alternative Healthy Eating Index score (OR per 1 standard deviation: 0.59, 95% CI: 0.39, 0.90,  = 0.01), ever smoking (OR: 3.06, 95% CI: 1.20, 7.81,  = 0.02), receptor-negative genotype (OR: 3.17, 95% CI: 1.16, 8.66,  = 0.02), lipoprotein(a) year-score (OR per 1 standard deviation of log-transformed year-score: 1.53, 95% CI: 0.99, 2.36,  = 0.05).

Conclusions: In individuals with HeFH, age, family history of premature cardiovascular disease, sex, statin use, diet quality, smoking status, the genotype, and lipoprotein(a) concentrations were independently associated with CAC prevalence and severity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cjco.2020.09.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801218PMC
January 2021

Ventricular Arrhythmia in Septal and Apical Hypertrophic Cardiomyopathy: The French-Canadian Experience.

Front Cardiovasc Med 2020 22;7:548564. Epub 2020 Oct 22.

Division of Cardiology, Multidisciplinary Cardiovascular Department, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ-UL), Université Laval, Québec City, QC, Canada.

Apical hypertrophic cardiomyopathy (aHCM) is thought to have a more benign clinical course compared to septal HCM (sHCM), but most data have been derived from Asian cohorts. Comparative data on clinical outcome in Caucasian aHCM cohorts are scarce, and the results are conflicting. The aim of this study was to estimate the prevalence and outcome of aHCM in French-Canadians of Caucasian descent. We conducted a retrospective, single-center cohort study. The primary endpoint was a composite of documented sustained ventricular arrhythmia (VA), appropriate ICD therapy, arrhythmogenic syncope, cardiac arrest, or all-cause mortality. A total of 301 HCM patients (65% males) were enrolled including 80/301 (27%) with aHCM and 221/301 (73%) with sHCM. Maximal wall thickness was similar in both groups. Left ventricular apical aneurysm was significantly more common in aHCM (10 vs. 0.5%; < 0.001). The proportion of patients with myocardial fibrosis ≥ 15% of the left ventricular mass was similar between aHCM and sHCM (21 vs. 24%; = 0.68). Secondary prevention ICDs were more often implanted in aHCM patients (16 vs. 7%; = 0.02). The primary endpoint occurred in 26% of aHCM and 10.4% of sHCM patients ( = 0.001) and was driven by an increased incidence of sustained VA (10 vs. 2.3%; = 0.01). Multivariate analysis identified apical aneurysm and a phenotype of aHCM as independent predictors of the primary endpoint and the occurrence of sustained ventricular tachycardia. Unexplained syncope and a family history of sudden cardiac death were additional predictors for sustained VA. Apical HCM was associated with an increased risk of ventricular arrhythmia even when excluding patients with apical aneurysm. The phenotype of apical HCM is much more common in French-Canadians (27%) of Caucasian descent compared to other Caucasian HCM populations. Apical HCM in French-Canadians is associated with an increased risk for ventricular arrhythmia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fcvm.2020.548564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642600PMC
October 2020

Effect of Regional Upper Septal Hypertrophy on Echocardiographic Assessment of Left Ventricular Mass and Remodeling in Aortic Stenosis.

J Am Soc Echocardiogr 2021 Jan 14;34(1):62-71. Epub 2020 Oct 14.

Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada. Electronic address:

Background: Transthoracic echocardiography (TTE) is the reference method for evaluation of aortic stenosis (AS), and it is extensively used to quantitate left ventricular (LV) mass and volumes. Regional upper septal hypertrophy (USH) or septal bulge is a frequent finding in patients with AS and may lead to overestimation of LV mass when using linear measurements. The objective of this study was to compare estimates of LV mass obtained by two-dimensional transthoracic echocardiographic LV dimensions measured at different levels of the LV cavity with those obtained by cardiovascular magnetic resonance (CMR).

Methods: One hundred six patients (mean age, 63 ± 15 years; 68% men) with AS were included in this subanalysis of the PROGRESSA study. Two-dimensional transthoracic echocardiographic measurements of LV dimensions were obtained at the basal level (BL; as recommended in guidelines), immediately below the septal bulge (BSB), and at a midventricular level (ML). Regional USH was defined as a basal interventricular septal thickness ≥ 13 mm and >1.3 times the thickness of the septal wall at the ML. Agreement between transthoracic echocardiographic and CMR measures was evaluated using Bland-Altman analysis.

Results: The distribution of AS severity was mild in 23%, moderate in 57%, and severe in 20% of patients. Regional USH was present in 28 patients (26%). In the whole cohort, two-dimensional TTE overestimated LV mass (bias: BL, +60 ± 31 g; BSB, +59 ± 32 g; ML, +54 ± 32 g; P = .02). The biplane Simpson method slightly but significantly underestimated LV end-diastolic volume (bias -10 ± 20 mL, P < .001) compared with CMR. Overestimation of LV mass was more marked in patients with USH when measuring at the BL and was significantly lower when measuring LV dimensions at the ML (P < .025 vs BL and BSB).

Conclusions: Two-dimensional TTE systematically overestimated LV mass and underestimated LV volumes compared with CMR. However, the bias between TTE and CMR was less important when measuring at the ML. Measurements at the BL as suggested in guidelines should be avoided, and measurements at the ML should be preferred in patients with AS, especially in those with USH.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.echo.2020.08.022DOI Listing
January 2021

Visceral adiposity and liver fat as mediators of the association between cardiorespiratory fitness and plasma glucose-insulin homeostasis.

Am J Physiol Endocrinol Metab 2020 09 27;319(3):E548-E556. Epub 2020 Jul 27.

Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec City, Québec, Canada.

