CORRELATION OF SPINOPELVIC PARAMETERS WITH DISABILITY STATUS IN PATIENTS WITH DEGENERATIVE LUMBAR DISEASES

Lumbar degenerative disease usually manifests in spine clinics. This study examines the spino-pelvic characteristics of lumbar degenerative disease patients as well as the clinical ramifications in the Indian population which help in early identification of sagittal spine anomalies. Purpose - to study the spinopelvic parameters and correlate them with disability status in patients with degenerative lumbar diseases. This cross-sectional observational study focused on patients aged 40 to 60, diagnosed with degenerative lumbar spine diseases, seen at the Orthopedics Outpatient Department. Thorough history, clinical examination, and disability assessment were conducted using the modified Oswestery Disability Questionnaire (ODI). Radiological evaluation included measuring spinopelvic parameters-Pelvic Incidence (PI), Pelvic Tilt (PT), Sacral Slope (SS), and Lumbar Lordosis (LL)-correlated with disability. Disability status was determined through the Oswestry Low Back Pain Disability (ODI) Questionnaire. Among the study population, the difference in mean of Pelvic Tilt, Sacral slope, Lumbar lordosis, Pelvic incidence across disability status was not statistically significant. BMI and sacral slope showed positive correlation to sacral slope and negative correlation to Pelvic Tilt, Lumbar Lordosis, ODI. This study concluded there was no association between spinopelvic characteristics and level of disability in degenerative lumbar disease. Early detection of spinopelvic changes can aid in early intervention, slow down disease progression, and lessen impairment brought on by degenerative disc diseases.

Preferential Impairment of Auditory Working Memory in Long COVID: An Observational Study of Undergraduate Medical Students

Background Long COVID is a multisystem condition with prolonged symptoms that develop after recovery from the COVID-19 infection, often following a mild infection. Few studies have been conducted on cognitive function among medical students after recovery from mild COVID-19. This study aimed to assess the attention span and working memory (WM) capacity of medical students after six months of recovery. Methods A cross-sectional study was performed on 17 young adult medical students who had suffered a mild COVID-19 infection at least six months prior. Eighteen age-matched healthy medical students served as the controls. Audio-visual WM tasks and attention spans were assessed using computerized software for both the cases and controls. Results The mean ages of the case and control were 19.67±1.6 and 20.0±1.2 years, respectively. The most common symptoms among cases were fatigue (33%), weight loss (26%), and nasal stuffiness (13%). The overall proportion of correct responses across all visual and auditory WM tasks (p=0.085) and reaction times (p=0.609) did not differ between the cases and controls. However, the overall target hit rate of the auditory WM task was significantly lower in cases than in controls (p=0.002). This difference was not observed in the visual WM task (p=0.374). Conclusion In the current study, the overall WM functions (visual and auditory combined) and attention span did not differ between cases and controls. However, auditory WM performance was significantly impaired in patients compared with controls, indicating selective impairment of auditory WM in patients with long COVID.

FUNCTIONAL AND RADIOLOGICAL OUTCOME FOLLOWING EXTENDED POSTERIOR CIRCUMFERENTIAL DECOMPRESSION IN THE TUBERCULOSIS OF DORSAL SPINE

Spinal Tuberculosis ranks as one of the most common extrapulmonary varieties of tuberculosis. The study outlines the Extended Posterior Circumferential Decompression (EPCD) procedure for managing tuberculous spondylitis, a prevalent extrapulmonary form of tuberculosis. EPCD involves 360-degree dural decompression, anterior column debridement, and reconstruction following posterior instrumentation. This technique addresses both the infection and associated complications, particularly beneficial in cases with or without paraplegia. EPCD aims to improve outcomes by effectively tackling the pathology and restoring spinal stability. Purpose - to evaluate the functional and radiological outcome following Extended Posterior Circumferential Decompression in the tuberculosis of dorsal spine. A total of 10 patients were included after fulfilling inclusion criteria between July 2019 to December 2021, all patient underwent Extended Posterior Circumferential Decompression. All patients assessed using Visual analog scale (VAS), Medical Research council (MRC) grading, Frankel grading, Kyphus angle, Erythrocyte sedimentation rate (ESR), X-rays preoperative, immediate postoperative period and 9 month follow up. All patients were available for follow up, in this study mean age was 55.7±17.91. Out of 10 patients 60% were female, 40% was male. VAS, MRC grading, Frankel, ESR values, Kyphus angle showed better results in terms of functional and radiological outcome at 9 month follow up compared to preoperative values. The Employed Posterior Costotransversectomy Decortication (EPCD) technique grants ample ingress to both the lateral and anterior domains of the spinal cord, ensuring an equally efficacious decompression. This approach, characterized by its diminished morbidity, steers clear of the entanglements linked with thoracotomy and laparotomy. Moreover, it fosters prompt mobilization, thereby forestalling the adversities entailed by protracted immobility. With its capability for favorable kyphosis correction, adept surgical decompression, and enhanced functional outcomes, it stands as a beacon of surgical finesse.

