135 research outputs found
Influence of atrial fibrillation on efficacy and safety of omecamtiv mecarbil in heart failure: the GALACTIC-HF trial
No full textAims:
In GALACTIC-HF, the cardiac myosin activator omecamtiv mecarbil compared with placebo reduced the risk of heart failure events or cardiovascular death in patients with heart failure with reduced ejection fraction. We explored the influence of atrial fibrillation or flutter (AFF) on the effectiveness of omecamtiv mecarbil.
Methods and results:
GALACTIC-HF enrolled patients with New York Heart Association (NYHA) Class II–IV heart failure, left ventricular ejection fraction ≤35%, and elevated natriuretic peptides. We assessed whether the presence or absence of AFF, a pre-specified subgroup, modified the treatment effect for the primary and secondary outcomes, and additionally explored effect modification in patients who were or were not receiving digoxin. Patients with AFF (n = 2245, 27%) were older, more likely to be randomized as an inpatient, less likely to have a history of ischaemic aetiology or myocardial infarction, had a worse NYHA class, worse quality of life, lower estimated glomerular filtration rate, and higher N-terminal pro-B-type natriuretic peptide. The treatment effect of omecamtiv mecarbil was modified by baseline AFF (interaction P = 0.012), with patients without AFF at baseline deriving greater benefit. The worsening of the treatment effect by baseline AFF was significantly more pronounced in digoxin users than in non-users (interaction P = 0.007); there was minimal evidence of effect modification in those patients not using digoxin (P = 0.47) or in digoxin users not in AFF.
Conclusion:
Patients in AFF at baseline were less likely to benefit from omecamtiv mecarbil than patients without AFF, although the attenuation of the treatment effect was disproportionally concentrated in patients with AFF who were also receiving digoxin.
Clinical Trial Registration: NCT02929329
Atrial cardiomyopathy in postmenopausal female healthcare professionals – a single-center study
No full textВъведение: Добре проучено е разпространението на затлъстяването и хипертонията сред здравните работници. И двете заболявания са известни като рискови фактори за предсърдна кардиомиопатия (ПКМП) – нова клинична единица с потенциал да предизвиква сърдечна недостатъчност, предсърдно мъждене и тромбоемболични усложнения. В тази връзка е необходимо планирането на превантивни стратегии и интервенции при тази специфична популация. Цел: Да се дефинира ПКМП при здравни работници от женски пол в менопауза. Материал и методи: Сто и пет жени на средна възраст, здравни работници, разделени в три групи: с централно затлъстяване (n = 50, 47%), със затлъстяване и хипертония (n = 24, 23%) и здрави контроли (n = 31, 30%), преминаха през ехокардиографско изследване с волуметричен и speckle tracking анализ. Резултати: Установиха се значителни разлики в обемите на лявото предсърдие (ЛП) между трите групи. Фазовата функция на ЛП беше значително намалена, а stiffness индексът значително увеличен при групите със затлъстяване. По-високият индекс на телесната маса беше свързан с увеличен индексиран максимален обем на ЛП (p < 0.001, r = 0.56) и редуциран пиков лонгитудинален стрейн на ЛП (p < 0.001, r = -0.59) и пиков контрактилен стрейн на ЛП (p < 0.001, r = -0.56). Заключение: Здравните работници от женски пол в менопауза със затлъстяване и хипертония са в риск от асимптомна ПМКП. Необходими са допълнителни изследвания за потвърждаване на тази концепция. Background: The prevalence of obesity and hypertension among healthcare professionals has been previously described. Both diseases are known risk factors for atrial cardiomyopathy (ACM), a new clinical entity with potential to be a determinant of heart failure, atrial fi brillation and thromboembolic complications. In this perspective, early preventive strategy should be initiated in this special population. Aim: To defi ne ACM in middle-aged women healthcare professionals. Material and methods: Hundred and fi ve middle-aged women healthcare professionals, separated in 3 groups: with