Cardiorespiratory fitness (CRF) is positively associated with insulin sensitivity, whereas excessive levels of visceral adipose tissue (AT) and liver fat (LF) are both associated with insulin resistance and impaired plasma glucose-insulin homeostasis. To what extent levels of visceral AT and LF content contribute to the relationship between CRF and indices of plasma glucose-insulin homeostasis is uncertain. Our objective was to explore the interactions among CRF, visceral AT, and LF with glucose tolerance/insulin levels in asymptomatic and apparently healthy individuals. CRF was measured in 135 women and 177 men with a maximal treadmill graded exercise test. Indices of plasma glucose-insulin homeostasis were derived from a 3-h oral glucose tolerance test (OGTT) performed in the morning after a 12-h fast. Visceral AT levels and LF content were measured using magnetic resonance imaging and spectroscopy. For any given CRF level, women presented significantly lower visceral AT and LF than men as well as lower homeostasis model assessment of insulin resistance (HOMA-IR) and plasma glucose-insulin levels during the OGTT compared with men. In both sexes, there were significant negative correlations between CRF and HOMA-IR as well as glucose and insulin levels measured during the OGTT. Both glucose and insulin levels during the OGTT correlated positively with visceral AT and LF. In women and men, being in the top CRF tertile was associated with low levels of visceral AT and LF. Multivariable linear regression analyses suggested that visceral AT and LF were plausible mediators of the association between CRF and indices of plasma glucose-insulin homeostasis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1152/ajpendo.00251.2020DOI Listing
September 2020

Global quieting of high-frequency seismic noise due to COVID-19 pandemic lockdown measures.

Science 2020 09 23;369(6509):1338-1343. Epub 2020 Jul 23.

Geophysical Institute, University of Alaska Fairbanks, Fairbanks, AK, USA.

Human activity causes vibrations that propagate into the ground as high-frequency seismic waves. Measures to mitigate the coronavirus disease 2019 (COVID-19) pandemic caused widespread changes in human activity, leading to a months-long reduction in seismic noise of up to 50%. The 2020 seismic noise quiet period is the longest and most prominent global anthropogenic seismic noise reduction on record. Although the reduction is strongest at surface seismometers in populated areas, this seismic quiescence extends for many kilometers radially and hundreds of meters in depth. This quiet period provides an opportunity to detect subtle signals from subsurface seismic sources that would have been concealed in noisier times and to benchmark sources of anthropogenic noise. A strong correlation between seismic noise and independent measurements of human mobility suggests that seismology provides an absolute, real-time estimate of human activities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/science.abd2438DOI Listing
September 2020

Hemodynamic performance of the balloon-expandable SAPIEN 3 valve as assessed by cardiac magnetic resonance.

Int J Cardiol 2020 12 21;320:128-132. Epub 2020 Jul 21.

Heart Center, Bad Segeberg, Germany; Heart Center Leipzig at the University of Leipzig, Leipzig, Germany. Electronic address:

Background: Scarce data exist on transcatheter heart valve (THV) performance evaluated by cardiac magnetic resonance (CMR) in newer generation THV patients. Furthermore, it has been suggested that echocardiographic evaluation after TAVR may inaccurately assess residual AR in some patients. This study aimed to determine the incidence and severity of aortic regurgitation (AR) assessed by CMR in patients undergoing TAVR with the SAPIEN 3 valve, and evaluate the agreement between CMR and transthoracic echocardiography (TTE) on the assessment of AR severity in such patients.

Methods: This multicentric observational study included 146 SAPIEN 3 patients with TTE and CMR within the month following their procedure. According to the CMR regurgitation fraction (RF), AR was considered mild and moderate-severe if the RF was 15-<30% and ≥ 30%, respectively. TTE exams followed VARC-2 recommendations.

Results: By CMR, SAPIEN 3 recipients displayed a mean RF of 5.0 ± 6.1%, and mild and moderate-severe AR rates of 3.4% and 0.7%, respectively. The agreement between CMR-TTE was modest (weighted κ = 0.2640, p<0.001), due to an overestimation of AR severity by TTE. A historical cohort of 139 SAPIEN XT patients with a post-procedure CMR, displayed a mean RF of 9.6 ± 10.7% and mild and moderate-severe AR rates of 18.7% and 3.6%, respectively (p < .001 vs. SAPIEN 3 group).

Conclusions: SAPIEN 3 recipients exhibited very low rates of residual AR by CMR, suggesting a surgical-like performance regarding AR with this newer generation THV. TTE tended to overestimate the severity of AR, particularly among mild AR patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2020.07.024DOI Listing
December 2020

Computed tomography coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial (IMAGE-HF 1C).

Eur Heart J Cardiovasc Imaging 2020 Jun 26. Epub 2020 Jun 26.

Department of Medicine (Cardiology), The University of Ottawa Heart Institute and University of Ottawa, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada.

Aims: This randomized controlled trial sought to determine the financial impact of an initial diagnostic strategy of coronary computed tomography angiography (CCTA) in patients with heart failure (HF) of unknown aetiology. Invasive coronary angiography (ICA) is used to investigate HF patients. CCTA may be a non-invasive cost-effective alternative to ICA. This randomized controlled trial sought to determine the financial impact of an initial diagnostic strategy of coronary computed tomography angiography (CCTA) in patients with heart failure (HF) of unknown aetiology.

Methods And Results: This multicentre, international trial enrolled patients with HF of unknown aetiology. The primary outcome was the cost of CCTA vs. ICA strategies at 12 months. Clinical outcomes were also collected. An 'intention-to-diagnose' analysis was performed and a secondary 'as-tested' analysis was based on the modality received. Two hundred and forty-six patients were randomized (age = 57.8 ± 11.0 years, ejection fraction = 30.1 ± 10.1%). The severity of coronary artery disease was similar in both groups. In the 121 CCTA patients, 93 avoided ICA. Rates of downstream ischaemia and viability testing were similar for both arms. There were no significant differences in the composite clinical outcomes or quality of life measures. The cost of CCTA trended lower than ICA [CDN -$871 (confidence interval, CI -$4116 to $3028)]. Using an 'as-tested' analysis, CCTA was associated with a decrease in healthcare costs (CDN -$2932, 95% CI -$6248 to $746).

Conclusion: In patients with HF of unknown aetiology, costs were not statistically different between the CCTA and ICA strategies.

Clinical Trials.gov: NCT01283659.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjci/jeaa109DOI Listing
June 2020

Novel Z Scores to Correct Biases Due to Ventricular Volume Indexing to Body Surface Area in Adolescents and Young Adults.

Can J Cardiol 2021 Mar 22;37(3):417-424. Epub 2020 Jun 22.

Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada. Electronic address:

Background: Reference values for cardiac magnetic resonance imaging (cMRI) in children and young adults are scarce. This leads to risk stratification of patients with congenital heart diseases being based on volumes indexed to body surface area (BSA). We aimed to produce cMRI Z score equations for ventricular volumes in children and young adults and to test whether indexing to BSA resulted in an incorrect assessment of ventricular dilation according to sex, body composition, and growth.

Methods: We retrospectively included 372 subjects aged < 26 years with either normal hearts or conditions with no impact on ventricular volumes (reference group), and 205 subjects with repaired tetralogy of Fallot (TOF) aged < 26 years. We generated Z score equations by means of multivariable regression modelling. Right ventricular dilation was assessed with the use of Z scores and compared with indexing to BSA in TOF subjects.

Results: Ventricular volume Z scores were independent from age, sex, and anthropometric measurements, although volumes indexed to BSA showed significant residual association with sex and body size. In TOF subjects, indexing overestimated dilation in growing children and underestimated dilation in female compared with male subjects, and in overweight compared with lean subjects.

Conclusions: Indexed ventricular volumes measured with cMRI did not completely adjust for body size and resulted in a differential error in the assessment of ventricular dilation according to sex and body size. Our proposed Z score equations solved this problem. Future studies should evaluate if ventricular volumes expressed as Z scores have a better prognostic value than volumes indexed to BSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cjca.2020.06.009DOI Listing
March 2021

Estimation of Stroke Volume and Aortic Valve Area in Patients with Aortic Stenosis: A Comparison of Echocardiography versus Cardiovascular Magnetic Resonance.

J Am Soc Echocardiogr 2020 08 21;33(8):953-963.e5. Epub 2020 Jun 21.

Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec City, Québec, Canada. Electronic address:

Background: In aortic stenosis, accurate measurement of left ventricular stroke volume (SV) is essential for the calculation of aortic valve area (AVA) and the assessment of flow status. Current American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines suggest that measurements of left ventricular outflow tract diameter (LVOTd) at different levels (at the annulus vs 5 or 10 mm below) yield similar measures of SV and AVA. The aim of this study was to assess the effect of the location of LVOTd measurement on the accuracy of SV and AVA measured on transthoracic echocardiography (TTE) compared with cardiovascular magnetic resonance (CMR).

Methods: One hundred six patients with aortic stenosis underwent both TTE and CMR. SV was estimated on TTE using the continuity equation with LVOTd measurements at four locations: at the annulus and 2, 5, and 10 mm below annulus. SV was also determined on CMR using phase contrast acquired in the aorta (SV), and a hybrid AVA was calculated by dividing SV by the transthoracic echocardiographic Doppler aortic velocity-time integral. Comparison between methods was made using Bland-Altman analysis.

Results: Compared with the referent method of phase-contrast CMR for the estimation of SV and AVA (SV 83 ± 16 mL, AVA 1.27 ± 0.35 cm), the best agreement was obtained by measuring LVOTd at the annulus or 2 mm below (P = NS), whereas measuring 5 and 10 mm below the annulus resulted in significant underestimation of SV and AVA by up to 15.9 ± 17.3 mL and 0.24 ± 0.28 cm, respectively (P < .01 for all). Accuracy for classification of low flow was best at the annulus (86%) and 2 mm below (82%), whereas measuring 5 and 10 mm below the annulus significantly underperformed (69% and 61%, respectively, P < .001).

Conclusions: Measuring LVOTd at the annulus or very close to it provides the most accurate measures of SV and AVA, whereas measuring LVOTd 5 or 10 mm below significantly underestimates these parameters and leads to significant overestimation of the severity of aortic stenosis and prevalence of low-flow status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.echo.2020.03.020DOI Listing
August 2020

Rain and small earthquakes maintain a slow-moving landslide in a persistent critical state.

Nat Commun 2020 Feb 7;11(1):780. Epub 2020 Feb 7.

OVI-INGEMMET, Arequipa, Peru.

In tectonically active mountain belts, landslides contribute significantly to erosion. Statistical analysis of regional inventories of earthquake-triggered-landslides after large earthquakes (Mw > 5.5) reveal a complex interaction between seismic shaking, landslide material, and rainfall. However, the contributions of each component have never been quantified due to a lack of in-situ data for active landslides. We exploited a 3-year geodetic and seismic dataset for a slow-moving landslide in Peru affected by local earthquakes and seasonal rainfalls. Here we show that in combination, they cause greater landslide motion than either force alone. We also show the rigidity of the landslide's bulk clearly decreasing during Ml ≥ 5 earthquakes. The recovery is affected by rainfall and small earthquakes (Ml < 3.6), which prevent the soil from healing, highlighting the importance of the timing between forcings. These new quantitative insights into the mechanics of landslides open new perspectives for the study of the mass balance of earthquakes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-020-14445-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005893PMC
February 2020

Tracking fluids in multiple scattering and highly porous materials: Toward applications in non-destructive testing and seismic monitoring.

Ultrasonics 2020 Mar 12;102:106019. Epub 2019 Sep 12.

Univ. Grenoble Alpes, CNRS - ISTerre, CS 40700, 38058 GRENOBLE Cedex 9, France.

Seismic and ultrasonic waves are sometimes used to track fluid injections, propagation, infiltrations in complex material, including geological and civil engineered ones. In most cases, one use the acoustic velocity changes as a proxy for water content evolution. Here we propose to test an alternative seismic or acoustic observable: the waveform decorrelation. We use a sample of compacted millimetric sand as a model medium of highly porous multiple scattering materials. We fill iteratively the sample with water, and track changes in ultrasonic waveforms acquired for each water level. We take advantage of the high sensitivity of diffuse coda waves (late arrivals) to track small water elevation in the material. We demonstrate that in the mesoscopic regime where the wavelength, the grain size and the porosity are in the same order of magnitude, Coda Wave Decorrelation (waveform change) is more sensitive to fluid injection than Coda Wave Interferometry (apparent velocity change). This observation is crucial to interpret fluid infiltration in concrete with ultrasonic record changes, as well as fluid injection in volcanoes or snow melt infiltration in rocky glaciers. In these applications, Coda Wave Decorrelation might be an extremely interesting tool for damage assessment and alert systems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ultras.2019.106019DOI Listing
March 2020

Cardiovascular risk scoring and magnetic resonance imaging detected subclinical cerebrovascular disease.

