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Understanding small-scale COVID-19 transmission dynamics with the Granger causality test
No full textMobility patterns have been broadly studied and deeply altered due to the coronavirus disease (COVID-19). In this paper, we study small-scale COVID-19 transmission dynamics in the city of Valencia and the potential role of subway stations and healthcare facilities in this transmission. A total of 2,398 adult patients were included in the analysis. We study the temporal evolution of the pandemic during the first six months at a small-area level. Two Voronoi segmentations of the city (based on the location of subway stations and healthcare facilities) have been considered, and we have applied the Granger causality test at the Voronoi cell level, considering both divisions of the study area. Considering the output of this approach, the so-called 'donor stations' are subway stations that have sent more connections than they have received and are mainly located in interchanger stations. The transmission in primary healthcare facilities showed a heterogeneous pattern. Given that subway interchange stations receive many cases from other regions of the city, implementing isolation measures in these areas might be beneficial for the reduction of transmission.Innovation, University, Science and Digital Society Council through the Valencia Innovation Agency (AVI)European Union’s Horizon 2020 research and innovation program (Grant No. 851255)Spanish State Research Agency through the Severo Ochoa and María de Maeztu Program for Centers and Units of Excellence in Research and Development (MDM-2017- 0711)1.8 Q4 JCR 20220.409 Q2 SJR 2022No data IDR 2022UE
Heart rate disorders in patients with Tako-tsubo syndrome
No full textObjectives: This study sought to evaluate the incidence, prognosis and treatment of heart rhythm disorders (HRD) in Tako-tsubo syndrome (TTS).Background: TTS is associated with HRD. The HRD prognostic value is not well characterized in TTS yet. Methods: The HRD of patients included in the National Registry of Tako-tsubo syndrome, admitted between 2002 and 2018 and coming from 38 hospitals throughout the country, was analyzed. We analyzed any heart rhythm disorder in patients presented before admission, at admission and in long-term follow-up.Results: All types of HRD were described in 259 (23.5%) cases, from a cohort of 1,097 consecutive patients with TTS. HRD was more associated with diabetes mellitus, smoking, hyperuricemia, sleep apnea, anemia with a worse LVEF on admission. The most frequent HRD was a new onset of atrial fibrillation. During hospitalization, patients with HRD showed more complications such as shock on admission, major bleeding, acute renal failure, and combined infections. At follow-up, they presented higher mortality and more major adverse cardiac events, but with a non-significant correlation.Conclusions: The incidence of HRD in patients with TTS is not infrequent. TTS, when associated with HRD, presents more complications and a worse prognosis both in hospital and in the long term.(c) 2023 Elsevier Espana, S.L.U. All rights reserved.Sin financiación3.9 Q2 JCR 2022No data IDR 20220.347 Q3 SJR 2022UE
Pathogenic variants in SMARCA1 cause an X-linked neurodevelopmental disorder modulated by NURF complex composition
No full textPathogenic variants in ATP-dependent chromatin remodeling proteins are a recurrent cause of neurodevelopmental disorders (NDDs). The NURF complex consists of BPTF and either the SNF2H (SMARCA5) or SNF2L (SMARCA1) ISWI-chromatin remodeling enzyme. Pathogenic variants in BPTF and SMARCA5 were previously implicated in NDDs. Here, we describe 40 individuals from 30 families with de novo or maternally inherited pathogenic variants in SMARCA1. This novel NDD was associated with mild to severe ID/DD, delayed or regressive speech development, and some recurrent facial dysmorphisms. Individuals carrying SMARCA1 loss-of-function variants exhibited a mild genome-wide DNA methylation profile and a high penetrance of macrocephaly. Genetic dissection of the NURF complex using Smarca1, Smarca5, and Bptfsingle and double mouse knockouts revealed the importance of NURF composition and dosage for proper forebrain development. Finally, we propose that genetic alterations affecting different NURF components result in a NDD with a broad clinical spectrum.Sin financiaciónNo data 2022UE
Clinical description, molecular delineation and genotype-phenotype correlation in 340 patients with KBG syndrome: Addition of 67 new patients
No full textBackground KBG syndrome is a highly variable neurodevelopmental disorder and clinical diagnostic criteria have changed as new patients have been reported. Both loss-of-function sequence variants and large deletions (copy number variations, CNVs) involving ANKRD11 cause KBG syndrome, but no genotype–phenotype correlation has been reported.