A Doctor in the House, An Ethical Consideration on Treating Their Family Members: A Mixed-Method Study

BACKGROUND

 The ethical dilemma of doctors treating their own family members has long been a contentious issue in the field of medicine. Despite these dilemmas, doctors may feel compelled to become involved in the care of family members and reluctant to set standards for themselves. Therefore, this study aimed to assess the experience of doctors in the treatment of their families in Perambalur District, Tamil Nadu, India.

METHODOLOGY

 A mixed-method study was conducted among the doctors in Perambalur District, Tamil Nadu, India from December 2021 to October 2022. A semi-structured questionnaire was used to assess the socio-demographic details and the experience of doctors in treating their family members, followed by a focused group discussion (FGD). Data were analyzed using SPSS version 16 (SPSS Inc., Chicago). A scatter plot was created to visualize the relationship between age, experience of doctors, and confidence level with the frequency of treating family members. A chi-square test was performed to find any associations, and a p-value <0.05 was considered significant. For qualitative data, a fish herringbone model was constructed.

RESULTS

 A total of 72 doctors participated in the study. The study found that almost all the doctors (100%) received medical requests from family members, the median number of requests received in a year was 6.5 with an interquartile range of 4-8 and three-quarters (66.6%) of them accepted the requests and treated them. However, concerns about maintaining objectivity, emotional attachment, and loss of confidentiality were cited as primary reasons for not accepting all requests. The study also found a positive relationship between age, years of experience, and the frequency of treating family members. The FGD highlighted challenges related to potential risks in managing complex cases, emotional involvement impacting decision-making, conflicts of interest, and pressures from family members and societal norms.

CONCLUSION

 In the present study, almost all the doctors received requests from their family members in the last year, and more than three-fourths of the doctors treated their family members. One-fourth of the doctors rejected requests from family members due to concerns about the potential loss of objectivity and the risk of misdiagnosing symptoms caused by emotional attachments. This study sheds light on the complexities and ethical considerations doctors face when treating family members. It emphasizes the need for medical ethics education in the curriculum to guide future doctors in making ethical decisions in such situations. Implementing clear-cut medical ethics guidelines in India would be instrumental in addressing these issues and ensuring ethical practices in the medical field.

The mitral to aortic/pulmonary velocity-time integral ratio is a simple, feasible and accurate discriminator for echocardiographic evaluation of severe isolated mitral regurgitation

Background

Echocardiographic quantification of mitral regurgitation (MR) remains challenging, requiring dedicated image acquisition, and is limited by potential error from geometric assumptions of annular dimensions. Volume is a product of area and flow and assuming proportional mitral/aortic areas, an increased mitral-inflow volume compared to LV/RV-outflow semi-quantitatively represents greater MR regurgitant volume. Therefore, we investigated the feasibility and diagnostic performance of the mitral-aortic velocity-time integral (VTI) ratio in isolated MR. We also investigated the use of the mitral-pulmonary VTI ratio as an alternative in clinical situations where the LV outflow tract (LVOT) VTI could not be used.

Methods

We reviewed 166 consecutive patients (54 (33% severe MR by multi-parameter integrated expert opinion)). Pulsed-Doppler VTI at the mitral leaflet tips and the left ventricular outflow and continuous-wave Doppler of the right ventricular outflow tract were measured individually and independently by blinded readers (expert and trainee status) to derive the ratio. Receiver operator characteristic area under the curve (AUC) comparison was calculated and compared with effective regurgitant orifice area (EROA &gt;40 mm), regurgitant volume (RVol &gt;6 0mL), vena contracta (VC &gt;0.7 cm), E-velocity &gt;1.2 cm, systolic flow reversal (SFR), left atrial and ventricular dilatation.

Results

Increasing ratio was associated with severe MR (AUC 0.94) with optimal threshold defined at 1.3. This provided significant discrimination for severe MR (AUC 0.81) compared to EROA (0.68), VC (0.52), LV dilatation (0.69), LA dilatation (0.70), SFR (0.73), E-velocity (0.68) all p&lt;0.05, with sensitivity 82% and specificity 94%. The mitral-pulmonary VTI ratio demonstrated similar discrimination (AUC 0.92) with optimal threshold defined at 1.14. Excellent inter-observer reproducibility (intra-class correlation 0.97) was seen between trainee and expert readers. There was no difference in AUC comparison by MR mechanism or patient rhythm.