Eur Heart J Cardiovasc Imaging 2020 06;21(6):692-700

Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.

Aims: Cardiovascular risk factors are used for risk stratification in primary prevention. We sought to determine if simple cardiac risk scores are associated with magnetic resonance imaging (MRI)-detected subclinical cerebrovascular disease including carotid wall volume (CWV), carotid intraplaque haemorrhage (IPH), and silent brain infarction (SBI).

Methods And Results: A total of 7594 adults with no history of cardiovascular disease (CVD) underwent risk factor assessment and a non-contrast enhanced MRI of the carotid arteries and brain using a standardized protocol in a population-based cohort recruited between 2014 and 2018. The non-lab-based INTERHEART risk score (IHRS) was calculated in all participants; the Framingham Risk Score was calculated in a subset who provided blood samples (n = 3889). The association between these risk scores and MRI measures of CWV, carotid IPH, and SBI was determined. The mean age of the cohort was 58 (8.9) years, 55% were women. Each 5-point increase (∼1 SD) in the IHRS was associated with a 9 mm3 increase in CWV, adjusted for sex (P < 0.0001), a 23% increase in IPH [95% confidence interval (CI) 9-38%], and a 32% (95% CI 20-45%) increase in SBI. These associations were consistent for lacunar and non-lacunar brain infarction. The Framingham Risk Score was also significantly associated with CWV, IPH, and SBI. CWV was additive and independent to the risk scores in its association with IPH and SBI.

Conclusion: Simple cardiovascular risk scores are significantly associated with the presence of MRI-detected subclinical cerebrovascular disease, including CWV, IPH, and SBI in an adult population without known clinical CVD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjci/jez226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237958PMC
June 2020

Coronary Stent Protruding in the Ascending Aorta: Multimodality Imaging Evaluation.

JACC Cardiovasc Interv 2020 01 25;13(2):263-264. Epub 2019 Sep 25.

Quebec Heart and Lung Institute, Laval University, Quebec, Canada. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcin.2019.07.052DOI Listing
January 2020

Sex-Related Differences in the Extent of Myocardial Fibrosis in Patients With Aortic Valve Stenosis.

JACC Cardiovasc Imaging 2020 03 14;13(3):699-711. Epub 2019 Aug 14.

Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec City, Québec, Canada. Electronic address:

Objectives: The aim of this study was to assess the effect of sex on myocardial fibrosis as assessed by using cardiac magnetic resonance (CMR) imaging in aortic stenosis (AS).

Background: Previous studies reported sex-related differences in the left ventricular (LV) remodeling response to pressure overload in AS. However, there are very few data regarding the effect of sex on myocardial fibrosis, a key marker of LV decompensation and adverse cardiac events in AS.

Methods: A total of 249 patients (mean age 66 ± 13 years; 30% women) with at least mild AS were recruited from 2 prospective observational cohort studies and underwent comprehensive Doppler echocardiography and CMR examinations. On CMR, T1 mapping was used to quantify extracellular volume (ECV) fraction as a marker of diffuse fibrosis, and late gadolinium enhancement (LGE) was used to assess focal fibrosis.

Results: There was no difference in age between women and men (age 66 ± 15 years vs 66 ± 12 years; p = 0.78). However, women presented with a better cardiovascular risk profile than men with less hypertension, dyslipidemia, diabetes, and coronary artery disease (all, p ≤ 0.10). As expected, LV mass index measured by CMR imaging was smaller in women than in men (p < 0.0001). Despite fewer comorbidities, women presented with larger ECV fraction (median: 29.0% [25th to 75th percentiles: 27.4% to 30.6%] vs. 26.8% [25th to 75th percentiles: 25.1% to 28.7%]; p < 0.0001) and similar LGE (median: 4.5% [25th-75th percentiles: 2.3% to 7.0%] vs. 2.8% [25th-75th percentiles: 0.6% to 6.8%]; p = 0.20) than men. In multivariable analysis, female sex remained an independent determinant of higher ECV fraction and LGE (all, p ≤ 0.05).

Conclusions: Women have greater diffuse and focal myocardial fibrosis independent of the degree of AS severity. These findings further emphasize the sex-related differences in LV remodeling response to pressure overload.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcmg.2019.06.014DOI Listing
March 2020

Locating structural changes in a multiple scattering domain with an irregular shape.

J Acoust Soc Am 2019 Jul;146(1):595

ISTerre, CNRS, Université Grenoble Alpes, CS 40700, 38058 GRENOBLE Cedex 9, France.

Locadiff is a method for imaging local structural changes in a random, heterogeneous medium. It relies on the combination of a forward model to calculate the sensitivity kernel of the source-receiver pairs, with an inversion method to determine the position of the changes. So far, the sensitivity kernel has been evaluated based on an analytical solution of the diffusion equation, which lacks the flexibility to handle problems where the domain has boundaries with an irregular shape. Moreover, the accuracy of the previous inversion method, based on linear algebra tools, was very sensitive to the values of the inversion parameters. This paper introduces a more generic approach to solve both these issues. The first problem is tackled by the implementation of a numerical method as an alternative for solving the diffusion equation. The second problem is tackled by the introduction of enhanced optimization algorithms to improve the stability of the inversion. This improved version of Locadiff is validated via both numerical examples and experimental data from an actual civil engineering problem.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1121/1.5118246DOI Listing
July 2019

Characterizing horizontally-polarized shear and infragravity vibrational modes in the Arctic sea ice cover using correlation methods.

J Acoust Soc Am 2019 Mar;145(3):1600

Institut des Sciences de la Terre, Université Savoie Mont Blanc, UMR CNRS 5275, Le Bourget du Lac, France.

