Myocarditis

2018 ◽  
pp. 290-308
Author(s):  
Vanessa M Ferreira ◽  
Juliano L Fernandes ◽  
Cristina Basso ◽  
Matthias G Friedrich
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Myocardial Inflammation ◽  
Aged Patients ◽  
Non Invasive ◽  
Quantitative Mapping ◽  
Patients With Heart Failure ◽  
High Prevalence ◽  
Mapping Techniques

Myocarditis has a high prevalence, especially in young and middle-aged patients. It is the most important differential diagnosis in patients with acute cardiac disease and evidence for cellular injury (positive troponin). In clinical decision-making, it is important to rule in or rule out myocardial inflammation. While endomyocardial biopsy, which remains the gold standard to achieve an aetiopathogenetic diagnosis, can be helpful in patients with heart failure, it is less used in the majority of cases. Cardiovascular magnetic resonance (CMR) imaging has become the most efficient non-invasive diagnostic tool for patients with suspected myocarditis. Its unique value is based on the ability to identify inflammation and myocardial injury, in combination with an accurate assessment of ventricular volumes, as well as regional and global function. In many centres, myocarditis is the most frequent indication for CMR. The diagnostic criteria include markers for myocardial oedema, hyperaemia, and necrosis, while regional or global dysfunction and pericardial effusion serve as supportive criteria. Novel markers, such as quantitative mapping techniques, may allow for even better identification and classification of myocarditis.

scholarly journals Evaluation and treatment of premature ventricular contractions in heart failure with reduced ejection fraction

Heart ◽  
2020 ◽  
Vol 107 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Bart A Mulder ◽  
Michiel Rienstra ◽  
Yuri Blaauw
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Decision Making ◽  
Biventricular Pacing ◽  
Clinical Decision ◽  
Premature Ventricular Contractions ◽  
Reduced Ejection Fraction ◽  
Density Mapping ◽  
Non Invasive ◽  
Mapping Techniques

Premature ventricular complexes (PVCs) are often observed in patients presenting with heart failure with a reduced ejection fraction (HFrEF). PVCs may in some patients be considered to be the cause of heart failure, while in others it may be the consequence of heart failure. PVCs are important prognostic markers in HFrEF. The uncertainty whether PVCs are the cause or effect in HFrEF impacts clinical decision making. In this review, we discuss the complexity of the cause–effect relationship between PVCs and HFrEF. We demonstrate a workflow with the use of a trial period of amiodarone that may discover whether the reduced LVEF is reversible, the symptoms are due to PVCs and whether biventricular pacing can be increased by the reduction of PVCs. The use of non-invasive and invasive (high-density) mapping techniques may help to improve accuracy and efficacy in the treatment of PVC, which will be demonstrated. With these results in mind, we conclude this review highlighting the future directions for PVC research and treatment.

scholarly journals Driver somatic mutations identify distinct disease entities within myeloid neoplasms with myelodysplasia

Blood ◽  
2014 ◽  
Vol 124 (9) ◽  
pp. 1513-1521 ◽  
Author(s):  
Luca Malcovati ◽  
Elli Papaemmanuil ◽  
Ilaria Ambaglio ◽  
Chiara Elena ◽  
Anna Gallì ◽  
...  
Keyword(s):  
Somatic Mutations ◽  
Clinical Decision Making ◽  
Myeloproliferative Neoplasms ◽  
Clinical Decision ◽  
Driver Mutations ◽  
Myeloid Neoplasms ◽  
Key Points ◽  
Distinct Disease ◽  
Disease Entities

Key Points Different driver mutations have distinct effects on phenotype of myelodysplastic syndromes (MDS) and myelodysplastic/myeloproliferative neoplasms (MDS/MPN). Accounting for driver mutations may allow a classification of these disorders that is considerably relevant for clinical decision-making.

scholarly journals Wearable bioimpedance for continuous and context-aware clinical monitoring