Conclusions

The mitral-aortic or mitral-pulmonary VTI ratio is a simple, geometric-free parameter feasibly reproducible from routine echocardiographic datasets and is an excellent discriminative tool for severe MR. Readers should consider integration of this parameter in routine reporting.

Funding Acknowledgement

Type of funding sources: None.

Can a simple echocardiographic Doppler VTI based flow comparison between the RVOT and LVOT assist in identifying patients with a significant atrial septal defect?

Background

Detection of haemodynamically significant shunting from atrial septal defect (ASD) can be identified by using the pulmonary-systemic flow ratio (Qp/Qs). However, calculation of Qp/Qs by echocardiography relies on geometric assumptions that outflow tracts are circular, suffers from squared linear measures, and accurate measurement of right ventricular outflow tract (RVOT) diameter is challenging. Whilst adults with ASD should have overt right ventricular dilatation, RV sizing on echocardiography is often subjective and underappreciated. We evaluated whether a dimensionless index of flow (VTI) differences between the RVOT and left ventricular outflow tract (LVOT) could assist in identifying patients with ASD, and compared it with relative atrial index (RAI), a parameter previously assessed in identifying atrial shunting.

Methods

Data from 64 consecutive patients who underwent ASD closure and had no concomitant lesions, were compared with 63 normal controls. RVOT VTI, LVOT VTI, LVOT diameter, and atrial areas were measured.

Results

Between controls and ASD patients, there was no difference in LVOT VTI or forward stroke volume, but ASD patients had significantly higher RVOT VTI. The RVOT-LVOT VTI ratio was 1:1 in controls and 1.5:1 in ASD patients. Area under the ROC curve analysis of RVOT-LVOT VTI ratio was 0.83, and a ratio of 1.1:1 predicted patients with ASD with 86% sensitivity and 73% specificity. In comparison, the area under the ROC curve analysis of RAI was 0.70, and an RAI of 1.05:1 predicted patients with ASD with 77% sensitivity and 44% specificity.

Conclusion

Calculation of the dimensionless RVOT-LVOT VTI ratio is simple, and may be a useful additional semi-quantitative tool to assist cardiologists and sonographers in detecting atrial shunting, particularly in patients with borderline or overt right heart dilatation, and identify who patients should undergo further evaluation.

Funding Acknowledgement

Type of funding sources: None.

Long term prognostic utility of exercise capacity in renal transplant candidates

Background

Pharmacological stress testing is commonly performed for cardiovascular risk stratification in potential renal transplant candidates due to a perceived inability for these patients to exercise. We have previously reported that exercise stress testing is feasible in renal transplant candidates but the prognostic utility of exercise capacity in this patient group is not known.

Purpose

This study prospectively evaluated the effect of exercise capacity on the risk of major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction, and stroke, in renal transplant candidates undergoing exercise stress echocardiography (ESE) for pre-transplant cardiovascular assessment.

Methods

We evaluated 898 consecutive patients with chronic kidney disease stage 4/5 who underwent symptom-limited treadmill ESE over 5-year mean follow-up. Exercise capacity was measured by age and sex predicted metabolic equivalents (METs). The primary outcome was achievement of predicted METs with first MACE. Cox proportional hazard multivariable modelling was used to determine MACE predictors with transplantation treated as a time-varying covariate. We also performed secondary analysis using a 7 MET threshold.

Results

There were 106 MACE with an annual cumulative risk of 2.4%. During follow-up, 525 (58%) received transplantation. Achievement of predicted METs (48%) (hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.29–0.82, p=0.007) and transplantation (HR 0.52, 95% CI 0.30–0.91, p=0.02) were independently associated with reduced MACE. Similar results were observed using a 7 MET threshold achieved by 734 (82%) patients. Patients achieving predicted METs had no difference in MACE regardless of subsequent transplantation (HR 0.78, 95% CI 0.32–1.92, p=0.59). Patients who achieved predicted METs and did not receive transplantation had similar outcomes to those that did not achieve predicted METs and received transplantation (HR 0.97, 95% CI 0.42–2.25, p=0.95).

Conclusions

Exercise capacity is associated with reduced long-term MACE in renal transplant candidates undergoing ESE for pre-transplant cardiovascular assessment. Achievement of age and sex predicted METs confers excellent prognosis independent of subsequent transplantation.

Funding Acknowledgement

Type of funding sources: None.

