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Magliocco M, Conti M, Pane B, Canepa M, Seitun S, Morganti S, Pratesi G, Spinella G. Assessment of the Aorto-Septal Angle Post-Thoracic Endovascular Aortic Repair through Segmentation and the Semi-Automatic Analysis of Cardiosynchronized Computed Tomography Angiography Images. J Cardiovasc Dev Dis 2024; 11:275. [PMID: 39330334 PMCID: PMC11432616 DOI: 10.3390/jcdd11090275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/28/2024] Open
Abstract
The aim of this study was to inviestigate cardiac and arterial remodelling before and after thoracic endovascular aortic repair (TEVAR) by measuring the Aorto-Septal Angle (AoSA) and the geometric characteristics of the aorta. Five patients were prospectively included. Pre- and post-operative cardio-CTA scans were used to create patient-specific 3D models to calculate the AoSA, defined by the intersection of the aortic and left ventricular axes. Additionally, geometric parameters and the inclination of the ascending aorta (AA) were measured. The results demonstrated a variation between pre- and post-operative AoSA in all patients, with an increase in the case of an aneurysmal disease from 112.36° ± 8.21° to 117.16° ± 9.65° (+4.1%, p = 0.041) and a decrease in the case of aortic dissection from 113.62° ± 0.96° to 107.83° ± 1.45° (-5.1%). Additionally, an increase in the length of both the outer and inner curvatures of the AA was observed from 102.21 ± 10.17 mm to 105.73 ± 11.2 mm (+ 3.33% p = 0.016) and from 55.55 ± 9.53 mm to 58.35 ± 9.96 mm (+4.8%, p = 0.04), respectively. This study introduced a new repeatable and reproducible method for assessing the AoSA using cardiac-CTA images. Thoracic stent deployment changes the AoSA, potentially impacting long-term left ventricle hemodynamics.
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Affiliation(s)
- Marco Magliocco
- Department of Experimental Medicine, University of Genova, 16132 Genova, Italy
| | - Michele Conti
- Deparment of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Integrated Surgical and Diagnostic Science (DISC), University of Genoa, 16132 Genoa, Italy
| | - Marco Canepa
- Department of Experimental Medicine, University of Genova, 16132 Genova, Italy
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
| | - Sara Seitun
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Simone Morganti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Integrated Surgical and Diagnostic Science (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giovanni Spinella
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Integrated Surgical and Diagnostic Science (DISC), University of Genoa, 16132 Genoa, Italy
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Sandovici I, Knee O, Lopez-Tello J, Shreeve N, Fowden AL, Sferruzzi-Perri AN, Constância M. A genetically small fetus impairs placental adaptations near term. Dis Model Mech 2024; 17:dmm050719. [PMID: 39207227 PMCID: PMC11381921 DOI: 10.1242/dmm.050719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024] Open
Abstract
The placenta is a gatekeeper between the mother and fetus, adapting its structure and functions to support optimal fetal growth. Studies exploring adaptations of placentae that support the development of genetically small fetuses are lacking. Here, using a mouse model of impaired fetal growth, achieved by deleting insulin-like growth factor 2 (Igf2) in the epiblast, we assessed placental nutrient transfer and umbilical artery (UA) blood flow during late gestation. At embryonic day (E) 15.5, we observed a decline in the trans-placental flux of glucose and system A amino acids (by using 3H-MeG and 14C-MeAIB), proportionate to the diminished fetal size, whereas UA blood flow was normal. However, at E18.5, the trans-placental flux of both tracers was disproportionately decreased and accompanied by blunted UA blood flow. Feto-placental growth and nutrient transfer were more impaired in female conceptuses. Thus, reducing the fetal genetic demand for growth impairs the adaptations in placental blood flow and nutrient transport that normally support the fast fetal growth during late gestation. These findings have important implications for our understanding of the pathophysiology of pregnancies afflicted by fetal growth restriction.