Methods 67 patients with KBG syndrome were assessed using a custom phenotypical questionnaire. Manifestations present in >50% of the patients and a ‘phenotypical score’ were used to perform a genotype–phenotype correlation in 340 patients from our cohort and the literature.
Results Neurodevelopmental delay, macrodontia, triangular face, characteristic ears, nose and eyebrows were the most prevalentf (eatures. 82.8% of the patients had at least one of seven main comorbidities: hearing loss and/or otitis media, visual problems, cryptorchidism, cardiopathy, feeding difficulties and/or seizures. Associations found included a higher phenotypical score in patients with sequence variants compared with CNVs and a higher frequency of triangular face (71.1% vs 42.5% in CNVs). Short stature was more frequent in patients with exon 9 variants (62.5% inside vs 27.8% outside exon 9), and the prevalence of intellectual disability/attention deficit hyperactivity disorder/autism spectrum disorder was lower in patients with the c.1903_1907del variant (70.4% vs 89.4% other variants). Presence of macrodontia and comorbidities were associated with larger deletion sizes and hand anomalies with smaller deletions.
Conclusion We present a detailed phenotypical description of KBG syndrome in the largest series reported to date of 67 patients, provide evidence of a genotype–phenotype correlation between some KBG features and specific ANKRD11 variants in 340 patients, and propose updated clinical diagnostic criteria based on our findings.Juan Rodes programInstituto de Salud Carlos III (JR17/00020)European Union (EU) (PI18/01098)4.0 Q2 JCR 20221.816 Q1 SJR 2022No data IDR 2022UE
Influence of the dental arch and number of cutting-off and rescanning mesh holes on the accuracy of implant scans in partially edentulous situations
No full textObjectives:To evaluate the influence of the dental arch and cutting-off and rescanning procedures on the accuracy of complete-arch implant scans in partially edentulous arches.
Material and methods: A maxillary and a mandibular partially edentulous typodont with implant abutment analogs placed in the right and left first molar and right central incisor sites were digitized to create reference models by using an industrial optical scanner (7 Series Desktop Scanner; Dentalwings). Two experimental groups were scanned using an intraoral scanner (IOS) (TRIOS 4; 3Shape A/S): the Maxillary group (Mx) and the Mandibular group (Mb). Four subgroups were generated depending on the number of rescanned mesh holes: No holes (Mx-G0, Mb-G0), 1 hole (Mx-G1, Mb-G1), 2 holes (Mx-G2, Mb-G2) and 3 holes (Mx-G3, Mb-G3). A 3-dimensional metrology software (Geomagic Control X; 3D Systems) was used to measure the difference between the reference and the experimental scans computing the root mean square (RMS) error calculation. Two-way ANOVA and a post-hoc Tukey test were used to analyze the trueness data (α=0.05). Levene test was used to evaluate the prevision (α=0.05).
Results: The Mx group obtained a trueness mean value of 54 ± 17 µm and a mean precision value of 54 ± 17 µm, while the Mb group presented a trueness mean value of 67 ± 23 µm and a mean precision value of 66 ± 22 µm. The Mx group demonstrated significantly better trueness than the Mb group (P<.001). The G0 and G1 subgroups had the highest trueness values among the subgroups tested. No significant difference was observed between G0 and G1, G1 and G2, and G2 and G3 subgroups in trueness and precision. However, the G0 had significantly better trueness and precision values compared to G2 and G3 subgroups. In addition, the G1 had significantly better trueness values than the G3 subgroup. However, the Levene test revealed no difference in the precision mean values among the subgroups tested.
Conclusions: Implant scanning trueness was affected by the dental arch and the number of rescanned mesh holes using the IOS tested. A higher number of rescanned mesh holes decreased the scanning trueness. The stitching algorithm of the IOS software tested after the mesh hole scan demonstrated a significant error, especially when multiples mesh holes are involved in the same arch.