central obesity (n = 50,47%), obesity and hypertension (n = 24,23%), healthy control (n = 31,30%), underwent echocardiographic examination with volumetric and speckle-tracking analysis. Results: There were signifi cant differences in LA volumes between 3 groups. LA phasic function was signifi cantly reduced, and LA stiffness index was signifi cantly increased in obese groups compared to control. Higher body mass index was associated with increased LA volume index (p < 0.001, r = 0.56) and with reduced Peak atrial longitudinal strain (p < 0.001, r = -0.59) and Peak atrial contractile strain (p < 0.001, r= -0.56). Conclusion: Postmenopausal women, healthcare professionals with obesity and hypertension are at risk for asymptomatic ACM. Further investigations are needed to confi rm this concept
Safety management within Task Force Uruzgan: A report of working with Unmanned Aerial Vehicles
No full textIn this paper we present a conceptualization of safety management that is based on the cybernetic concepts of “controllability” and “control capacity”. In particular, we explore what this conceptualization means for safety management of the Dutch Army’s UAV unit that was part of Task Force Uruzgan (TFU) in the years 2006–2007 and 2008–2009. In this research we applied a qualitative research strategy. We conducted 20 interviews, 13 with employees of the UAV unit and 7 with key TFU-partners with whom the unit had to cooperate. We analyzed the interviews by means of the concepts developed in the theoretical framework. By going back and forth between theory and practice, we show that it was rather problematic for the unit to develop controllability and operate safely. We conclude with a reflection on a safety management strategy for this particular unit and the relevance of our conceptualization for other organizations.Values and TechnologyTechnology, Policy and Managemen
Perceived object motion variance across optical contexts
No full textVisual motion computation is challenging under real-world conditions due to continuous contextual changes such as varying lighting conditions and a large range of optical material properties. Due to these changes the retinal optical flow can drastically vary while the physical motion of an object remains constant. Especially materials with high reflective and refractive interactions can cause complex motion patterns. Here we investigate object motion constancy across various optical contexts and if the human visual system compensates for other causal sources in motion.We performed two experiments. In the first experiment observers had to estimate which of two stimuli was rotating faster around the vertical axis. The stimuli were displayed for 500 ms in a 2-IFC staircase design. For the Match stimulus the illumination, material properties and shape were constant. The stimulus was rendered at a high temporal resolution allowing for small rotational speed changes for the staircase design. The Test stimuli varied in ten optical properties (e.g., matte, glossy, anisotropic, translucent), three illumination maps (sunny, cloudy, indoor), and three shapes (knot, cubic, blobby), the rotational speed remained constant. There were three different conditions in the second experiment: 1. unmasked Match and Test stimulus (same as experiment one); 2. masked Test stimulus (circular gaussian mask, masking outer shape contours); 3. masked Test stimulus and masked Match stimulus where the Match stimulus was replaced by horizontally moving 2D pink noise. In this experiment a subset of the optical conditions was used.Expanding on our previously presented work [1], we applied three image-based motion capturing models (Figure 1) to gain deeper insights on motion cues that are predictive of human judgements. The models are Lucas-Kanade (optical flow), RAFT (optical flow DNN), FFV1MT (motion energy). First, we found that there are clear illusory differences of perceived rotational speed with even bigger effects when the circular mask was applied. The transparent material with the refractive index of water is systematically perceived to be rotating faster than