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Affiliation(s)
- Ionel Sandovici
- Department of Obstetrics and Gynaecology and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Olatejumoye Knee
- Department of Obstetrics and Gynaecology and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK
| | - Jorge Lopez-Tello
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - Norman Shreeve
- Department of Obstetrics and Gynaecology and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK
| | - Abigail L Fowden
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Amanda N Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Miguel Constância
- Department of Obstetrics and Gynaecology and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
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Longino AA, Martin KC, Leyba KR, McCormack L, Siegel G, Sharma VM, Riscinti M, Lopez CO, Douglas IS, Gill EA. Reliability and reproducibility of the venous excess ultrasound (VExUS) score, a multi-site prospective study: validating a novel ultrasound technique for comprehensive assessment of venous congestion. Crit Care 2024; 28:197. [PMID: 38858766 PMCID: PMC11165888 DOI: 10.1186/s13054-024-04961-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/17/2024] [Indexed: 06/12/2024] Open
Abstract
Though the novel venous excess ultrasound (VExUS) score is increasingly used as a noninvasive means of venous congestion measurement, the inter-rater reliability (IRR), inter-user reproducibility (IUR), and utility of concurrent ECG have not been evaluated. We conducted a multicenter study of the IRR, IUR, and utility of ECG for VExUS interpretation between four attending physicians of diverse specialties, reporting the Kappa statistic (KS) and Intraclass Correlation Coefficient (ICC) for IRR and IUR for scans with and without ECG. Eighty-four paired VExUS exams from 42 patients, 60 of which had a concurrent ECG tracing, were interpreted. They showed substantial IRR, with a KS of 0.71 and ICC of 0.83 for the overall VExUS grade (p < 0.001), and IUR, with a KS 0.63 and ICC of 0.8. There was greater agreement among images with an ECG tracing. These results suggest that ECG-augmented VExUS may be a reliable and reproducible measure interpretable by clinicians with diverse backgrounds.
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Affiliation(s)
- August A Longino
- Department of Internal Medicine, University of Colorado Hospital, 12631 E 17th Avenue, Aurora, CO, 80045, USA.
| | - Katharine C Martin
- Department of Internal Medicine, University of Colorado Hospital, 12631 E 17th Avenue, Aurora, CO, 80045, USA
| | - Katarina R Leyba
- Department of Internal Medicine, University of Colorado Hospital, 12631 E 17th Avenue, Aurora, CO, 80045, USA
| | - Luke McCormack
- Department of Internal Medicine, University of Colorado Hospital, 12631 E 17th Avenue, Aurora, CO, 80045, USA
| | - Gabriel Siegel
- Department of Emergency Medicine, University of Colorado Hospital, Aurora, CO, USA
| | - Vibhu M Sharma
- Department of Pulmonary and Critical Care Medicine, University of Colorado Hospital, Aurora, CO, USA
| | - Matthew Riscinti
- Department of Emergency Medicine, University of Colorado Hospital, Aurora, CO, USA
| | - Carolina O Lopez
- Department Hospital Medicine, University of Colorado Hospital, Aurora, CO, USA
| | - Ivor S Douglas
- Department of Pulmonary and Critical Care Medicine, University of Colorado Hospital, Aurora, CO, USA
- Department of Pulmonary and Critical Care Medicine, Denver Health Medical Center, Aurora, CO, USA
| | - Edward A Gill
- Department of Cardiology, University of Colorado Hospital, Aurora, CO, USA
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Callegari S, Feher A, Smolderen KG, Mena-Hurtado C, Sinusas AJ. Multi-modality imaging for assessment of the microcirculation in peripheral artery disease: Bench to clinical practice. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 42:100400. [PMID: 38779485 PMCID: PMC11108852 DOI: 10.1016/j.ahjo.2024.100400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Peripheral artery disease (PAD) is a highly prevalent disorder with a high risk of mortality and amputation despite the introduction of novel medical and procedural treatments. Microvascular disease (MVD) is common among patients with PAD, and despite the established role as a predictor of amputations and mortality, MVD is not routinely assessed as part of current standard practice. Recent pre-clinical and clinical perfusion and molecular imaging studies have confirmed the important role of MVD in the pathogenesis and outcomes of PAD. The recent advancements in the imaging of the peripheral microcirculation could lead to a better understanding of the pathophysiology of PAD, and result in improved risk stratification, and our evaluation of response to therapies. In this review, we will discuss the current understanding of the anatomy and physiology of peripheral microcirculation, and the role of imaging for assessment of perfusion in PAD, and the latest advancements in molecular imaging. By highlighting the latest advancements in multi-modality imaging of the peripheral microcirculation, we aim to underscore the most promising imaging approaches and highlight potential research opportunities, with the goal of translating these approaches for improved and personalized management of PAD in the future.