The deployment of three drifting seismic stations on the Arctic sea ice during the winter of 2014-2015 with station inter-spacing between 30 and 80 km enables the characterization of the coherent seismic wavefield at these scales through the use of array methods. Two distinct vibrational modes are observed, corresponding to the fast and non-dispersive horizontally-polarized shear (SH) mode and the slow and dispersive flexural, infragravity mode (ice swell). The excitation of these two modes is not synchronous. The activation of the infragravity mode is linked to the arrival of energetic, dispersive wavetrains that can be readily seen on individual spectrograms, and that, as previous studies have shown, are likely to have their origins in distant storms. In contrast, the SH mode is excited at other time intervals and cannot be isolated on the recording of single stations due to the broadband and emergent nature of these wavetrains; given the horizontal polarization of these waves, the authors hypothesize that SH waves are caused by episodes of rapid SH deformation along major leads located outside the station network. The existence of horizontally-polarized waves propagating over long distances opens the possibility of monitoring ice deformation at the scale of the Arctic basin with unprecedented time resolution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1121/1.5094343DOI Listing
March 2019

Effect of Aortic Regurgitation by Cardiovascular Magnetic Resonance After Transcatheter Aortic Valve Implantation.

Am J Cardiol 2019 07 9;124(1):78-84. Epub 2019 Apr 9.

Heart Center, Bad Segeberg, Germany; Heart Center Leipzig at the University of Leipzig, Leipzig, Germany. Electronic address:

Cardiovascular magnetic resonance (CMR) has demonstrated a high accuracy for evaluating the severity of aortic regurgitation (AR). However, scarce data exist on the impact of AR as evaluated by CMR on clinical outcomes following transcatheter aortic valve implantation (TAVI). The objective of this study was to evaluate the impact of AR as determined by CMR on clinical outcomes (mortality, heart failure [HF] hospitalization) post-TAVI. A total of 448 TAVI recipients from 2 centers (mean age: 80 ± 7 years, mean STS: 5.8 ± 5.4%) who survived the periprocedural period with no pacemaker implantation were included. A newer generation transcatheter valve system was used in 213 patients (48%). The CMR examination was performed at a median of 12 (IQR: 7 to 21) days post-TAVI. After a mean follow-up of 24 ± 19 months, a total of 94 patients (21%) had died and 72 patients (16%) had at least 1 hospitalization because of decompensated HF. The aortic regurgitation fraction (RF) as determined by CMR was an independent predictor of mortality (hazard ratio[HR]:1.06 for each increase of 10%, 95% confidence interval [CI]: 1.01 to 1.12, p = 0.03) and HF hospitalization (HR:1.15 for each increase of 10%, 95% CI:1.02 to 1.30, p = 0.02). The rate of moderate-severe CMR-AR defined as a RF ≥30% was 3%, and this was associated with an increased risk of mortality (HR: 2.63, 95% CI: 2.30 to 2.99, p <0.001) and HF hospitalization (HR: 2.96, 95% CI: 1.62 to 5.42, p ˂0.001). A stepwise increase in the risk of mortality and HF hospitalization was observed with an increase in AR severity, with a peak increase among patients with RF ≥30%. In conclusion, our results showed the clinical usefulness of evaluating AR severity by CMR post-TAVI. CMR would be particularly helpful in doubtful cases or those with discordances between echocardiography and clinical data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2019.04.007DOI Listing
July 2019

Machine learning for phenotyping opioid overdose events.

J Biomed Inform 2019 06 25;94:103185. Epub 2019 Apr 25.

Marshfield Clinic Research Institute, Marshfield, WI, USA.

Objective: To develop machine learning models for classifying the severity of opioid overdose events from clinical data.

Materials And Methods: Opioid overdoses were identified by diagnoses codes from the Marshfield Clinic population and assigned a severity score via chart review to form a gold standard set of labels. Three primary feature sets were constructed from disparate data sources surrounding each event and used to train machine learning models for phenotyping.

Results: Random forest and penalized logistic regression models gave the best performance with cross-validated mean areas under the ROC curves (AUCs) for all severity classes of 0.893 and 0.882 respectively. Features derived from a common data model outperformed features collected from disparate data sources for the same cohort of patients (AUCs 0.893 versus 0.837, p value = 0.002). The addition of features extracted from free text to machine learning models also increased AUCs from 0.827 to 0.893 (p value < 0.0001). Key word features extracted using natural language processing (NLP) such as 'Narcan' and 'Endotracheal Tube' are important for classifying overdose event severity.

Conclusion: Random forest models using features derived from a common data model and free text can be effective for classifying opioid overdose events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jbi.2019.103185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6622451PMC
June 2019

Benefits of 1-Year Lifestyle Modification Program on Exercise Capacity and Diastolic Function Among Coronary Artery Disease Men With and Without Type 2 Diabetes.

Metab Syndr Relat Disord 2019 04 21;17(3):149-159. Epub 2019 Feb 21.

1 Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada.

Background: To assess the benefits of a 1-year lifestyle modification program on exercise capacity and diastolic function in men with left ventricular (LV) diastolic dysfunction (LVDD) and coronary artery disease (CAD), according to glucose tolerance status.

Methods: Fifty-three men (62 ± 8 years; BMI: 27.3 ± 3.5 kg/m) with LVDD and CAD were enrolled in a 1-year lifestyle modification program based on dietary management and increased physical activity. Patients were classified by using a 75 grams oral glucose tolerance test as having normal glucose tolerance (n = 16), prediabetes (n = 23), or type 2 diabetes mellitus (T2DM) (n = 14). Cardiac morphology and function, visceral fat, and cardiac fat depots were measured using magnetic resonance imaging, whereas exercise capacity [cardiorespiratory fitness (CRF)] (VO) was assessed with a maximal treadmill test.

Results: The 1-year lifestyle modification program was associated with reductions in body weight, and visceral and cardiac fat levels (all P < 0.05). CRF increased by 13% (24.9 ± 4.1 vs. 28.2 ± 4.8 mL O/kg/min, P < 0.0001). Moreover, half of patients (53%) improved LV diastolic function in response to the lifestyle intervention. Multiple regression analyses revealed that age (partial R = 26.9, P < 0.0001) and presence of T2DM (partial R = 5.9, P = 0.04) were the stronger predictors of change in diastolic function, while favorable change in LV remodeling index was the best predictor of improvement in LV diastolic function after the lifestyle intervention (R = 21.9, P = 0.002).

Conclusions: Irrespective of glucose tolerance status, a 1-year lifestyle modification program in men with LVDD and CAD is associated with significant improvements in exercise capacity and LV diastolic function in more than half of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/met.2018.0092DOI Listing
April 2019

Ectopic adiposity and cardiometabolic health in COPD.