other materials across all conditions. We performed an RSA (representational similarity analysis) to compare a range of different metrics across conditions and flow models. We find that the gradient of the optical flow is a particularly good predictor of human performance. The gradient emphasizes local speed changes in the optical flow, for example with moving highlights. Another observation is that Lucas-Kanade is most predictive of human performance under most conditions while RAFT is most stable across materials and closest to the ground truth. Our results further suggest that the human visual system does partially compensate for motion flow effects across optical contexts in object motion.[1] Van Assen, J. J. R., Kawabe, T., & Nishida, S. Y. (2020). Object motion and flow variance across optical contexts. Journal of Vision, 20(11), 458-458.This work has been supported by a Marie-Skłodowska-Curie Actions Individual Fellowship (H2020-MSCA-IF-2019-FLOW) and by JSPS Kakenhi JP20H05957.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Human Information Communication Desig
Advantages of left atrial mechanic assessment as an additional indicator of diastolic dysfunction in patients with arterial hypertension
No full textУвод: Артериалната хипертония е най-често срещаният фактор за структурни и функционални промени в сърдечните кухини, но тези изменения се наблюдават в по-напреднали стадии и при пациенти с лош контрол на артериалната хипертония. Ехокардиографията има ключова роля за установяване на тези промени, но за откриване на ранни промени е необходима по-детайлна оценка. Все още се доказва ролята на ЛП механика, като допълнителен показател за диастолна дисфункция, особено за пациенти, при които стандартните ехокардиографски показатели са с гранични стойности и неубедителни. Цел: Целта на нашето проучване е да се изследват левопредсърдната механика и структурните и функционални показатели на ЛК при пациенти с контролирана артериална хипертония с давност от 5 години. Материал и методи: Проведе се едноцентрово проучване с 45 пациенти с лека към умерена хипертония (с давност до 5 години) и 15 здрави контроли. Всички параметри за 24-часово проследяване на съдовата ригидност: централно систолно налягане (cSys24h), централно пулсово налягане (cPP24h) и скорост на пулсовата вълна (PWV24h), са измерени неинвазивно с апарат Mobil-O-graph PWA. Пациентите преминаха през стандартна двуразмерна ехокардиография със spеckle tracking анализ ЛК (LV-GLS) и ЛП резервоарен лонгитудинален стрейн (LA-RLS). Резултати: Пациентите с хипертония имат концентрична ЛК хипертрофия (КЛХ), измерена чрез RWT (p < 0,001), редуциран LV-GLS (-15,83 ± 3,17 спрямо -17,57 ± 2,83, p < 0,001). Забелязва се тенденция към по- високи налягания на пълнене Е/e’m ratio (9,84 ± 2,85 vs. 7,62 ± 1,58, p < 0,006), по-голям ЛП обем (LAVI: 31,86 ± 9,78 vs. 24,96 ± 4,89 ml/m2, p < 0,011) и редуциран LA-GLS (29,14 ± 3,90 спрямо 41,33 ± 4,37%, p < 0,0001) в сравнение с контролната група. Силно позитивна връзка се установи между скоростта на пулсовата вълна за 24 часа (PWV24h) и ЛК концентрична хипертрофия, измерена чрез RWT (r = 0,545, p<0,0001). Установи се умерено позитивна връзка между cSys24h и ЛК концентрична хипертрофия (r = 0,333, p = 0,009) и слабо негативна връзка с LA-RLS (r = -0,221, p = 0, 09). E/e’m корелира позитивно с LAVI (r = 0,309, p = 0,016) и негативно с LA-RLS (r = -0,324, p=0,012). От проведения множествен регресионен линеен анализ се установи, че най-силни независими предиктори на LA-GLS са PWV24h (R=0,459, B= -4,59, p < 0,0001) и Е/e’m: (R=0,535, B = -291, p = 0,017). Независим предиктор за ЛК хипертрофия, определена чрез RWT, са PWV24h (R = 0,488, B = 238, p < 0,0001) и Е/e’m (R = 0,561, B = 263, p = 0,022). Заключение: Показателите на ЛП механика имат допълнителна диагностична стойност при оценката на диастолната функция там, където стандартните показатели за диастолна функция не са достатъчно убедителни. При пациенти с контролирана АХ се наблюдават ранни промени в оста атрио-вентрикуло-съдово куплиране. Background: Arterial hypertension is the most common factor for structural and