Clinical significance: Given that cutting-off and rescanning techniques can reduce trueness, clinicians should consider whether these techniques are necessary in complete digital workflows. This is particularly important when fabricating multiple single implant-supported restorations in the same arch.Sin financiación4.4 Q1 JCR 20221.189 Q1 SJR 2022No data IDR 2022UE
Desarrollo de aspectos técnicos de la psicoterapia psicoanalítica desde el enfoque modular-transformacional
No full textTesis inédita presentada en la Universidad Europea de Madrid. Escuela de Doctorado e Investigación. Programa de Doctorado en Biomedicina y Ciencias de la SaludNo data 2022UE
Electromyographic Activity of the Pelvic Floor Muscles and Internal Oblique Muscles in Women during Running with Traditional and Minimalist Shoes: A Cross-Over Clinical Trial
No full textThe study aimed to investigate the effects of footwear on the electromyographic (EMG)
activity of pelvic floor muscles (PFMs) and internal oblique (IO) muscles during running at different
speeds. The study also aimed to explore the correlation between EMG activity of PFMs and IO muscles
and participants’ morphological characteristics. Ten nulliparous female runners were included in
the study. The participants ran for 90 s at speeds of 9, 11, and 13 km/h wearing both traditional and
minimalist shoes. EMG outcomes were presented as a percentage of maximum voluntary contraction
(%MVC). Comparative analysis was conducted using the Wilcoxon rank test. Correlational analysis
was performed using the Rho–Spearman correlation coefficient. The %MVC for the IO muscles
was significantly lower when using minimalist shoes compared to traditional shoes (p = 0.04). No
statistically significant differences were found for the PFMs (p > 0.05). The study also observed large
correlations between age and %MVC of the PFMs and IO muscles (rho = −0.64; p = 0.04). Minimalist
shoes decreased the activity of IO muscles in female runners. However, no significant differences
in EMG activity of PFMs were found when comparing traditional and minimalist footwear. The
long-term effects of minimalist footwear on EMG activity of PFMs and IO muscles, as well as their
relationship to morphological characteristics, require further investigation.Sin financiación3.9 Q2 JCR 20220.786 Q1 SJR 2023No data IDR 2022UE
Techniques to improve the accuracy of complete arch implant intraoral digital scans: A systematic review
No full textStatement of problem: The best method of optimizing the accuracy of complete arch intraoral digital scans is still unclear. For instance, the location of the scan bodies can be significantly distorted with respect to their actual positions, which would lead to a nonpassive fit of the definitive prosthesis.
Purpose: The purpose of this systematic review was to analyze available techniques for improving the accuracy of digital scans in implant-supported complete arch fixed prostheses.
Material and methods: Three databases (Medline, Embase, and Google Scholar) were searched, and the results obtained were supplemented by a hand search. Specific descriptors identified techniques whose objective were to increase the accuracy of digital scans in implant-supported complete arch fixed prostheses. Titles and abstracts were screened by 2 independent reviewers, and unclear results were discussed with a third independent reviewer. A qualitative analysis based on procedural parameters was used. The interexaminer agreements of both were assessed by the Cohen kappa statistic, and the Risk of Bias Tool was used to assess the risk of bias across the studies.
Results: A total of 17 techniques matching the inclusion criteria were evaluated. Higher accuracy but also differences regarding the need for supplementary devices, number of intraoral scans, and time consumption of clinical and software program steps were observed compared with the conventional digital scanning protocol. The use of a splinting device was common to most of the studies. The outcome variables for the evaluation of the effectiveness of these protocols were heterogeneous.
Conclusions: The use of additional techniques during intraoral scanning can improve accuracy in implant-supported complete arch fixed prostheses. However, higher complexity for those procedures should be expected.Sin financiación4.6 Q1 JCR 20221.154 Q1 SJR 2022No data IDR 2022UE
Motivación, identidad y dependencia en los deportistas que practican pruebas de alta exigencia
No full textTesis inédita presentada en la Universidad Europea de Madrid. Escuela de Doctorado e Investigación. Programa de Doctorado en Actividad Física y DeporteLa práctica deportiva hoy en día es un motor utilizado por muchos como vía de escape de la realidad vital que persigue al ciudadano en su día a día. Es un fenómeno social de masas que se lleva a cabo para mejorar la salud del practicante haciendo frente a situaciones de estrés que tanto predominan en nuestra sociedad actual. Los individuos, a través de la práctica deportiva y la actividad física, han ampliado sus recursos y fortalezas optimizando su resiliencia y su adaptación al medio.
La investigación pretende determinar el grado de motivación, dependencia e identidad de los deportistas de pruebas de alta exigencia en los ámbitos de la salud física, los logros deportivos y los aspectos psicosociales. Además, busca conocer el grado de identidad de los deportistas con la prueba deportiva, establecer relaciones entre la motivación para participar en la prueba y aspectos sociodemográficos como la edad y el género, aportar información a los organizadores de eventos deportivos y reconocer posibles diferencias estadísticas entre grupos (nivel de estudios, estado laboral, edad y género) que animan a los deportistas a realizar este tipo de pruebas.