Int J Chron Obstruct Pulmon Dis 2018;13:3331-3340. Epub 2018 Oct 15.

Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,

Rationale: Obesity/overweight is the most prevalent body composition abnormality in COPD. However, little is known about the impact of fat distribution on cardiometabolic health in COPD.

Objective: To study the associations between ectopic adiposity, cardiometabolic health, and COPD.

Methods: A total of 263 subjects (166 males; age=65±9 years) were randomly selected from the general population. Subjects were classified as non-COPD controls and COPD, according to the Global initiative for chronic Obstructive Lung Disease (GOLD) classification, and the presence of cardiometabolic comorbidities was recorded. Ectopic fat accumulation was documented from computed tomography measurements of visceral adipose tissue cross-sectional areas and muscle mean attenuation, assessed at L4-L5. Blood glucose, lipid, and adipokine profiles were also evaluated.

Results: After correcting for age, sex, and tobacco exposure, visceral adipose tissue cross-sectional area was higher in GOLD 2+ compared to GOLD 1 individuals. Consistent with this, mean muscle tissue attenuation was lower in GOLD 2+ vs GOLD 1 and non-COPD controls (<0.001). In multiple regression models, visceral adipose tissue cross-sectional area was strongly associated with hypertension (<0.001) and diabetes (<0.001), while muscle attenuation was associated with coronary artery disease (<0.001). Blood glucose, lipid, and adipokine profiles were similar across groups with the exception of leptin level which was higher in GOLD 2+ subjects compared to GOLD 1 and controls.

Conclusion: GOLD 2+ COPD was associated with ectopic fat accumulation which modulated cardiometabolic health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/COPD.S168963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197246PMC
March 2019

Prevalence of left ventricle non-compaction criteria in adult patients with bicuspid aortic valve versus healthy control subjects.

Open Heart 2018;5(2):e000869. Epub 2018 Oct 7.

Institut Universitaire de Cardiologie et de Pneumologie de Québec / Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.

Objective: The aim of this study was to compare the prevalence of left ventricle non-compaction (LVNC) criteria (or hypertrabeculation) in a cohort of patients with bicuspid aortic valve (BAV) and healthy control subjects (CTL) without cardiovascular disease using cardiovascular MR (CMR).

Methods: 79 patients with BAV and 85 CTL with tricuspid aortic valve and free of known cardiovascular disease underwent CMR to evaluate the presence of LVNC criteria. The left ventricle was assessed at end-systole and end-diastole, in the short-axis, two-chamber and four-chamber views and divided into the 16 standardised myocardial segments. LVNC was assessed using the non-compacted/compacted (NC/C) myocardium ratio and was considered to be present if at least one of the myocardial segments had a NC/C ratio superior to the cut-off values defined in previous studies: Jenni (>2.0 end-systole); Petersen (>2.3 end-diastole); or Fazio (>2.5 end-diastole).

Results: 15 CTL (17.6%) vs 8 BAV (10.1%) fulfilled Jenni 's criterion; 69 CTL (81.2%) vs 49 BAV (62.0%) fulfilled Petersen 's criterion; and 66 CTL (77.6%) vs 43 BAV (54.4%) fulfilled Fazio 's criterion. Petersen and Fazio 's LVNC criteria were met more often by CTL (p=0.006 and p=0.002, respectively) than patients with BAV, whereas this difference was not statistically significant according to Jenni 's criterion (p=0.17). In multivariable analyses, after adjusting for age, sex, the presence of significant valve dysfunction (>mild stenosis or >mild regurgitation), indexed LV mass, indexed LV end-diastolic volume and LV ejection fraction, BAV was not associated with any of the three LVNC criteria.

Conclusion: Patients with BAV do not harbour more LVNC than the general population and there is no evidence that they are at higher risk for the development of LVNC cardiomyopathy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/openhrt-2018-000869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196966PMC
February 2021

A case study evaluating the portability of an executable computable phenotype algorithm across multiple institutions and electronic health record environments.

J Am Med Inform Assoc 2018 11;25(11):1540-1546

Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Electronic health record (EHR) algorithms for defining patient cohorts are commonly shared as free-text descriptions that require human intervention both to interpret and implement. We developed the Phenotype Execution and Modeling Architecture (PhEMA, http://projectphema.org) to author and execute standardized computable phenotype algorithms. With PhEMA, we converted an algorithm for benign prostatic hyperplasia, developed for the electronic Medical Records and Genomics network (eMERGE), into a standards-based computable format. Eight sites (7 within eMERGE) received the computable algorithm, and 6 successfully executed it against local data warehouses and/or i2b2 instances. Blinded random chart review of cases selected by the computable algorithm shows PPV ≥90%, and 3 out of 5 sites had >90% overlap of selected cases when comparing the computable algorithm to their original eMERGE implementation. This case study demonstrates potential use of PhEMA computable representations to automate phenotyping across different EHR systems, but also highlights some ongoing challenges.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jamia/ocy101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213083PMC
November 2018

Hemodynamic Deterioration of Surgically Implanted Bioprosthetic Aortic Valves.

J Am Coll Cardiol 2018 07 9;72(3):241-251. Epub 2018 Jul 9.

Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Quebec City, Québec, Canada. Electronic address:

Background: Dysmetabolic profile has been associated with native aortic valve stenosis. However, there are limited data on the effects of an atherogenic milieu and its potential implications on the structural and hemodynamic deterioration of aortic bioprosthetic valves.

Objectives: This prospective longitudinal study sought to determine the predictors and impact on outcomes of hemodynamic valve deterioration (HVD) of surgically implanted aortic bioprostheses.

Methods: A total of 137 patients with an aortic bioprosthesis implanted for a median time of 6.7 (interquartile range: 5.1 to 9.1) years prospectively underwent a first (baseline) assessment with complete Doppler echocardiography, quantitation of bioprosthesis leaflet calcification by multidetector computed tomography (CT), and a fasting blood sample to assess cardiometabolic risk profile. All patients underwent a second (follow-up) Doppler echocardiography examination at 3 (interquartile range: 2.9 to 3.3) years post-baseline visit. HVD was defined by an annualized change in mean transprosthetic gradient ≥3 mm Hg/year and/or worsening or transprosthetic regurgitation by ≥1/3 class. The primary endpoint was a nonhierarchical composite of death from any cause or aortic reintervention procedure (redo surgical valve replacement or transcatheter valve-in-valve implantation) for bioprosthesis failure.