functional changes in the heart, but these changes are observed in more advanced stages and in patients with poor control of arterial hypertension. Echocardiography plays a key role in detecting these changes, but a more detailed assessment is needed to identify early changes. The role of left atrium mechanics as an additional indicator of diastolic dysfunction is still being proven, especially for patients in whom standard echocardiographic indicators are borderline and inconclusive. Aim: The aim of our study is to investigate the left atrial mechanics and the structural and functional parameters of the LC in patients with controlled arterial hypertension with a period of 5 years. Material and methods: We studied 45 consecutive middle-aged patients with mild to moderate hypertension and duration up to 5 years and 15 healthy controls. All parameters for arterial stiffness – 24-hour central systolic pressure (cSys24h), central pulse pressure (cPP24h) and 24-hour pulse wave velocity (PWV24h) were measured non – invasively with oscillometric method by Mobil-O-graph PWA. All patients underwent standard two-dimensional echocardiography with spackle tracking analysis for left ventricle (LV) and left atrium (LA) global longitudinal strain (GLS). Results: The patients with hypertension have concentric LV hypertrophy, measured by RWT (p < 0,001), reduced LV GLS (-15,83 ± 3,17 vs. -17,57 ± 2,83, p < 0,001). There is a tendency towards higher fi lling pressures E/e’m ratio (9,84 ± 2,85 vs. 7,62 ± 1,58, p = 0,006), dilated LA (LAVI: 31,86 ± 9,78 vs. 24,96 ± 4,89 ml/m2, p < 0,011) and reduced LA - GLS (29,14 ± 3,90 vs. 41,33 ± 4,37%, p < 0,0001) in comparison to control group. Strongly positive correlation is registered between PWV24h and LV concentric hypertrophy indicated as RWT (r = 0,545, p < 0,0001) There is positive correlation between cSys24h and LV concentric hypertrophy (r = 0,333, p = 0,009) and negative correlation with LA-GLS (r = -0,221, p = 0,09). E/e’ correlated positively with LAVI (r = 0,309, p = 0,016) and negatively with LA-GLS (r = 0,324, p=0,012). Multiple linear regression with multivariate models were used to estimate RWT and LA-GLS. We initially selected clinically relevant variables and known confounders for inclusion in the multivariable regression analysis, using stepwise logistic regression analysis we found that the most powerful predictors for LA-GLS are PWV24h (R = 0,459, B = -4,59, p < 0,0001) and Е/e’m: (R = 0,535, B = -291, p = 0,017). The most powerful predictor for LV hypertrophy, determine by RWT is PWV24h (R = 0,488, B = 238, p< 0,0001) and Е/e’ m (R = 0,561, B = 263, p = 0,022). Conclusion: Left atrial mechanics indicators have additional diagnostic value in assessing diastolic function, where standard indicators of diastolic function are not suffi ciently conclusive. In patients with controlled AH, early changes in the atrio-ventruculo-vascular coupling axis are observed
Quality of Life and Mental Health in Patients with Exacerbated Heart Failure: The Role of Obstructive and Central Sleep Apnea Phenotypes
No full textBackground: Managing acute decompensated heart failure (ADHF) is complex, particularly when combined with comorbidities like sleep apnea. Effective treatment requires personalized approaches, focusing on quality of life (QoL) and mental health outcomes. Purpose: This study explored the prevalence and characteristics of sleep apnea in patients with obesity and AHF exacerbations. It assessed how different sleep apnea phenotypes impact QoL and mental health, applying personalized medicine strategies. Methods: A prospective cohort study was conducted on 150 patients admitted for AHF exacerbation. Inclusion criteria included an Apnea–Hypopnea Index (AHI) > 5, an Epworth Sleepiness Scale (ESS) > 8, NT-proBNP > 900 pg/mL and informed consent obtained prior to participation. Optimized medical treatment was provided. QoL and mental health were evaluated using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Beck Depression Inventory (BDI). Results: Among 81 patients with sleep apnea, 73% (n = 59) had obstructive sleep apnea (OSA) and 27% (n = 19) had central sleep apnea (CSA). OSA patients reported a higher QoL (61.12 ± 17.88) compared to CSA patients (37.18 ± 19.98, p < 0.001). CSA patients exhibited more severe depression (BDI: 26.18 ± 5.5 vs. 16.64 ± 4.1, p < 0.001). Significant correlations were noted between KCCQ and BDI scores (r = −0.849, p < 0.001) and central apnea events (r = −0.485, p < 0.001). Conclusions: Sleep apnea is common in ADHF patients, with CSA being linked to poorer QoL and greater depression. Personalized medicine offers promising strategies to enhance care and outcomes