A través de una encuesta basada en tres escalas validadas, se recogen datos de motivación, identidad y dependencia al ejercicio de 387 deportistas no profesionales cuyo rango de edad estuvo entre 18 y 74 años. Los resultados reflejan que el factor que más peso tiene sobre la motivación es el significado de la vida y autoestima, en la identidad deportiva es la afectividad negativa y en la dependencia al ejercicio es el tiempo. El estudio descubre las variables que predicen significativamente correr y competir como son el significado de la vida y autoestima que fueron predichas por puntuar alto en las subescalas de superación de metas personales y competición, afiliación, metas psicológicas, abstinencia y tiempo, y por puntuar bajo en la subescala de efectos deseados. En cuanto al género, los hombres destacan con puntuaciones significativamente mayores en las subescalas de peso, reconocimiento e identidad social, mientras que las mujeres lo hacen en significado de la vida y autoestima. 8
Referido al nivel académico, los estudiantes presentan unos altos niveles en la mayoría de las subescalas motivacionales, sobre todo en las relacionadas con la motivación intrínseca mientras que por el contrario los empleados manifiestan los más bajos. En cuanto a los valores de dependencia, los estudiantes presentan valores muy por encima de empleados y desempleados en cuanto a tiempo empleado, continuo incremento de la actividad, falta de control para reducir la práctica de ejercicio, etc., lo que parece ser normal dado el contexto madurativo de los mismos.
Para finalizar, desde el punto de vista laboral, se corrobora que la práctica de ejercicio para evitar la ansiedad va implícita en los empleados, la práctica de ejercicio físico pese a estar lesionado va ligado a los desempleados y la participación en este tipo de pruebas con el fin de mejorar la salud y el peso está vinculada a empleados y desempleados.
Con todo ello, el deporte de alta exigencia puede quedar encuadrado en dos posiciones diferentes, pero convergentes: una como fin último en el que el deportista lo posiciona en su vida como guía principal de su existencia, u otra como medio para conseguir una proyección en otros aspectos de la vida del deportista.Sports practice today is a driving force used by many as an escape from the vital reality that haunts citizens in their daily lives. It is a mass social phenomenon that is carried out to improve the health of the practitioner by coping with stressful situations that predominate so much in our current society. Through sports and physical activity, individuals have expanded their resources and strengths, optimizing their resilience and adaptation to the environment.
The research aims to determine the degree of motivation, dependence and identity of athletes in high-demand events in the areas of physical health, sporting achievements and psychosocial aspects. In addition, it seeks to know the degree of identity of the athletes with the sports event, establish causal relationships between the motivation to participate in the test and sociodemographic aspects such as age and sex, provide information to the organizers of sporting events and recognize possible statistical differences between groups (educational level, employment status, age and sex) that encourage athletes to participate in this type of events.
Through a survey based on three validated scales, data on motivation, identity and dependence on exercise were collected from 387 unprofessional athletes whose age range was between 18 and 74 years old. The results show that themost influential factor in motivation is the meaning of life and self-esteem, in sports identity it is negative affectivity and in dependence on exercise it is time. In addition, the study discovers the variables that significantly predict running and competition, such as the meaning of life and self-esteem, which were predicted by scoring high on the subscales of exceeding personal goals and competition, affiliation, psychological goals, abstinence and time, and by scoring low on the desired effects subscale. In turn, it should be noted that men stand out significantly in the subscales of weight, recognition and social identity while women do so in meaning of life and self-esteem. 10
Referring to the academic level, students present high levels in most of the motivational subscales, especially those related to intrinsic motivation, while on the contrary, employees show the lowest levels. Regarding the dependency values, the students present values well above those of employed and unemployed in terms of time spent, continuous increase in activity, lack of control to reduce exercise practice, etc., which seems to be normal given their maturational context.
Finally, from a work point of view, it is confirmed that the practice of exercise to avoid anxiety is implicit in employees, the practice of physical exercise despite being injured is linked to the unemployed and participation in this type of tests with The goal of improving health and weight is linked to employed and unemployed.