Gender differences in rates of percutaneous coronary intervention, cardiac surgery and valvular disease in indigenous Australians with suspected acute coronary events

Background

Indigenous populations globally have a higher burden of cardiovascular disease and increased mortality after acute coronary events, partly due to inequitable access to specialised care like cardiac catheterisation. Gender differences in revascularisation rates have been well described in non-Indigenous patients. Whether this applies to Indigenous patients when cardiac catheterisation facilities are readily available is unclear.

Purpose

We compared the rates of percutaneous coronary intervention (PCI), cardiac surgery, 30-day and long-term all-cause mortality in Indigenous (Aboriginal and Torres Strait Islanders) patients in Far North Queensland (FNQ) – a region with a large Indigenous population and 24/7 cardiac catheterisation facilities.

Method

All patients who presented to the tertiary referral center for FNQ, for their first inpatient angiogram between November 2012 and October 2019 were identified. The primary study outcomes were rates of PCI or cardiac surgery and all-cause mortality measured at 30 days and long term. Secondary study outcomes were significant left ventricular dysfunction (ejection fraction &lt;50%) and valvular disease (moderate to severe) in patients who had an echocardiogram. Other differences in baseline characteristics, including age, gender, body mass index, postcode and indication for angiography were accounted for using logistic and cox regression analysis.

Results

1042 patients (mean age 53.7±11.6 years, 45.5% female, median follow-up 1092 days) self-identified as Indigenous. Indigenous women were older 54.8±11.4 vs 52.8±11.7 years, p=0.005 and had different angiography indications. For Indigenous women and men respectively, rates of ST elevation myocardial infarction (STEMI) were 14.6% vs 22.9%, non-STEMI 44.3% vs 46.8%, angina 32.7% vs 21.0%, cardiac arrest 2.7% vs 3.3% and other 5.7% vs 6.0%, p&lt;0.001.

Indigenous women had significantly lower rates of PCI or cardiac surgery, 40.5% vs 60.7%, p&lt;0.001, but similar 30-day mortality, 1.5% vs 2.3% p=0.34 and long-term all-cause mortality rates 11.2% vs 10.9%, p=0.89, in unadjusted data.

685 patients (mean age 53.8±11.5 years, 45.5% female) were included in the echocardiogram subgroup. Indigenous women had significantly more valvular disease, 23.3% vs 16.3%, p=0.022 but similar rates of left ventricular dysfunction, 30.2% vs 35.8%, p=0.12.

Following adjustment for other baseline characteristics female gender independently predicted lower rates of PCI or cardiac surgery, OR 0.49 (95% CI 0.38–0.64) and higher rates of valvular disease, OR 1.60 (95% CI 1.07–2.39). Rates of ventricular dysfunction, 30-day and long-term all-cause mortality were similar.

Conclusions

Indigenous women had significantly different indications for angiography, lower rates of PCI or cardiac surgery and higher rates of clinically significant valvular disease despite presenting in gender ratios similar to the general population in FNQ.

Funding Acknowledgement

Type of funding source: None

Differences in rates of percutaneous coronary intervention, cardiac surgery and all-cause mortality in indigenous and non-indigenous Australians with suspected acute coronary events

Background

Indigenous populations globally are known to have lower revascularisation rates following acute coronary events and higher mortality partly due to inequitable access to specialised care like cardiac catheterisation. Whether these disparities persist when access is readily available is unclear.

Purpose

We compared the rates of percutaneous coronary intervention (PCI), cardiac surgery, 30-day and long-term all-cause mortality in Indigenous (Aboriginal and Torres Strait Islanders) and non-Indigenous Australians in Far North Queensland (FNQ) – a region with a large Indigenous population and 24/7 cardiac catheterisation facilities.

Method

All public patients in FNQ having their first inpatient angiogram from November 2012 to October 2019 were identified. The primary study outcomes were rates of PCI or cardiac surgery and all-cause mortality at 30 days and long term. Secondary study outcomes were significant left ventricular dysfunction (ejection fraction &lt;50%) and valvular disease (moderate to severe) in the echocardiogram subset. Other differences in baseline characteristics, including age, gender, body mass index, postcode and indication for angiography were accounted for using logistic and cox regression analysis.

Results

We identified 4489 patients (mean age, 61.7±13.0 years, 64.9% male, median follow-up 1045 days). 1042 (23.2%) self-identified as Indigenous. Indigenous patients were younger (53.7±11.6 vs 64.1±12.5 years, p&lt;0.001), more likely female (45.5% vs 32.0%, p&lt;0.001) and had small differences in angiography indications, ST elevation myocardial infarction (STEMI) 19.1% vs 18.1%, non-STEMI 45.7% vs 41.8%, angina 26.3% vs 28.0%, cardiac arrest 3.1% vs 3.7% and other 5.8% vs 8.4%, p=0.02.

