Magnetic Resonance Assessment of Ejection Fraction Versus Echocardiography for Cardioverter-Defibrillator Implantation Eligibility

Background: The aim of this study was to investigate the potential impact of performing two-dimensional echocardiography (2DE) compared to cardiovascular magnetic resonance (CMR) for left ventricular ejection fraction (LVEF) on implantable cardioverter defibrillator (ICD) eligibility. Methods: A prospective cohort of 166 consecutive patients with nonischemic cardiomyopathy (NICM) was designed to compare transthoracic 2DE and CMR imaging. Results: Echocardiography measurements have important differences and large limits of agreement compared to CMR, especially when assessing ventricle volumes, and smaller but relevant differences when assessing LVEF. The agreement between CMR and 2DE regarding the identification of subjects with EF <= 35, respectively <= 30, and thus eligible for an ICD measured by Cohen’s Kappa was 0.78 (95% CI: 0.68–0.88), p < 0.001, respectively 0.65 (95% CI: 0.52–0.78), p < 0.001. The disagreement represented 7.9%/11.3% of the subjects who had EF < 35%/< 30% as observed by CMR, who would have been classified as eligible for an ICD, resulting in an additional need to use an ICD. Moreover, 2.6%/3.3% would have been deemed eligible by echocardiography for an ICD. Conclusions: These measurement problems result in incorrect assignments of eligibility that may have serious implications on the quality of life and the prevention of death events for patients assessed for eligibility of an ICD.

Metabolomic Profiles and Heart Failure Risk in Black Adults: Insights From the Jackson Heart Study

Background: Heart failure (HF) is a heterogeneous disease characterized by significant metabolic disturbances; however, the breadth of metabolic dysfunction before the onset of overt disease is not well understood. The purpose of this study was to determine the association of circulating metabolites with incident HF to uncover novel metabolic pathways to disease. Methods: We performed targeted plasma metabolomic profiling in a deeply phenotyped group of Black adults from the JHS (Jackson Heart Study; n=2199). We related metabolites associated with incident HF to established etiological mechanisms, including increased left ventricular mass index and incident coronary heart disease. Furthermore, we evaluated differential associations of metabolites with HF with preserved ejection fraction versus HF with reduced ejection fraction. Results: Metabolites associated with incident HF included products of posttranscriptional modifications of RNA, as well as polyamine and nitric oxide metabolism. A subset of metabolite-HF associations was independent of well-established HF pathways such as increased left ventricular mass index and incident coronary heart disease and included homoarginine (per 1 SD increase in metabolite level, hazard ratio, 0.77; P =1.2×10 −3 ), diacetylspermine (hazard ratio, 1.34; P =3.4×10 −3 ), and uridine (hazard ratio, 0.79; P , 3×10 −4 ). Furthermore, metabolites involved in pyrimidine metabolism (orotic acid) and collagen turnover ( N -methylproline) among others were part of a distinct metabolic signature that differentiated individuals with HF with preserved ejection fraction versus HF with reduced ejection fraction. Conclusions: The integration of clinical phenotyping with plasma metabolomic profiling uncovered novel metabolic processes in nontraditional disease pathways underlying the heterogeneity of HF development in Black adults.

Redistribution of cardiac output during exercise by functional mitral regurgitation in heart failure: compensatory O2 peripheral uptake to delivery failure

This is an analysis involving 134 heart failure patients with reduced ejection fraction versus 80 controls investigated during functional evaluation with gas exchange and hemodynamic, addressing the severe mitral regurgitation phenotype and testing the hypothesis that the backward cardiac output redistribution to the lung during exercise impairs delivery and overexpresses peripheral extraction. This information is new and has important implications in the management of heart failure.