With all this, high-demand events can be framed in two different but convergent positions: one as an ultimate goal in which the athlete positions it in his life as the main guide of his existence, or another as a means to achieve a projection in other aspects of life. life of the athlete.No data 2022UE
Análisis de la deformación miocárdica mediante Feature Tracking-Resonancia Magnética Cardiaca en la Miocardiopatía No Isquémica
No full textTesis inédita presentada en la Universidad Europea de Madrid. Escuela de Doctorado e Investigación. Programa de Doctorado en Biomedicina y Ciencias de la SaludAntecedentes y objetivos: El análisis de la deformación miocárdica (strain) es factible realizarlo a través de técnicas de imagen cardíaca, primordialmente mediante ecocardiografía (speckle-tracking/Doppler tisular) o cardiorresonancia magnética (CRM). El Feature-Tracking (FT) CRM, sin limitación de ventana acústica, con un postprocesado rápido y sencillo sobre secuencias clásicas cine CRM, se posiciona como una atractiva técnica para su determinación. El strain ha demostrado la capacidad de detectar disfunción contráctil ventricular de forma precoz en un gran número de enfermedades cardiovasculares. Diferentes autores han estudiado el valor del strain CRM en el escenario de miocardiopatía no isquémica (MNI) con resultados contradictorios. Nuestro objetivo fue valorar la deformación miocárdica de ventrículo izquierdo (VI) y ventrículo derecho (VD) mediante strain-CRM en pacientes con MNI: Miocardiopatía dilatada no isquémica (MDNI) y miocardiopatía inflamatoria. Evaluar el comportamiento del strain circunferencial miocárdico en CRM en este tipo de pacientes. Métodos: Se estudió retrospectivamente el análisis de deformación miocárdica mediante FT-CRM de VI y VD en 98 pacientes con MDNI, se valoró el FT y Deep learning strain (DLS) en CRM diagnóstica y de control de VI en 17 pacientes con miocarditis aguda. Finalmente, de forma prospectiva, se analizó el FT-CRM de 57 pacientes tras infección por COVID-19. Las características basales y el tratamiento hospitalario de los pacientes fueron obtenidos de la historia clínica electrónica. Los estudios de CRM se llevaron a cabo en equipos de 1.5T utilizando softwares de análisis cardíaco avanzado para la determinación del FT global circunferencial, radial y longitudinal, así como el FT de pared libre de VD y CAF VD en MDNI. Por otro lado, se determinó el FT global circunferencial y radial de VI tras infección por COVID-19, así como el FT y DLS global circunferencial de VI en pacientes tras ingreso por miocarditis aguda. Las variables cualitativas se presentaron como número absoluto y porcentaje, mientras que las variables cuantitativas se expresaron como media ± desviación estándar o mediana [rango intercuartílico]. Se determinó la variabilidad intra- e interobservador del FT en los diversos escenarios. Las variables continuas se compararon mediante la prueba de la t de Student o la de la U de Mann-Whitney, según su comportamiento. Las variables cualitativas se compararon mediante test ¿2. En el caso del análisis de FT en MDNI, se crearon modelos de regresión logística para valorar su efecto sobre el evento combinado insuficiencia cardíaca (IC)/mortalidad/desfibrilador automático implantable (DAI) como prevención secundaria. El análisis de los datos se realizó con el SPSS y software estadístico R, estableciéndose un nivel de significación del 5%. Resultados: 98 pacientes con diagnóstico de MDNI, 71.4% varones, con etiología fundamentalmente de origen idiopático. Presentaban severa dilatación de VI [volumen telediástolico indexado (VTDVIi) de 133,6 ± 33,4 ml/m2] y disfunción sistólica severa [Fracción de eyección ventricular izquierda (FEVI) 29,5 ± 9,6%]. Se detectó realce tardío de gadolinio (RTG) en el 38,8%, siendo el patrón de realce intramiocárdico septal el más frecuente (16,3%). El strain de VI CRM estaba alterado de forma significativa en nuestra muestra; con un strain circunferencial global de -7,7 ± 3,5%. Se evidenció escasa variabilidad intra- e interobservador con el strain circunferencial y longitudinal en MDNI, con elevada concordancia entre FEVI-CRM y FT. Los volúmenes ventriculares y la FEVI presentaron