Differential trajectories in LVEF predicts divergent clinical outcomes in HFrEF patients

Background

Recovery or improvement in LVEF is observed in many HFrEF patients following optimal medical management and device therapies, but whether this reflects true myocardial recovery remains controversial and the significance of LVEF decompensation in relation to clinical outcomes is unclear.

Purpose

To elucidate clinical characteristics and assess prognosis of HFrEF patients with differential trajectories in LVEF.

Methods

Heart failure (HF) patients were enrolled in a prospective Heart Function registry from outpatient cardiology clinics at an academic institution between Feb 2018 and Nov 2019. Retrospective analysis was conducted on 2D-echocardiography (echo) performed between Jan 2009 and Nov 2019. In total, 590 patients met the inclusion criteria with ≥2 repeated echo evaluations separated by ≥1 year. Patient demographics and clinical characteristics at enrollment were collected through review of medical records. Cardiovascular and HF specific admissions were captured using the corresponding ICD-10-CA codes. During a median follow-up of 5.9 years (IQR: 3.1 to 8.5 years) from the first echo date, clinical outcomes were assessed through composite mortality and hospitalizations endpoints.

Results

We identified 3 independent cohorts with 279 patients having permanently reduced LVEF (<40%, HFrEF), 236 patients with recovered LVEF (>40% on serial evaluations, HFrecEF) and 75 patients with subsequent decompensation in LVEF (>40%, then <40%, HFdecEF) following initial recovery. Use of ACE inhibitors or ARBs (94% vs. 99% vs. 91%) and beta blockers (88% vs. 87% vs. 87%) at baseline echo was similar amongst HFrEF, HFrecEF and HFdecEF cohorts respectively. HFrecEF cohort had higher usage of MRA (55% vs. 65% vs. 44%, p=0.002) and diuretics (74% vs. 80% vs. 65%, p=0.026). HFdecEF cohort was characterized by a predominance of males (80% vs. 69% vs. 80%, p=0.01), and more patients with ischemic etiology (41% vs. 28% vs. 60%, p<0.001) compared with the HFrecEF cohort and resembled more closely to demographics of the HFrEF cohort. Median LVEF at baseline echo was similar across the cohorts. However, HFdecEF cohort had lower LV end-diastolic diameter (p<0.001), LV end-systolic diameter (p<0.001) and LV mass (p=0.01) compared with the HFrEF cohort sharing similarities with the HFrecEF cohort on baseline echo, suggesting lesser extent of adverse cardiac remodeling in both HFrecEF and HFdecEF cohorts initially. Over a median 5.9 years follow-up, HFdecEF and HFrEF patients had a significantly higher risk (compared to those with HFrecEF) of composite all-cause mortality with all-cause (80% vs. 75% vs. 57%, p=0.004), cardiovascular (48% vs. 50% vs. 29%, p=0.001) and HF hospitalizations (31% vs. 32% vs. 16%, p=0.004).

Conclusion

HFrEF patients who never recover their LVEF and patients with decompensation in LVEF following initial recovery represent a clinically higher risk group than patients who remained recovered during follow-up.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): University of Alberta Hospital Foundation, Canadian Institutes of Health Research

Precision Constraints for Three-Flavor Neutrino Oscillations from the Full MINOS+ and MINOS Dataset

We report the final measurement of the neutrino oscillation parameters Δm_{32}^{2} and sin^{2}θ_{23} using all data from the MINOS and MINOS+ experiments. These data were collected using a total exposure of 23.76×10^{20} protons on target producing ν_{μ} and ν[over ¯]_{μ} beams and 60.75 kt yr exposure to atmospheric neutrinos. The measurement of the disappearance of ν_{μ} and the appearance of ν_{e} events between the Near and Far detectors yields |Δm_{32}^{2}|=2.40_{-0.09}^{+0.08}(2.45_{-0.08}^{+0.07})×10^{-3}  eV^{2} and sin^{2}θ_{23}=0.43_{-0.04}^{+0.20}(0.42_{-0.03}^{+0.07}) at 68% C.L. for normal (inverted) hierarchy.

Improved Constraints on Sterile Neutrino Mixing from Disappearance Searches in the MINOS, MINOS+, Daya Bay, and Bugey-3 Experiments

Searches for electron antineutrino, muon neutrino, and muon antineutrino disappearance driven by sterile neutrino mixing have been carried out by the Daya Bay and MINOS+ collaborations. This Letter presents the combined results of these searches, along with exclusion results from the Bugey-3 reactor experiment, framed in a minimally extended four-neutrino scenario. Significantly improved constraints on the θ_{μe} mixing angle are derived that constitute the most constraining limits to date over five orders of magnitude in the mass-squared splitting Δm_{41}^{2}, excluding the 90% C.L. sterile-neutrino parameter space allowed by the LSND and MiniBooNE observations at 90% CL_{s} for Δm_{41}^{2}<13  eV^{2}. Furthermore, the LSND and MiniBooNE 99% C.L. allowed regions are excluded at 99% CL_{s} for Δm_{41}^{2}<1.6 eV^{2}.