Results: Thirty-four patients (25.6%) had leaflet calcification on baseline CT, and 18 patients (13.1%) developed an HVD between baseline and follow-up echocardiography. Fifty-two patients (38.0%) met the primary endpoint during subsequent follow-up after the second echocardiographic examination. Leaflet calcification (hazard ratio [HR]: 2.58; 95% confidence interval [CI]: 1.35 to 4.82; p = 0.005) and HVD (HR: 5.12; 95% CI: 2.57 to 9.71; p < 0.001) were independent predictors of the primary endpoint. Leaflet calcification, insulin resistance (homeostatic model assessment index ≥2.7), lipoprotein-associated phospholipase A2 activity (Lp-PLA2 per 0.1 nmol/min/ml increase), and high level of proprotein convertase subtilisin/kexin 9 (PCSK9) (≥305 ng/ml) were associated with the development of HVD after adjusting for age, sex, and time interval since aortic valve replacement.

Conclusions: HVD identified by Doppler echocardiography is independently associated with a marked increase in the risk of valve reintervention or mortality in patients with a surgical aortic bioprosthesis. A dysmetabolic profile characterized by elevated plasma Lp-PLA2, PCSK9, and homeostatic model assessment index was associated with increased risk of HVD. The presence of leaflet calcification as detected by CT was a strong predictor of HVD, providing incremental risk-predictive capacity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jacc.2018.04.064DOI Listing
July 2018

Progression of Hypertrophy and Myocardial Fibrosis in Aortic Stenosis: A Multicenter Cardiac Magnetic Resonance Study.

Circ Cardiovasc Imaging 2018 06;11(6):e007451

British Heart Foundation Centre for Cardiovascular Science (R.J.E., J.K., M.G., E.J.R.v.B., C.W., S.S., D.E.N., M.R.D.).

Background: Aortic stenosis is accompanied by progressive left ventricular hypertrophy and fibrosis. We investigated the natural history of these processes in asymptomatic patients and their potential reversal post-aortic valve replacement (AVR).

Methods: Asymptomatic and symptomatic patients with aortic stenosis underwent repeat echocardiography and magnetic resonance imaging. Changes in peak aortic-jet velocity, left ventricular mass index, diffuse fibrosis (indexed extracellular volume), and replacement fibrosis (late gadolinium enhancement [LGE]) were quantified.

Results: In 61 asymptomatic patients (43% mild, 34% moderate, and 23% severe aortic stenosis), significant increases in peak aortic-jet velocity, left ventricular mass index, indexed extracellular volume, and LGE mass were observed after 2.1±0.7 years, with the most rapid progression observed in patients with most severe stenosis. Patients with baseline midwall LGE (n=16 [26%]; LGE mass, 2.5 g [0.8-4.8 g]) demonstrated particularly rapid increases in scar burden (78% [50%-158%] increase in LGE mass per year). In 38 symptomatic patients (age, 66±8 years; 76% men) who underwent AVR, there was a 19% (11%-25%) reduction in left ventricular mass index (<0.0001) and an 11% (4%-16%) reduction in indexed extracellular volume (=0.003) 0.9±0.3 years after surgery. By contrast midwall LGE (n=10 [26%]; mass, 3.3 g [2.6-8.0 g]) did not change post-AVR (n=10; 3.5 g [2.1-8.0 g]; =0.23), with no evidence of regression even out to 2 years.

Conclusions: In patients with aortic stenosis, cellular hypertrophy and diffuse fibrosis progress in a rapid and balanced manner but are reversible after AVR. Once established, midwall LGE also accumulates rapidly but is irreversible post valve replacement. Given its adverse long-term prognosis, prompt AVR when midwall LGE is first identified may improve clinical outcomes.

Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01755936 and NCT01679431.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCIMAGING.117.007451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023592PMC
June 2018

Using Machine Learning Algorithms to Predict Risk for Development of Calciphylaxis in Patients with Chronic Kidney Disease.

AMIA Jt Summits Transl Sci Proc 2018 18;2017:139-146. Epub 2018 May 18.

Marshfield Clinic Research Institute, Marshfield, WI.

Calciphylaxis is a disorder that results in necrotic cutaneous lesions with a high rate of mortality. Due to its rarity and complexity, the risk factors for and the disease mechanism of calciphylaxis are not fully understood. This work focuses on the use of machine learning to both predict disease risk and model the contributing factors learned from an electronic health record data set. We present the results of four modeling approaches on several subpopulations of patients with chronic kidney disease (CKD). We find that modeling calciphylaxis risk with random forests learned from binary feature data produces strong models, and in the case of predicting calciphylaxis development among stage 4 CKD patients, we achieve an AUC-ROC of 0.8718. This ability to successfully predict calciphylaxis may provide an excellent opportunity for clinical translation of the predictive models presented in this paper.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5961821PMC
May 2018

MCIndoor20000: A fully-labeled image dataset to advance indoor objects detection.

Data Brief 2018 Apr 3;17:71-75. Epub 2018 Jan 3.

Biomedical Informatics Research Center, Marshfield Clinic Research Institute, WI, USA.

A fully-labeled image dataset provides a unique resource for reproducible research inquiries and data analyses in several computational fields, such as computer vision, machine learning and deep learning machine intelligence. With the present contribution, a large-scale fully-labeled image dataset is provided, and made publicly and freely available to the research community. The current dataset entitled includes more than 20,000 digital images from three different indoor object categories, including doors, stairs, and hospital signs. To make a comprehensive dataset addressing current challenges that exist in indoor objects modeling, we cover a multiple set of variations in images, such as rotation, intra-class variation plus various noise models. The current dataset is freely and publicly available at https://github.com/bircatmcri/MCIndoor20000.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dib.2017.12.047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5988436PMC
April 2018

Longitudinal Changes in Cholesterol Efflux Capacities in Patients With Coronary Artery Disease Undergoing Lifestyle Modification Therapy.

