scholarly journals Maturational patterns of left ventricular rotational mechanics in pre-term infants through 1 year of age

2020 ◽  
Vol 30 (9) ◽  
pp. 1238-1246
Author(s):  
Gloria C. Lehmann ◽  
Philip T. Levy ◽  
Meghna D. Patel ◽  
Timothy Sekarski ◽  
HongJie Gu ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Neonatal Period ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Term Infants ◽  
Apical Rotation ◽  
Cardiopulmonary Complications ◽  
Rotational Mechanics ◽  
The Impact ◽  
Over Time

AbstractBackground:Pre-mature birth impacts left ventricular development, predisposing this population to long-term cardiovascular risk. The aims of this study were to investigate maturational changes in rotational properties from the neonatal period through 1 year of age and to discern the impact of cardiopulmonary complications of pre-maturity on these measures.Methods:Pre-term infants (<29 weeks at birth, n = 117) were prospectively enrolled and followed to 1-year corrected age. Left ventricular basal and apical rotation, twist, and torsion were measured by two-dimensional speckle-tracking echocardiography and analysed at 32 and 36 weeks post-menstrual age and 1-year corrected age. A mixed random effects model with repeated measures analysis was used to compare rotational mechanics over time. Torsion was compared in infants with and without complications of cardiopulmonary diseases of pre-maturity, specifically bronchopulmonary dysplasia, pulmonary hypertension, and patent ductus arteriosus.Results:Torsion decreased from 32 weeks post-menstrual age to 1-year corrected age in all pre-term infants (p < 0.001). The decline from 32 to 36 weeks post-menstrual age was more pronounced in infants with cardiopulmonary complications, but was similar to healthy pre-term infants from 36 weeks post-menstrual age to 1-year corrected age. The decline was due to directional and magnitude changes in apical rotation over time (p < 0.05).Conclusion:This study tracks maturational patterns of rotational mechanics in pre-term infants and reveals torsion declines from the neonatal period through 1 year. Cardiopulmonary diseases of pre-maturity may negatively impact rotational mechanics during the neonatal period, but the myocardium recovers by 1-year corrected age.

scholarly journals Comparison of left ventricular rotational mechanics between term and extremely premature infants over the first week of age

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001458
Author(s):  
Aisling Smith ◽  
Neidin Bussmann ◽  
Phillip Levy ◽  
Orla Franklin ◽  
Naomi McCallion ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Left Ventricular ◽  
Strong Positive Correlation ◽  
Term Infants ◽  
Time Points ◽  
Apical Rotation ◽  
Extremely Preterm ◽  
Basal Rotation ◽  
Rotational Mechanics

ObjectiveLeft ventricle (LV) rotational mechanics is an emerging tool to characterise LV function, but warrants further evaluation in neonates. The aim of this study was to compare LV rotational mechanics between term and extremely preterm babies over the first week of age.MethodsIn this prospective study, we serially assessed LV rotational parameters in 50 term infants and compared them with a historical dataset of 50 preterm infants born <29 weeks gestation. LV basal and apical rotation, LV twist, LV twist/untwist rate and torsion were derived using two-dimensional speckle tracking echocardiography at three time points over the first week of age.ResultsThere was no change in LV twist, LV torsion, basal rotation or apical rotation in term infants over the study period (all p>0.05). LV twist and torsion were higher in preterm infants, and increased over time. In preterm infants, basal rotation evolved from anticlockwise to clockwise rotation. Apical rotation remained anticlockwise in both groups (all p>0.05). LV twist rate (LVTR) and untwist rate was higher in preterm infants and increased over the three time points (all p>0.05). There was a strong positive correlation between LV torsion and LV untwist rate (LVUTR) in the entire cohort during the third scan.ConclusionTerm infants exhibit minimal LV twist which remains unchanged over the first week of age. This is in contrast to premature infants who demonstrate increasing indices of twist, torsion, LVTR and LVUTR over the first week, likely as a compensatory mechanism for reduced LV compliance.

scholarly journals The Impact of Overnight Orthokeratology on Accommodative Response in Myopic Subjects

2020 ◽  
Vol 9 (11) ◽  
pp. 3687
Author(s):  
Ana F. Pereira-da-Mota ◽  
Jéssica Costa ◽  
Ana Amorim-de-Sousa ◽  
José M. González-Méijome ◽  
António Queirós
Keyword(s):  
Repeated Measures ◽  
Friedman Test ◽  
Repeated Measures Anova ◽  
Accommodative Response ◽  
Baseline Levels ◽  
Accommodative Lag ◽  
Objectively Measured ◽  
The Impact ◽  
Lens Wear ◽  
Over Time