Culture-Independent Analysis of Linuron-Mineralizing Microbiota and Functions in on-Farm Biopurification Systems via DNA-Stable Isotope Probing: Comparison with Enrichment Culture

Our understanding of the microorganisms involved in in situ biodegradation of xenobiotics, like pesticides, in natural and engineered environments is poor. On-farm biopurification systems (BPSs) treat farm-produced pesticide-contaminated wastewater to reduce surface water pollution. BPSs are a labor and cost-efficient technology but are still mainly operated as black box systems. We used DNA-stable isotope probing (DNA-SIP) and classical enrichment to be informed about the organisms responsible for in situ degradation of the phenylurea herbicide linuron in a BPS matrix. DNA-SIP identified Ramlibacter, Variovorax, and an unknown Comamonadaceae genus as the dominant linuron assimilators. While linuron-degrading Variovorax strains have been isolated repeatedly, Ramlibacter has never been associated before with linuron degradation. Genes and mobile genetic elements (MGEs) previously linked to linuron catabolism were enriched in the heavy DNA-SIP fractions, suggesting their involvement in in situ linuron assimilation. BPS material free cultivation of linuron degraders from the same BPS matrix resulted in a community dominated by Variovorax, while Ramlibacter was not observed. Our study provides evidence for the role of Variovorax in in situ linuron biodegradation in a BPS, alongside other organisms like Ramlibacter, and further shows that cultivation results in a biased representation of the in situ linuron-assimilating bacterial populations.

Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn's Disease: A Population-based Study

INTRODUCTION

Most studies of elderly-onset Crohn's disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD.

METHOD

All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD.

RESULTS

A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p < 10-4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6-5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up.

CONCLUSION

During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients.

[Evaluation of the trabecular bone score (TBS) in routine clinical care of patients with inflammatory rheumatic and non-inflammatory diseases : Correlation with conventional bone mineral density measurement and prevalence of vertebral fractures]

Hintergrund

Osteoporosebedingte Frakturen sind bei Patienten mit rheumatoider Arthritis (RA) häufig. Die Messung der Knochenmineraldichte (KDM) mit der Dual-Energie-Röntgenabsorptionsmessung (DXA) allein sagt das Frakturrisiko nur begrenzt voraus. Der Trabecular Bone Score (TBS) ist ein Surrogatmarker für die trabekuläre Mikroarchitektur des Knochens, der das Frakturrisiko unabhängig von der KDM vorhersagen kann.

Ziel

Ermittlung der Prävalenz von KDM, TBS und osteoporotisch bedingten Wirbelkörperbrüchen („vertebral fractures“ [VF]) bei Patienten mit RA im Vergleich zu Kontrollen mit nichtentzündlichen Muskel-Skelett-Erkrankungen (MSK).

Methoden

Die Daten von Patienten mit von Rheumatologen diagnostizierter RA und verfügbaren TBS- und DXA-Messungen, die in unserem Krankenhaus von 2006 bis 2014 erhoben wurden, wurden retrospektiv analysiert. Den RA-Patienten wurden Kontrollen mit nichtentzündlichen MSK zugeordnet. Eine „reduzierte Knochengesundheit“ wurde definiert als ein T‑Score <−1,0 und/oder ein TBS-Wert <−1,31. Statistische Vergleiche wurden mit dem Mann-Whitney- und dem Wilcoxon-Test durchgeführt.

Ergebnisse

Es wurden 143 Patienten mit RA (Alter 72,1 ± 11,1 Jahre, 72 % weiblich) und 106 Kontrollen (Alter 69,6 ± 12,6 Jahre, 75 % weiblich) eingeschlossen. RA-Patienten hatten häufiger eine erniedrigte KDM (n = 102; 71,3 %) und einen erniedrigen TBS-Wert (n = 125; 87,4 %) als die Kontrollen (n = 63; 59,4 % und n = 79; 74,5 %, p = 0,049 und p = 0,009). RA-Patienten hatten mehr VF (n = 52, 36,4 %) als Kontrollen (n = 24, 22,6 %, p = 0,02). Insgesamt hatten 20 Patienten mit VF (26,3 %) eine normale Wirbelsäulen-KDM und 9 (11,8 %) auch eine normale Hüft-KDM. Bei Patienten mit VF war die Kombination eines niedrigen TBS bei normaler WS-KDM häufiger als ein normaler TBS bei niedriger WS-KDM (p = 0,008 für RA, p = 0,025 für Kontrollen).

Diskussion

VF treten bei Patienten mit normaler KDM auf. Bei Patienten mit VF wurde eine niedrige TBS bei normaler Wirbelsäulen-KDM häufiger gefunden als eine normale TBS bei niedriger Wirbelsäulen-KDM. Die Messung des TBS scheint für die Erkennung eines erhöhten Frakturrisikos bei RA-Patienten mit normaler WS-KDM nützlich zu sein.