una correlación significativa con el FT circunferencial, sin relación con el grado de RTG. El strain circunferencial se asoció con la presencia de FEVI >50% en ecocardiografía de seguimiento y con el evento combinado, con un punto de corte de -8,2%. Al mismo tiempo, valoramos el strain de VD en los 98 enfermos con MDNI, con un volumen telediastólico indexado de VD de 68,1 ± 12,2 ml/m2 y función sistólica conservada (FEVD 52,5 ± 14,6%). Estos pacientes presentaron un strain de pared libre de VD de -23,8 ± 9,9% y un cambio de área fraccional (CAF) de 39,7 ± 16,6%. Se evidenció una buena correlación entre la FEVD y el FT/CAF CRM. En los pacientes con FEVI ¿ 30%, los ingresos por IC estuvieron asociados a valores más bajos de strain VD y CAF, independientemente de la FEVD, con puntos de corte de -19.5% y 36.5%, respectivamente. En estos pacientes, la disminución de ambos valores predijo el evento combinado IC/mortalidad/DAI como prevención secundaria. En lo que respecta a la miocardiopatía inflamatoria, de 17 pacientes hospitalizados por miocarditis, 88.2% varones, todos con clínica manifiesta y elevación de biomarcadores cardíacos. Presentaban función sistólica conservada y un 94,1% de pacientes con RTG y edema miocárdico en CRM. Presenciamos valores disminuidos de FT y DLS circunferencial global de VI comparado con grupo sano referencia. Se objetivó un aumento del FT y DLS entre CRM diagnóstica y de control, sin relación con la evolución del grado de RTG. Por otra parte, objetivamos buena correlación entre la FEVI y FT/DLS circunferencial de VI, con excelente variabilidad intra- e interobservador. Finalmente, en 57 pacientes tras hospitalización por infección COVID-19, de los cuales un 80.7% eran varones, con un tiempo entre primer contacto y realización de CRM de 81 ± 27 días. Presentaban función sistólica conservada, FEVI (61 ± 10%) y un VTDVIi normal 76 ± 17 ml/m2. Se objetivó RTG en 19,3% de los pacientes y un aumento de T2 mapa respecto a grupo control. Objetivamos excelente variabilidad intra- e interobservador del FT circunferencial y radial de VI en este escenario clínico. En pacientes con primer contacto ¿ realización de CRM menor de 8 semanas, se objetivaron valores disminuidos de FT global circunferencial y radial de VI respecto a aquellos con CRM tras las primeras 8 semanas de la infección. Conclusión: En pacientes con MDNI, el análisis de FT de VI y VD mediante CRM fue factible y altamente reproducible, siendo el strain global circunferencial de VI y el strain de pared libre de VD, parámetros predictores de eventos cardiovasculares en el seguimiento. En pacientes con miocardiopatía inflamatoria por miocarditis aguda, se objetivaron menores valores de FT y DLS circunferencial global de VI respecto a grupo control, presenciando mejoría entre CRM diagnóstica y CRM de seguimiento, sin relación con el grado de RTG. Finalmente, en miocardiopatía inflamatoria tras infección por COVID-19, evidenciamos valores reducidos de FT circunferencial y radial de VI en pacientes con CRM realizada durante las primeras 8 semanas de la enfermedad. El strain circunferencial, representó el parámetro de deformación con mayor reproducibilidad y aplicabilidad clínica en CRM en estos escenarios clínicos.Background and objectives: The analysis of myocardial deformation (strain) can be performed by cardiac imaging techniques, mainly by echocardiography (speckle-tracking/tissue Doppler) or cardiac magnetic resonance (CMR). Feature-Tracking (FT). CMR, without acoustic window limitation, with fast and easy post-processing on classical cine CMR sequences, is positioned as an attractive technique for its determination. Strain has demonstrated the ability to detect early ventricular contractile dysfunction in a large number of cardiovascular diseases. Different authors have studied the value of CMR strain in the setting of non-ischaemic cardiomyopathy (NICM) with contradictory results. Our aim was to assess left ventricular (LV) and right ventricular (RV) myocardial deformation by CMR strain in patients with NICM: non-ischaemic dilated cardiomyopathy (NIDCM) and inflammatory cardiomyopathy. Assessing the behavior of myocardial circumferential strain on CMR in these patients.