J Am Heart Assoc 2018 06 1;7(11). Epub 2018 Jun 1.

Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Canada

Background: Our objective was to identify the determinants of high-density lipoprotein cholesterol efflux capacity (HDL-CEC) changes in patients with coronary artery disease who participated in a lifestyle modification program aimed at increasing physical activity levels and improving diet quality.

Methods And Results: A total of 86 men with coronary artery disease aged between 35 and 80 years participated in a 1-year lifestyle modification program that aimed to achieve a minimum of 150 minutes of aerobic physical activity weekly and improve diet quality. HDL-CECs were measured before and after the 1-year intervention using H-cholesterol-labeled J774 and HepG2 cells. Visceral, subcutaneous, and cardiac adipose tissue levels were assessed before and after the intervention using magnetic resonance imaging. Lipoprotein particle size and concentrations were measured by proton nuclear magnetic resonance spectroscopy and a complete lipoprotein-lipid profile was obtained. At baseline, the best correlate of HDL-CECs were apolipoprotein AI (=0.35, <0.0001) and high-density lipoprotein cholesterol (=0.21, <0.0001) for J774-HDL-CECs and HepG2-HDL-CECs, respectively. Baseline and longitudinal changes in HDL-CECs were associated with several lipoprotein size and concentration indices, although high-density lipoprotein cholesterol was the best predictor of longitudinal changes in J774-HDL-CECs (=0.18, =0.002) and apolipoprotein AI was found to be the best predictor of longitudinal changes in HepG2 cholesterol efflux capacities (=0.21, =0.002).

Conclusions: Results of this study suggest that increases in high-density lipoprotein cholesterol and apolipoprotein AI levels typically observed in patients with coronary artery disease undergoing healthy lifestyle modification therapy may be indicative of higher plasma concentrations of functional high-density lipoprotein particles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.118.008681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015361PMC
June 2018

A Randomized Double-Blind Placebo-Controlled Study Comparing Intracoronary Versus Intravenous Abciximab in Patients With ST-Elevation Myocardial Infarction Undergoing Transradial Rescue Percutaneous Coronary Intervention After Failed Thrombolysis.

Am J Cardiol 2018 07 28;122(1):47-53. Epub 2018 Mar 28.

Quebec Heart-Lung Institute, Quebec, Canada.

The risk and benefit ratio of glycoprotein IIb/IIIa inhibitors with dual oral antiplatelet therapy after failed thrombolysis and rescue percutaneous coronary intervention (PCI) is unclear. Using a randomized placebo-controlled, double-blind design, we compared intravenous (IV) and intracoronary (IC) abciximab delivery in 74 patients referred for rescue transradial PCI. The primary angiographic end points were the final thrombolysis in myocardial infarction flow and myocardial blush grades. Secondary end points included acute and 6-month outcomes using angiographic parameters, platelet aggregation parameters, cardiac biomarkers, cardiac magnetic resonance measurements (CMR) and clinical end points. After rescue PCI, normal thrombolysis in myocardial infarction 3 flows were obtained in 70% in the IC group, 48% in the IV group, and 71% in the placebo group, respectively (p = 0.056). Final myocardial blush grades 2 and 3 were obtained in 43% and 39% in the IC group, 48% and 26% in the IV group, and 46% and 42% in the placebo group (p = 0.67), respectively. Acutely, peak release of cardiac biomarkers, necrosis size, myocardial perfusion and no-reflow as assessed by CMR, and clinical end points were similar between the groups and did not suggest a benefit for IC or IV abciximab compared with placebo. There was no increase in bleeding or access site-related complications with abciximab compared with placebo. Clinical, angiographic, and CMR outcomes at 6 months remained comparable between the groups. In patients with ST-elevation myocardial infarction presenting with failed thrombolysis undergoing transradial rescue PCI, IC or IV abciximab had no significant clinical impact.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2018.03.007DOI Listing
July 2018

Hypertriglyceridemic Waist: A Simple Marker of High-Risk Atherosclerosis Features Associated With Excess Visceral Adiposity/Ectopic Fat.

J Am Heart Assoc 2018 04 13;7(8). Epub 2018 Apr 13.

Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada

Background: Subclinical atherosclerosis identification remains challenging; abdominal visceral adiposity may improve risk stratification beyond traditional cardiovascular risk factors. Hypertriglyceridemic waist, a visceral adiposity marker combining elevated triglycerides (≥2 mmol/L) and waist circumference (≥90 cm), has been related to carotid atherosclerosis, although associations with high-risk features, including lipid-rich necrotic core (LRNC), remain unknown. We tested the hypothesis that hypertriglyceridemic waist is an independent marker of high-risk atherosclerosis features.

Methods And Results: In this cross-sectional study including 467 white men (mean age, 45.9±14.8 years; range 19.4-77.6 years), carotid atherosclerosis characteristics were examined by magnetic resonance imaging and associations with hypertriglyceridemic waist and benefits beyond Framingham Risk Score (FRS) and Pathobiological Determinants of Atherosclerosis in Youth (PDAY) were determined. Subclinical carotid atherosclerosis was present in 61.9% of participants, whereas 50.1% had LRNC. Hypertriglyceridemic waist was associated with carotid maximum wall thickness (=0.014), wall volume (=0.025), normalized wall index (=0.004), and Carotid Atherosclerosis Score (derived from wall thickness and LRNC; =0.049). Hypertriglyceridemic waist was associated with carotid LRNC volume beyond FRS (=0.037) or PDAY (=0.015), contrary to waist circumference alone (both >0.05). Although 69.7% and 62.0% of participants with carotid atherosclerosis and/or LRNC were not high-risk by FRS or PDAY, respectively, hypertriglyceridemic waist correctly reclassified 9.7% and 4.5% of them, respectively. Combining hypertriglyceridemic waist with FRS (net reclassification improvement=0.17; <0.001) or PDAY (net reclassification improvement=0.05; =0.003) was superior to each score alone in identifying individuals with carotid atherosclerosis and/or LRNC.

Conclusions: Hypertriglyceridemic waist is an independent marker of carotid high-risk atherosclerosis features in men, improving on FRS and PDAY risk score.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.117.008139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015425PMC
April 2018