Rates of PCI or surgery 35.6% vs 38.5%, p=0.17, 30-day mortality 1.9% vs 2.7%, p=0.17 and long-term mortality 11.0% vs 11.5%, p=0.71 were similar in unadjusted data.

2959 patients (mean age, 62.1±13.0 years, 23.1% Indigenous, 64.9% male) were included in the echocardiogram subgroup. In unadjusted data Indigenous patients had similar rates of ventricular dysfunction 33.3% vs 31.3%, p=0.33 and valvular disease 19.4% vs 19.3%, p=0.93.

After adjustment for other baseline characteristics, Indigenous patients had higher rates of PCI or cardiac surgery, OR 1.39 (95% CI, 1.18–1.64, p&lt;0.001), ventricular dysfunction, OR 1.31 (95% CI, 1.07–1.60), p=0.01 and valvular disease, OR 1.93 (95% CI, 1.50–2.48), p&lt;0.001. 30-day mortality was similar but Indigenous patients had higher adjusted long-term hazard of mortality, HR 1.80 (95% CI, 1.42–2.27), p&lt;0.001.

Conclusion

When cardiac catheterisation was readily available Indigenous patients had higher rates of PCI and cardiac surgery and similar 30-day mortality to non-Indigenous patients. Equitable access to healthcare improves outcomes but the nearly double long-term mortality of Indigenous patients shows more is required to help close the gap for disadvantaged populations.

Funding Acknowledgement

Type of funding source: None

His bundle pacing–is it the final frontier of physiological pacing ?–A single centre experience from the Indian sub–Continent

Background

Long term right ventricular pacing can have deleterious effects on left ventricular (LV) function. His bundle pacing (HBP), a novel procedure can probably circumvent this setback. We investigated if (1) HBP is associated with pacing induced LV dysfunction by using LV global longitudinal strain (GLS) and (2) intermediate term performance of the Select Secure (3830) lead in the His bundle location. This report is probably the first on HBP in the Indian population.

Methods

61 patients, with normal LV ejection fraction (EF) with a guideline based indication for permanent pacing underwent a HBP pacemaker implantation using the His Select Secure 3830 lead; with lead guided mapping for locating the His bundle. The patients underwent GLS assessment; evaluation of the His lead parameters - sensing, impedance and capture thresholds immediately after implantation and at 6 months in addition to the standard follow up.

Results

At 6 month follow up, the average GLS did not show significant variation from baseline in patients requiring ventricular pacing more than 40% and was similar, irrespective of selective or non selective His bundle pacing. All the patients had stable pacemaker parameters - with little change in capture threshold, lead impedance or sensing of the His bundle lead - implying electrical and mechanical stability on intermediate term follow-up.

Conclusion

HBP is a feasible procedure in the hands of an experienced operator, with stable lead performance. It does not appear to be associated with pacing mediated left ventricular dysfunction at intermediate term follow up. It should probably become the default method of permanent pacing.

DESIGN AND DEVELOPMENT OF HUMAN COMPUTER INTERFACE USING ELECTROOCULOGRAM WITH DEEP LEARNING

Today's life assistive devices were playing significant role in our life to communicate with others. In that modality Human Computer Interface (HCI) based Electrooculogram (EOG) playing vital part. By using this method we can able to overcome the conventional methods in terms of performance and accuracy. To overcome such problem we analyze the EOG signal from twenty subjects to design nine states EOG based HCI using five electrodes system to measure the horizontal and vertical eye movements. Signals were preprocessed to remove the artifacts and extract the valuable information from collected data by using band power and Hilbert Huang Transform (HHT) and trained with Pattern Recognition Neural Network (PRNN) to classify the tasks. The classification results of 92.17% and 91.85% were shown for band power and HHT features using PRNN architecture. Recognition accuracy was analyzed in offline to identify the possibilities of designing HCI. We compare the two feature extraction techniques with PRNN to analyze the best method for classifying the tasks and recognizing single trail tasks to design the HCI. Our experimental result confirms that for classifying as well as recognizing accuracy of the collected signals using band power with PRNN shows better accuracy compared to other network used in this study. We compared the male subjects performance with female subjects to identify the performance. Finally we compared the male as well as female subjects in age group wise to identify the performance of the system. From that we concluded that male performance was appreciable compared with female subjects as well as age group between 26 to 32 performance and recognizing accuracy were high compared with other age groups used in this study.