Design and methodology of POWER, an open-label observation of the effect of primary care interventions on total cardiovascular risk in patients with hypertension
No full textThe Effect of Omecamtiv Mecarbil in Hospitalized Patients as Compared With Outpatients With HFrEF: An Analysis of GALACTIC-HF
No full textBACKGROUND:
In the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial, omecamtiv mecarbil, compared with placebo, reduced the risk of worsening heart failure (HF) events or cardiovascular death in patients with HF and reduced ejection fraction (HFrEF). The primary aim of this prespecified analysis was to evaluate the safety and efficacy of omecamtiv mecarbil by randomization setting i.e., whether participants were enrolled as outpatients or inpatients.
METHODS AND RESULTS:
Patients were randomized either during a HF hospitalization or as an outpatient, within one year of a worsening HF event (hospitalization or emergency department [ED] visit). The primary outcome was a composite of worsening HF event (HF hospitalization or an urgent ED or clinic visit) or cardiovascular death. Of the 8232 patients analyzed, 2084 (25%) were hospitalized at randomization. Hospitalized patients had higher NT-proBNP concentrations, lower systolic blood pressure, reported more symptoms and were less frequently treated with a renin-angiotensin system blocker or a beta-blocker than outpatients. The rate (per 100 person-years [PY]) of the primary outcome was higher in hospitalized patients (placebo group=38.3/100 PY) than in outpatients (23.1/100 PY); adjusted hazard ratio (HR) 1.21 (95%CI 1.12, 1.31). The effect of omecamtiv mecarbil versus placebo on the primary outcome was similar in hospitalized patients (HR 0.89, 95%CI 0.78, 1.01) and outpatients (HR 0.94, 95%CI 0.86, 1.02) (interaction P=0.51).
CONCLUSION:
Hospitalized HFrEF patients had a higher rate of the primary outcome than outpatients. Omecamtiv mecarbil reduced the risk of the primary outcome both when initiated in hospitalized patients and in outpatients
Effect of Antihypertensive Therapy on SCORE-Estimated Total Cardiovascular Risk: Results from an Open-Label, Multinational Investigation—The POWER Survey
No full textBackground. High blood pressure is a substantial risk factor for cardiovascular disease. Design & Methods. The Physicians' Observational Work on patient Education according to their vascular Risk (POWER) survey was an open-label investigation of eprosartan-based therapy (EBT) for control of high blood pressure in primary care centers in 16 countries. A prespecified element of this research was appraisal of the impact of EBT on estimated 10-year risk of a fatal cardiovascular event as determined by the Systematic Coronary Risk Evaluation (SCORE) model. Results. SCORE estimates of CVD risk were obtained at baseline from 12,718 patients in 15 countries (6504 men) and from 9577 patients at 6 months. During EBT mean (±SD) systolic/diastolic blood pressures declined from 160.2 ± 13.7/94.1 ± 9.1 mmHg to 134.5 ± 11.2/81.4 ± 7.4 mmHg. This was accompanied by a 38% reduction in mean SCORE-estimated CVD risk and an improvement in SCORE risk classification of one category or more in 3506 patients (36.6%). Conclusion. Experience in POWER affirms that (a) effective pharmacological control of blood pressure is feasible in the primary care setting and is accompanied by a reduction in total CVD risk and (b) the SCORE instrument is effective in this setting for the monitoring of total CVD risk
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