Evaluation of using stromal vascular fraction and platelet rich plasma in the treatment of androgenetic alopecia

Background Platelet Rich Plasma (PRP) is based on the release of growth factors stimulating the initiation/extension of anagen phase as well as promoting vascularization, Adipose Derived Stem Cell (AT-ADSCs) treatment through injection of stromal vascular fraction were recently introduced as an alternative potential therapeutic application for hair growth. Purpose This study aims to compare the efficacy, safety and adverse effects of using lipo-aspirate stromal vascular fraction versus Platelet Rich Plasma injection in the treatment of Androgenetic Alopecia (AGA). Patients And Methods Forty randomized patients were treated by PRP, and SVF. Each patient was evaluated. And each lesion was treated by those modalities, patients received three sessions with one month interval for 3 months, follow up after 3 months. Results A highly significant improvement &lt;0.001 in terminal hair count of SVF group evaluated by videodermoscopy assessment of AGA. That were confirmed by highly significant improvement in inter-mediate hair count and mean caliber (&lt;0.001) associated with high incidence of side effects especially headache and erythema. In contrast. PRP group showed significant improvement 0.048 in terminal hair count and non-significant improvement in inter-mediate hair count and of mean caliber with minimum side effects. SVF group showed a significant improvement in terminal hair count than PRP and a highly significant improvement in Inter-mediate hair count. Regard the clinical improvement and photographic assessment, SVF evoked upper hand of clinical improvement than PRP without statistically difference. Also, side effects of SVF showed highly significant pain, headache and erythema but no serious adverse events. Our study suggests that was significant improvement in AGA after PRP and highly significant after SVF therapy, with significant difference of SVF in terminal hair count and highly significant in vellus hair. Both modalities could effectively and safely he used to treat AGA. Conclusion our study suggested that there was significant improvement in AGA after both PRP and highly significant after SVF therapy. The results indicated a significant difference between PRP and SVF regarding terminal hair count and highly significant for vellus hair count, but non-significant difference in hair diameter. Both modalities could effectively and safely be used to treat AGA and there was statistically improvement in AGA after both PRP and SVF therapies.

Stereotactic body radiation therapy with androgen deprivation therapy for unfavorable-risk prostate cancer.

332 Background: Current ASTRO consensus guidelines do not support routine use of SBRT in higher risk PC. However, the NCCN permits selective use of SBRT with ADT for unfavorable intermediate (UIR) and high (HiR) risk PC in cases where conventional/moderately fractionated radiation therapy (EBRT) present medical or social hardship. How SBRT+ADT compares to EBRT+ADT in UIR and HiR men is unknown. Methods: Men >40 years old with localized PC treated with RT and concomitant ADT for curative intent between 2004-2015 were analyzed from the National Cancer Database. Patients treated with brachytherapy or who lacked ADT or risk stratification data were excluded. A total of 558 men treated with SBRT (5 fractions, ≥7 Gy/fraction) versus 40,797 men treated with moderate or conventional EBRT (dose ≥60 Gy with ≤3 Gy/fraction) were included. Patients were stratified by UIR and HiR using NCCN criteria. Kaplan Meier and Cox proportional hazards were used to compare overall survival (OS) between RT modality, adjusting for age, race, and comorbidity index. Results: With a median follow up of 62 months, there was no difference in 5-year OS between men treated with SBRT versus EBRT regardless of risk group (UIR: 87.2% SBRT versus 87.0% EBRT, p=.40; HiR: 80.4% SBRT versus 80.8% EBRT, p=.21). On multivariable analysis, there was no difference in risk of death for men treated with SBRT compared to EBRT (UIR: adjusted HR 1.09, 95% CI 0.68-1.74, p=.72; HiR: adjusted HR 0.93, 95% CI 0.76-1.14, p=.51). Conclusions: We found no difference in survival between SBRT+ADT and standard of care EBRT+ADT for UIR or HiR PC. Randomized trials of SBRT versus EBRT, with standard concomitant ADT, in these risks groups are needed. If prospectively validated, more widespread use of SBRT for higher risk PC may be warranted, especially in an era of cost-effective care.