2020 ◽  
Author(s):  
Walter Karlen ◽  
Abhilash Guru Dutt ◽  
Michaela Verling
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Accelerometer Data ◽  
Non Invasive ◽  
Standardized Protocol ◽  
Current Consumption ◽  
Wide Range ◽  
Measurement Operation ◽  
Total Body ◽  
Commercial Device

<div>Bioimpedance monitoring provides a non-invasive,</div><div>safe and affordable opportunity to monitor total body water for a wide range of clinical applications. However, the measurement is susceptible to variations in posture and movement. Existing devices do not account for the variations and are therefore unsuitable to perform continuous measurements to depict trend changes. We developed a wearable bioimpedance monitoring system with embedded real-time posture detection using a distributed accelerometer network. We tested the device on 14 healthy volunteers following a standardized protocol of posture change and compared the obtained measurements with an existing commercial device. The impedance measured with both systems had a high correlation (r>0.98) and a Bland-Altman analysis revealed a bias of -4.5 and limits of agreement of -30 and 21. Context-awareness was achieved with processing accelerometer data placed at the upper and lower leg with an accuracy >95%. The calculated current consumption is as low as 10 mA during continuous measurement operation, suggesting that without recharge the system can be used for multiple days. The proposed motion-aware design will enable the measurement of relevant bioimpedance parameters continuously over long periods and aid in informed clinical decision making.</div>

scholarly journals Circulating MicroRNAs as Non-invasive Biomarkers for Canine Cushing's Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Karin Sanders ◽  
Anouk Veldhuizen ◽  
Hans S. Kooistra ◽  
Adri Slob ◽  
Elpetra P. M. Timmermans-Sprang ◽  
...  
Keyword(s):  
Decision Making ◽  
Cushing’S Syndrome ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cushing's Syndrome ◽  
Differentially Expressed ◽  
Circulating Micrornas ◽  
Blood Samples ◽  
Non Invasive ◽  
Healthy Dogs

Canine Cushing's syndrome (hypercortisolism) can be caused by a pituitary tumor (pituitary-dependent hypercortisolism; PDH) or a cortisol-secreting adrenocortical tumor (csACT). For both cases, non-invasive biomarkers that could pre-operatively predict the risk of recurrence after surgery would greatly impact clinical decision making. The aim of this study was to determine whether circulating microRNAs (miRNAs) can be used as diagnostic (presence of PDH or csACT) and/or prognostic (disease recurrence, histological grade) non-invasive biomarkers for canine Cushing's syndrome. After a pilot study with 40 miRNAs in blood samples of healthy dogs (n = 3), dogs with PDH (n = 3) and dogs with a csACT (n = 4), we selected a total of 20 miRNAs for the definitive study. In the definitive study, these 20 miRNAs were analyzed in blood samples of healthy dogs (n = 6), dogs with PDH (n = 19, pre- and post-operative samples) and dogs with a csACT (n = 26, pre-operative samples). In dogs with PDH, six miRNAs (miR-122-5p, miR-126-5p, miR-141-3p, miR-222-3p, miR-375-3p and miR-483-3p) were differentially expressed compared to healthy dogs. Of one miRNA, miR-122-5p, the expression levels did not overlap between healthy dogs and dogs with PDH (p = 2.9x10−4), significantly decreased after hypophysectomy (p = 0.013), and were significantly higher (p = 0.017) in dogs with recurrence (n = 3) than in dogs without recurrence for at least one year after hypophysectomy (n = 7). In dogs with csACTs, two miRNAs (miR-483-3p and miR-223-3p) were differentially expressed compared to healthy dogs. Additionally, miR-141-3p was expressed significantly lower (p = 0.009) in dogs with csACTs that had a histopathological Utrecht score of ≥ 11 compared to those with a score of &lt;11. These results indicate that circulating miRNAs have the potential to be non-invasive biomarkers in dogs with Cushing's syndrome that may contribute to clinical decision making.

scholarly journals Intra and Inter-observer Concordance of a New Classification System for Myopic Maculopathy