Methods: We retrospectively studied myocardial deformation analysis by FT CMR of LV and RV in 98 patients with NIDCM, and assessed FT and deep learning strain (DLS) in diagnostic and control CMR of LV in 17 patients with acute myocarditis. Finally, prospectively, FT CMR was analyzed in 57 patients after COVID-19 infection. Baseline characteristics and in-hospital treatment of the patients were obtained from the electronic medical records. The CMR studies were performed on 1.5T equipment using advanced cardiac analysis software for the determination of global circumferential, radial and longitudinal FT, as well as RV free wall FT and RV CAF in NIDCM. On the other hand, global circumferential and radial LV FT after COVID-19 infection was determined, as well as global circumferential LV FT and DLS in patients after admission for acute myocarditis. Qualitative variables were presented as absolute number and percentage, while quantitative variables were expressed as mean ± standard deviation or median (interquartile range). Intra- and inter-observer variability of FT in the various settings was determined. Continuous variables were compared by Student's t-test or Mann-Whitney U-test, according to their behavior. Qualitative variables were compared using the test. For the analysis of FT in NIDCM, logistic regression models were created to assess its effect on the combined event heart failure (HF)/mortality/implantable cardioverterdefibrillator (ICD) as secondary prevention. Data analysis was performed using SPSS and R statistical software, with a significance level of 5%.
Results: 98 patients with a diagnosis of NIDCM, 71.4% of whom were male, with an etiology mainly idiopathic in origin. They had severe LV dilatation [LV enddiastolic volume index (LVEDVi) 133.6 ± 33.4 ml/m2] and severe systolic dysfunction [left ventricular ejection fraction (LVEF) 29.5 ± 9.6%]. Late gadolinium enhancement (LGE) was detected in 38.8%, with intramyocardial septal enhancement pattern being the most frequent (16.3%). LV CMR strain was significantly altered in our sample; with an overall circumferential strain of -7.7 ± 3.5%. There was little intra- and inter-observer variability with circumferential and longitudinal strain in NIDCM, with high agreement between CMR LVEF and FT. Ventricular volumes and LVEF were significantly correlated with circumferential FT, unrelated to the degree of LGE. Circumferential strain was associated with the presence of LVEF >50% on follow-up echocardiography and with the combined event, with a cut-off point of -8.2%. At the same time, we assessed RV strain in the 98 patients with NIDCM, with an indexed RV enddiastolic volume of 68.1 ± 12.2 ml/m2 and preserved systolic function (RVEF 52.5 ± 14.6%). These patients had an RV free wall strain of -23.8 ± 9.9% and a fractional area change (FAC) of 39.7 ± 16.6%. There was a good correlation between RVEF and FT/CAF CMR. In patients with LVEF 30%, HF admissions were associated with lower RV strain and CAF values, independent of RVEF, with cut-off points of -19.5% and 36.5%, respectively. In these patients, decreases in both values predicted the combined HF/mortality/ADl event as secondary prevention.Regarding inflammatory cardiomyopathy, of 17 patients hospitalized for myocarditis, 88.2% were male, all with overt clinical manifestations and elevated cardiac biomarkers. They had preserved systolic function and 94.1% of patients had LGE and myocardial oedema on CMR. We observed decreased FT and LV global circumferential DLS compared to the healthy reference group. We observed an increase in FT and DLS between diagnostic and control CMR, unrelated to the evolution of the degree of LGE. On the other hand, we observed a good correlation between LVEF and LV circumferential FT/DLS, with excellent intra- and inter-observer variability. Finally, 57 patients after hospitalization for COVID-19 infection (80.7% were male) with a time between first contact and CRM of 81 ± 27 days had preserved systolic function, LVEF (61 ± 10%) and a normal LVEDVi of 76 ± 17 ml/m2. LGE was observed in 19.3% of patients and an increase in T2 map compared to the control group. We observed excellent intraand inter-observer variability of circumferential and radial LV FT in this clinical setting. In patients with first contact to completion of CMR of less than 8 weeks, decreased global circumferential and radial LV FT values were observed compared to those with CMR after the first 8 weeks of infection. Conclusion: In patients with NIDCM, analysis of LV and RV FT by CMR was feasible and highly reproducible, with LV circumferential global strain being a predictor of cardiovascular events at follow-up. In patients with inflammatory cardiomyopathy due to acute myocarditis, lower values of FT and LV global circumferential DLS were observed with respect to the control group, with improvement between diagnostic CMR and control CMR, unrelated to the degree of LGE. Finally, in inflammatory cardiomyopathy after COVID-19 infection, we found reduced values of circumferential and radial LV FT in patients with CMR performed during the first 8 weeks of the disease. Circumferential strain represented the deformation parameter with the highest reproducibility and clinical applicability in CMR in these pathologies.No data 2022UE