Electroencephalogram based communication system for locked in state person using mentally spelled tasks with optimized network model

Due to growth in population, Individual persons with disabilities are increasing daily. To overcome the disability especially in Locked in State (LIS) due to Spinal Cord Injury (SCI), we planned to design four states moving robot from four imagery tasks signals acquired from three electrode systems by placing the electrodes in three positions namely T1, T3 and FP1. At the time of the study we extract the features from Continuous Wavelet Transform (CWT) and trained with Optimized Neural Network model to analyze the features. The proposed network model showed the highest performances with an accuracy of 93.86 % then that of conventional network model. To confirm the performances we conduct offline test. The offline test also proved that new network model recognizing accuracy was higher than the conventional network model with recognizing accuracy of 97.50 %. To verify our result we conducted Information Transfer Rate (ITR), from this analysis we concluded that optimized network model outperforms the other network models like conventional ordinary Feed Forward Neural Network, Time Delay Neural Network and Elman Neural Networks with an accuracy of 21.67 bits per sec. By analyzing classification performances, recognizing accuracy and Information Transformation Rate (ITR), we concluded that CWT features with optimized neural network model performances were comparably greater than that of normal or conventional neural network model and also the study proved that performances of male subjects was appreciated compared to female subjects.

Optimized artificial neural network based performance analysis of wheelchair movement for ALS patients

Individuals with neurodegenerative attacks loose the entire motor neuron movements. These conditions affect the individual actions like walking, speaking impairment and totally make the person in to locked in state (LIS). To overcome the miserable condition the person need rehabilitation devices through a Brain Computer Interfaces (BCI) to satisfy their needs. BMI using Electroencephalogram (EEG) receives the mental thoughts from brain and converts into control signals to activate the exterior communication appliances in the absence of biological channels. To design the BCI, we conduct our study with three normal male subjects, three normal female subjects and three ALS affected individuals from the age of 20-60 with three electrode systems for four tasks. One Dimensional Local Binary Patterns (LBP) technique was applied to reduce the digitally sampled features collected from nine subjects was treated with Grey wolf optimization Neural Network (GWONN) to classify the mentally composed words. Using these techniques, we compared the three types of subjects to identify the performances. The study proves that subjects from normal male categories performance was maximum compared with the other subjects. To assess the individual performance of the subject, we conducted the recognition accuracy test in offline mode. From the accuracy test also, we obtained the best performance from the normal male subjects compared with female and ALS subjects with an accuracy of 98.33 %, 95.00 % and 88.33 %. Finally our study concludes that patients with ALS attack need more training than that of the other subjects.

P1482Preclinical diastolic dysfunction assessed by left atrial strain and association with incident heart failure

Background

Left atrial strain in the reservoir phase (LASr) measures passive LA stretch and is a sensitive marker of left ventricular diastolic dysfunction (DD). However, reduced LASr has not been prospectively validated against clinical heart failure (HF) endpoints and its place in diastology evaluation is unclear.

Aim

We sought whether DD grades defined by previously validated ranges of LASr predicted incident HF and whether reclassifying indeterminate diastolic function based on reduced LASr could facilitate assessment of HF risk.

Methods

Community dwelling elderly subjects were recruited and underwent baseline clinical and echocardiographic assessment. Where imaging was suitable, speckle-tracking echocardiography assessed LASr and subjects were assigned DD grades based on published ranges: normal >35%, grade 1 24–35%, grade 2 19–24%, grade 3 <19%. Current ASE/EACVI recommendations were used to identify those with indeterminate function; LASr-defined DD (LASr-DD) was defined as LASr ≤23%. Follow-up was ≤2 years and incident HF adjudicated by Framingham criteria.

Results

Of 610 subjects (age 71±5 yrs., 46% male) LASr analysis was feasible in 590 (97%); average LASr was 39% (IQR 34–43%). Incident HF was associated with LASr-DD grade, occurring in 8 (36%) with grade ≥2, 14 (10%) with grade 1 and 39 (9%) with normal function (p<0.001). Adjusted odds ratio for incident HF for LASr-DD grade ≥2 was 3.12 (95% CI 1.06–9.1, p=0.038) Diastolic function was indeterminate in 147 (24%) subjects; of 144 (98%) with LAS analysis, 6 (75%) of those with LASr-DD vs. 15 (11%) with normal LASr experienced incident HF (p<0.001).

Univariable Multivariable* OR (95% CI) p-value OR (95% CI) p-value LASr-DD grade:   1 1.13 (0.59–2.15) 0.7 0.84 (0.42–1.69) 0.63   ≥2 5.7 (2.26–14.5) <0.001 3.12 (1.06–9.1) 0.038 *Adjusted for age, hypertension, diabetes, BMI, global longitudinal strain, E/e', LA volume index, LV mass index (all p<0.1 on univariable analysis).