2020 ◽  
Author(s):  
Rong-rong Zhang ◽  
Yan Yu ◽  
Yin-fen Hou ◽  
Chang-fan Wu
Keyword(s):  
Classification System ◽  
Clinical Decision Making ◽  
Interobserver Reliability ◽  
Type A ◽  
Clinical Decision ◽  
Intraobserver Agreement ◽  
Intraobserver Reproducibility ◽  
Fundus Photographs ◽  
Myopic Maculopathy

Abstract Background: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with PM. However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system was proposed, known as the ATN grading and classification system, which was based on the fundus photographs and OCT images, including three variable components: atrophy (A), traction (T), and neovascularization (N). Hence, this study aimed to perform an independent interobserver and intraobserver agreement evaluation of the recently developed ATN grading system for MM. Methods: This was a retrospective study. Fundus photographs and the optical coherence tomography (OCT) images of 125 patients (226 eyes) with various of MM were evaluated and classified using the ATN grading of the new MM classification system by four evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were repeatedly evaluated by the same evaluators after an interval of 6 weeks. The Kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement.Results: The interobserver reliability was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the sub-types was good or excellent, except for stages A1, A2, and N1 which weighted κ value was less than 0.6, with a moderate agreement. The intraobserver reproducibility of types or sub-types was excellent, with κ>0.8. No significant differences were observed between attending ophthalmologists and residents in the interobserver reliability and intraobserver reproducibility.Conclusions: The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented at clinical decision-making and disease progression assessment.

scholarly journals ecTMB: a robust method to estimate and classify tumor mutational burden

2019 ◽  
Author(s):  
Lijing Yao ◽  
Yao Fu ◽  
Marghoob Mohiyuddin ◽  
Hugo YK Lam
Keyword(s):  
Somatic Mutations ◽  
Clinical Decision Making ◽  
Patient Survival ◽  
Clinical Decision ◽  
Statistical Framework ◽  
Mutational Burden ◽  
Mutation Model ◽  
Tumor Mutational Burden ◽  
Multiple Challenges

AbstractTumor Mutational Burden (TMB) is a measure of the abundance of somatic mutations in a tumor, which has been shown to be an emerging biomarker for both anti-PD-(L)1 treatment and prognosis. Nevertheless, multiple challenges still hinder the adoption of TMB for clinical decision-making. The key challenges are the inconsistency of TMB measurement among assays and a lack of meaningful threshold for TMB classification. We describe a powerful and flexible statistical framework for estimation and classification of TMB (ecTMB). ecTMB uses an explicit background mutation model to predict TMB robustly and consistently. In addition to the two known TMB subtypes, TMB-high and TMB-low, we discovered a novel TMB subtype, named TMB-extreme, which was significantly associated with patient survival outcome. This discovery enabled ecTMB to classify samples to biologically and clinically relevant subtypes defined by TMB.

Investigation in respiratory disease

2018 ◽  
Author(s):  
Pranabashis Haldar
Keyword(s):  
Respiratory Disease ◽  
Disease Severity ◽  
Clinical Decision Making ◽  
Clinical Symptoms ◽  
Clinical Decision ◽  
Respiratory Medicine ◽  
Clinical Expression ◽  
Serial Measurement ◽  
Non Invasive ◽  
Limited Spectrum

Investigation in respiratory disease may be broadly classified as (1) tests that aid with diagnosis; (2) tests that assess disease severity—these are usually measures of respiratory function and inform prognosis; and (3) tests that assess disease activity—these are usually non-invasive biomarkers, enabling serial measurement, and may inform therapy. One of the challenges of respiratory medicine is the limited spectrum of clinical expression associated with a diverse spectrum of pathologies. Clinical symptoms in respiratory medicine are often of poor specificity for securing a diagnosis or assessing disease severity. Investigations, therefore, necessarily form a critical part of assessment. The most appropriate choice of investigation is an important component of clinical decision-making that affects patient care and may be influenced by a number of different questions that the clinician will need to consider.

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