First measurement of neutrino oscillation parameters using neutrinos and antineutrinos by NOvA

The NOvA experiment has seen a 4.4σ signal of ν[over ¯]_{e} appearance in a 2 GeV ν[over ¯]_{μ} beam at a distance of 810 km. Using 12.33×10^{20} protons on target delivered to the Fermilab NuMI neutrino beamline, the experiment recorded 27 ν[over ¯]_{μ}→ν[over ¯]_{e} candidates with a background of 10.3 and 102 ν[over ¯]_{μ}→ν[over ¯]_{μ} candidates. This new antineutrino data are combined with neutrino data to measure the parameters |Δm_{32}^{2}|=2.48_{-0.06}^{+0.11}×10^{-3}  eV^{2}/c^{4} and sin^{2}θ_{23} in the ranges from (0.53-0.60) and (0.45-0.48) in the normal neutrino mass hierarchy. The data exclude most values near δ_{CP}=π/2 for the inverted mass hierarchy by more than 3σ and favor the normal neutrino mass hierarchy by 1.9σ and θ_{23} values in the upper octant by 1.6σ.

Development of methods for the preparation of radiopure 82Se sources for the SuperNEMO neutrinoless double-beta decay experiment

A radiochemical method for producing 82Se sources with an ultra-low level of contamination of natural radionuclides (40K, decay products of 232Th and 238U) has been developed based on cation-exchange chromatographic purification with reverse removal of impurities. It includes chromatographic separation (purification), reduction, conditioning (which includes decantation, centrifugation, washing, grinding, and drying), and 82Se foil production. The conditioning stage, during which highly dispersed elemental selenium is obtained by the reduction of purified selenious acid (H2SeO3) with sulfur dioxide (SO2) represents the crucial step in the preparation of radiopure 82Se samples. The natural selenium (600 g) was first produced in this procedure in order to refine the method. The technique developed was then used to produce 2.5 kg of radiopure enriched selenium (82Se). The produced 82Se samples were wrapped in polyethylene (12 μm thick) and radionuclides present in the sample were analyzed with the BiPo-3 detector. The radiopurity of the plastic materials (chromatographic column material and polypropylene chemical vessels), which were used at all stages, was determined by instrumental neutron activation analysis. The radiopurity of the 82Se foils was checked by measurements with the BiPo-3 spectrometer, which confirmed the high purity of the final product. The measured contamination level for 208Tl was 8–54 μBq/kg, and for 214Bi the detection limit of 600 μBq/kg has been reached.

Relationship of Functional Reach Test scores and falls in Special Olympics athletes

BACKGROUND

The Functional Reach Test is used to assess balance of Special Olympic athletes as part of the FUNfitness screens held at Special Olympics games. However, it is unknown if the Functional Reach Test is an accurate assessment of balance in this population. The objective of this study was to explore the relationship between Functional Reach Test scores and falls in Special Olympic athletes.

METHODS

Data were collected as a part of the FUNfitness screens during Arizona Special Olympics games. The Functional Reach Test scores of 272 Special Olympic athletes were recorded. Athletes were asked to report the number of falls they experienced in the last 12 months.

RESULTS

A two-tailed Kendall tau test revealed little to no relationship between number of falls and Functional Reach Test scores of either the left upper extremity (n = 263, τ = -0.063, P = 0.202) or the right upper extremity (n = 263, τ = -0.107, P = 0.030). Sensitivity of the Functional Reach Test to identify fallers was 28.8%, and specificity was 83.5%.

CONCLUSIONS

Scores of the Functional Reach Test did not correlate with actual falls. The relatively high specificity indicates the assessment is good at identifying non-fallers, while the low sensitivity results in a high number of fallers not being recognised as such. Therefore, the cut-off scores used for the Functional Reach Test in FUNfitness screenings may need to be altered to more accurately identify balance deficits in this population. FUNfitness screens need to be quick, efficient and accurate. As such, selection of the most appropriate assessment tools is essential. Consideration should be given on how to make the Functional Reach Test the most beneficial as a FUNfitness screen.

Individual exposure level following indoor and outdoor air pollution exposure in Dakar (Senegal)

The consequences of indoor and outdoor air pollution on human health are of great concern nowadays. In this study, we firstly evaluated indoor and outdoor air pollution levels (CO, CO₂, NO, NO₂, PM₁₀) at an urban site in Dakar city center and at a rural site. Then, the individual exposure levels to selected pollutants and the variations in the levels of biomarkers of exposure were investigated in different groups of persons (bus drivers, traders working along the main roads and housemaids). Benzene exposure levels were higher for housemaids than for bus drivers and traders. High indoor exposure to benzene is probably due to cooking habits (cooking with charcoal), local practices (burning of incense), the use of cleaning products or solvent products which are important emitters of this compound. These results are confirmed by the values of S-PMA, which were higher in housemaids group compared to the others. Urinary 1-HOP levels were significantly higher for urban site housemaids compared to semirural district ones. Moreover, urinary levels of DNA oxidative stress damage (8-OHdG) and inflammatory (interleukin-6 and -8) biomarkers were higher in urban subjects in comparison to rural ones. The air quality measurement campaign showed that the bus interior was more polluted with PM₁₀, CO, CO₂ and NO than the market and urban or rural households. However, the interior of households showed higher concentration of VOCs than outdoor sites confirming previous observations of higher indoor individual exposure level to specific classes of pollutants.