Incorporating LA strain in practice

Conclusion

DD defined by LASr is predictive of HF for grades ≥2 independent of other diastolic measures. Indeterminate diastolic function with LASr ≤23% is associated with incident HF. LASr may complement current diastolic function assessment recommendations.

Acknowledgement/Funding

Baker Heart and Diabetes Institute

3224Incremental benefit of left ventricular global longitudinal strain over clinical and left atrial parameters for predicting new-onset atrial fibrillation

Background

Although LV hypertrophy and dysfunction are associated with atrial fibrillation (AF), AF often occurs in the absence of LV hypertrophy or reduced ejection fraction. The effect of subclinical LV dysfunction on AF has not been fully studied.

Purpose

We sought the association between subclinical LV dysfunction (measured with global longitudinal strain, GLS) and new-onset AF.

Methods

This observational study evaluated 531 consecutive patients (median age, 67 years [interquartile range, 56 to 78]; 56% male), without a history of AF who underwent strain echocardiography after cryptogenic stroke. The CHARGE-AF score was used to calculate the 5-year risk of developing AF. Standard echocardiographic parameters were measured, and speckle-tracking was used to measure LA (reservoir strain, pump strain, and conduit strain) and LV strain (GLS). A strain analysis was conducted using a dedicated software package, using R-R gating. The baseline clinical and echocardiographic parameters of the patients who developed AF and those who did not were compared.

Results

Over 2.5 years of follow-up, 61 patients (11%) had new-onset AF. Patients who developed AF were older, had a higher CHARGE-AF score, larger LA volume, worse LA strain, and worse GLS than those who did not. Areas under the receiver-operating curve for GLS (0.84) was comparable to CHARGE-AF (0.79), LA pump strain (0.83), and LA reservoir strain (0.85). In the nested Cox models, GLS demonstrated an independent and incremental predictive value over the clinical and LA parameters (Figure). Moreover, adding GLS to the combined clinical and LA parameters model resulted in a significantly improved reclassification (net reclassification improvement, 0.32; p=0.016). Importantly, the predictive value of GLS was confirmed in patients with abnormal LA volumes (LA volume index≥34ml/m2) but not in patients with normal LA volumes.

Figure 1

Conclusion

GLS is associated with new-onset AF, especially in patients with abnormal LA volumes. This effect is independent of and incremental to the clinical and LA parameters.

P5979Impact of disease stage on performance of strain markers for prediction of atrial fibrillation

Background

Efforts to predict incident atrial fibrillation (AF) may be associated with complications, and there is interest in AF prediction in primary prevention (PP; pts with risk factors) and secondary prevention (SP; pts with possible AF complications). These pts have different risk levels, we sought whether that influenced the predictive value of LV dysfunction (measured as global longitudinal strain, GLS) or LA dysfunction (LA reservoir strain).

Methods

The PP cohort comprised 351 community-based pts ≥65 years with ≥1 risk factor for AF (age 70±4y,43% male, median follow-up 22 months) and the SP cohort comprised 532 pts after transient ischaemic attack or stroke (age 68±12y, 51% male, median follow-up 36 months). GLS and LA strain were measured offline (Image Arena-Tomtec, Germany). AF was diagnosed by 12 lead ECG, Holter or by single lead monitor. The clinical and echocardiographic characteristics of those with AF were compared to those in sinus rhythm. Nested Cox-regression models were used to assess for independent and incremental predictive value of LA strain/GLS in both cohorts.

Results

Compared to SP, PP had higher clinical AF risk (CHARGE-AF 5.6±5.5% vs 4.7±12.1%, p=0.02) but a lower thromboembolic risk (CHA2DS2-VASC 3±2 vs. 4±2, p<0.001). AF developed in 42 PP pts (12%) and 61 SP (12%). AF patients were older, with higher CHARGE-AF score, LA volume and LV mass. Pts developing AF had reduced GLS (17±4% vs. 20±3%, p<0.001), reservoir (28±11% vs. 35±8%, p<0.001) and pump strain (13±7% vs. 17±5%, p<0.001). GLS and LA strain had greater AUC in SP (0.84 vs 0.58 for GLS and 0.85 vs 0.57 for reservoir strain, both p<0.001). Nested cox-regression models showed that LA reservoir strain was independently associated with AF in both cohorts (p<0.05). GLS was only independently associated with incident AF in SP (Figure).