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Affiliation(s)
- Santiago Callegari
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, USA
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, USA
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Kim G. Smolderen
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, USA
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT, USA
| | - Albert J. Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, USA
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
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Grant MC, Salenger R, Lobdell KW. Perioperative hemodynamic monitoring in cardiac surgery. Curr Opin Anaesthesiol 2024; 37:1-9. [PMID: 38085877 DOI: 10.1097/aco.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
PURPOSE OF REVIEW Cardiac surgery has traditionally relied upon invasive hemodynamic monitoring, including regular use of pulmonary artery catheters. More recently, there has been advancement in our understanding as well as broader adoption of less invasive alternatives. This review serves as an outline of the key perioperative hemodynamic monitoring options for cardiac surgery. RECENT FINDINGS Recent study has revealed that the use of invasive monitoring such as pulmonary artery catheters or transesophageal echocardiography in low-risk patients undergoing low-risk cardiac surgery is of questionable benefit. Lesser invasive approaches such a pulse contour analysis or ultrasound may provide a useful alternative to assess patient hemodynamics and guide resuscitation therapy. A number of recent studies have been published to support broader indication for these evolving technologies. SUMMARY More selective use of indwelling catheters for cardiac surgery has coincided with greater application of less invasive alternatives. Understanding the advantages and limitations of each tool allows the bedside clinician to identify which hemodynamic monitoring modality is most suitable for which patient.
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Affiliation(s)
- Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Rawn Salenger
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kevin W Lobdell
- Sanger Heart & Vascular Institute, Advocate Health, Charlotte, North Carolina, USA
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Loi B, Barra PF, Vivalda L, Raimondi F, De Luca D. Inspiratory-expiratory variation of pleural line thickness in neonates with and without acute respiratory failure. Respir Res 2024; 25:12. [PMID: 38178128 PMCID: PMC10765855 DOI: 10.1186/s12931-023-02651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND There are relatively few data about the ultrasound evaluation of pleural line in patients with respiratory failure. We measured the pleural line thickness during different phases of the respiratory cycle in neonates with and without acute respiratory failure as we hypothesized that this can significantly change. METHODS Prospective, observational, cohort study performed in an academic tertiary neonatal intensive care unit recruiting neonates with transient tachypnoea of the neonate (TTN), respiratory distress syndrome (RDS) or neonatal acute respiratory distress syndrome (NARDS). Neonates with no lung disease (NLD) were also recruited as controls. Pleural line thickness was measured with high-frequency ultrasound at end-inspiration and end-expiration by two different raters. RESULTS Pleural line thickness was slightly but significantly higher at end-expiration (0.53 [0.43-0.63] mm) than at end-inspiration (0.5 [0.4-0.6] mm; p = 0.001) for the whole population. End-inspiratory (NLD: 0.45 [0.38-0.53], TTN: 0.49 [0.43-0.59], RDS: 0.53 [0.41-0.62], NARDS: 0.6 [0.5-0.7] mm) and -expiratory (NLD: 0.47 [0.42-0.56], TTN: 0.48 [0.43-0.61], RDS: 0.53 [0.46-0.65], NARDS: 0.61 [0.54-0.72] mm) thickness were significantly different (overall p = 0.021 for both), between the groups although the absolute differences were small. The inter-rater agreement was optimal (ICC: 0.95 (0.94-0.96)). Coefficient of variation was 2.8% and 2.5% for end-inspiratory and end-expiratory measurements, respectively. These findings provide normative data of pleural line thickness for the most common forms of neonatal acute respiratory failure and are useful to design future studies to investigate possible clinical applications.
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Affiliation(s)
- Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Center, Paris- Saclay University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay University, Paris, France
| | - Pasquale Fabio Barra
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Center, Paris- Saclay University Hospitals, APHP, Paris, France
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Laura Vivalda
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Center, Paris- Saclay University Hospitals, APHP, Paris, France
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Center, Paris- Saclay University Hospitals, APHP, Paris, France.
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay University, Paris, France.
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