Conclusion

LA reservoir strain is independently associated with AF in different risk cohorts and its effect is incremental to clinical parameters and LA volume. GLS may be more useful in AF risk assessment in those in SP.

Acknowledgement/Funding

This study was partially supported by the Tasmanian Community Fund and Siemens Healthcare Australia.

An Automatic Bone Disorder Classification Using Hybrid Texture Feature Extraction with Bone Mineral Density

A novel approach has been proposed to classify bone disorders for classifying the radiographic bone image as normal, Osteopenia and Osteoporosis. The proposed system consists of three major stages to predict the accurate bone disorder classification. In the first stage, image preprocessing is performed where bilateral filtering is applied to remove noise and to enhance the image quality. Then, the image is fed to Otsu based segmentation approach for segmenting the abnormal area of the bone image. In the second stage, Discrete Wavelet Transform (DWT) is used to the segmented image. Once the image gets segmented then, the Gray-Level Co-occurrence Matrix (GLCM) method is applied to extract the features in terms of statistical texture-based. Further the image which is applied to Principle Component Analysis (PCA) to reduce size of the feature vector. Besides, Bone Mineral Density (BMD) feature namely calcium volume is estimated from abnormal region in the segmented bone image and it is concatenated with the extracted texture features to obtain the final feature vectors. In the final stage, the Multi-class Support Vector Machine (MSVM) takes feature vectors as a inputto classify bone disorders. The simulation result demonstrates that the proposed system achieved the accuracy of 95.1% and sensitivity of 96.15%.

A Goal Unrealized: Patient Empowerment on Hand Hygiene- A Web-Based Survey from India

INTRODUCTION

Each year, millions of patients around the world are affected by Health Care Associated Infections (HCAIs). Understanding and assessing the global burden of HCAI is one of the key areas of work to improve the hand hygiene.

AIM

To assess the patient empowerment and awareness on hand hygiene among online users.

MATERIALS AND METHODS

A web-based cross-sectional survey was conducted during September 2013 to December 2013 among adults. A predesigned questionnaire to assess the awareness on hand hygiene was sent to volunteers through emails and social networking sites. The data were transferred to excel sheet and analyzed in Epi info and represented in proportions and percentages.

RESULTS

Total 94 (57%) participants responded to the survey among which 51.1% were males and 48.9% were females. Majority of them belongs to the age group of 20 to 35 years. Only 28.7% of them said they will ever ask health care worker to wash their hands before they examine. A 27.7% of the participants reported that their country/community have a program that educates/communicates with patients about the importance of hand hygiene.

CONCLUSION

Adherence and compliance to hand hygiene practices is suboptimal among people. There seems to be a lack of knowledge regarding hand hygiene.

MRI-Based Texture Analysis to Differentiate Sinonasal Squamous Cell Carcinoma from Inverted Papilloma

BACKGROUND AND PURPOSE

Because sinonasal inverted papilloma can harbor squamous cell carcinoma, differentiating these tumors is relevant. The objectives of this study were to determine whether MR imaging-based texture analysis can accurately classify cases of noncoexistent squamous cell carcinoma and inverted papilloma and to compare this classification performance with neuroradiologists' review.

MATERIALS AND METHODS

Adult patients who had inverted papilloma or squamous cell carcinoma resected were eligible (coexistent inverted papilloma and squamous cell carcinoma were excluded). Inclusion required tumor size of >1.5 cm and preoperative MR imaging with axial T1, axial T2, and axial T1 postcontrast sequences. Five well-established texture analysis algorithms were applied to an ROI from the largest tumor cross-section. For a training dataset, machine-learning algorithms were used to identify the most accurate model, and performance was also evaluated in a validation dataset. On the basis of 3 separate blinded reviews of the ROI, isolated tumor, and entire images, 2 neuroradiologists predicted tumor type in consensus.

RESULTS

The inverted papilloma (n = 24) and squamous cell carcinoma (n = 22) cohorts were matched for age and sex, while squamous cell carcinoma tumor volume was larger (P = .001). The best classification model achieved similar accuracies for training (17 squamous cell carcinomas, 16 inverted papillomas) and validation (7 squamous cell carcinomas, 6 inverted papillomas) datasets of 90.9% and 84.6%, respectively (P = .537). For the combined training and validation cohorts, the machine-learning accuracy (89.1%) was better than that of the neuroradiologists' ROI review (56.5%, P = .0004) but not significantly different from the neuroradiologists' review of the tumors (73.9%, P = .060) or entire images (87.0%, P = .748).

CONCLUSIONS

MR imaging-based texture analysis has the potential to differentiate squamous cell carcinoma from inverted papilloma and may, in the future, provide incremental information to the neuroradiologist.