This study aimed to evaluate the effects of two months of orthokeratology (OK) treatment in the accommodative response of young adult myopes. Twenty eyes (21.8 ± 1.8 years) were fitted with the Paragon CRT® 100 LENS to treat myopia between −1.00 and −2.00 D. Low- and high-contrast visual acuity (LCDVA and HCDVA), central objective refraction, light disturbance (LD), and objective accommodative response (using the Grand Seiko WAM-5500 open-field autorefractometer coupled with a Badal system) were measured at baseline (BL) before lens wear and after 1, 15, 30, and 60 nights of OK. Refractive error correction was achieved during the first fifty days of OK lens wear, with minimal changes afterwards. LD analysis showed a transient increase followed by a reduction to baseline levels over the first 30 nights of treatment. The accommodative response was lower than expected for all target vergences in all visits (BL: 0.61 D at 1.00 D to 0.96 D at 5.00 D; 60 N: 0.36 D at 1.00 D to 0.79 D at 5.00 D). On average, the accommodative lag decreases over time with OK lens wear. However, these differences were not statistically significant (p > 0.050, repeated-measures ANOVA and Friedman test). This shows that overnight OK treatment does not affect objectively measured the accommodative response of young, low myopic eyes after two months of treatment stabilization.

scholarly journals P784 Cardiac remodelling in elite rowers - insights from novel echocardiographic techniques

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Kleinnibbelink ◽  
N M Panhuyzen-Goedkoop ◽  
H G Hulshof ◽  
A P J Van Dijk ◽  
K P George ◽  
...  
Keyword(s):  
Exercise Training ◽  
Elite Athlete ◽  
Left Ventricular ◽  
Cardiac Remodelling ◽  
Physiological Adaptation ◽  
Training Volume ◽  
Short Term ◽  
Apical Rotation ◽  
Elite Rowers ◽  
The Impact

Abstract Funding Acknowledgements No financial support Background Chronic exercise training leads to cardiac remodelling; the so-called Athlete’s Heart. Previous studies are often limited by a cross-sectional design whilst longitudinal training studies are often constrained to the assessment of non-athletes. Echocardiography provides comprehensive assessment of mechanics and may give additional insight into short-term changes in training volume in the elite athlete. Purpose To examine the impact of a short-term (9 months) increase in training volume on cardiac structure and mechanics in elite international competing rowers. Methods As part of the work-up to the 2012 Olympic Games, twenty-seven elite rowers (26.4 ± 3.7 years, 19 male) underwent baseline echocardiography prior to and post (9-months) a planned increase in training volume. Conventional echocardiographic indices including mechanics of all cardiac chambers were assessed. Results In response to increased training volume, there was a significant increase in left ventricular (LV) size (IVSd 9.2 ± 1.2 to 9.7 ± 1.1 mm, p = 0.001; PWd 8.3 ± 1.3 to 8.7 ± 1.4 mm, p = 0.013), LVIDd (56.5 ± 4.6 to 57.9 ± 4.2 mm, p = 0.001), and LVMi (90.2 ± 17.8 to 100.8 ± 17.1 g/m2, p = 0.000), see table. There was a significant increase in LV twist (9.2 ± 4.5 to 11.2 ± 4.7 °, p = 0.04; basal rotation -4.4 ± 3.1 to -4.5 ± 3.4 °, p = 0.84; apical rotation 5.8 ± 3.4 to 7.1 ± 3.7 °, p = 0.011), see figure, however, there were no changes in any other conventional indices of function or any other cardiac mechanics. There was a significant increase in left atrial (LA) volume (58.8 ± 15.2 to 65.3 ± 17.6 mm, p = 0.01) whilst no changes were observed in right heart structure. Conclusion An increase in exercise training volume in elite rowers across 9-months induced mild balanced structural remodelling of the LV and LA with a concomitant increase in LV twist. Contradictory to findings in non-athletes, there was no increase in right ventricular or atrial structure or function which may be representative of the elite athlete status and possibly already at threshold for physiological adaptation. Abstract P784 Figure.

scholarly journals Association between cognitive phenotype in unaffected siblings and prospective 3- and 6-year clinical outcome in their proband affected by psychosis

2020 ◽  
pp. 1-11
Author(s):  
Thijs J. Burger ◽  
Frederike Schirmbeck ◽  
Jentien M. Vermeulen ◽  
Piotr J. Quee ◽  
Mariken B. de Koning ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Psychotic Disorders ◽  
Cognitive Vulnerability ◽  
Familial Risk ◽  
Related Factors ◽  
Cross Sectional ◽  
The Impact ◽  
Cognitive Alterations ◽  
Over Time

Abstract Background Cognitive alterations are a central and heterogeneous trait in psychotic disorders, driven by environmental, familial and illness-related factors. In this study, we aimed to prospectively investigate the impact of high familial risk for cognitive alterations, unconfounded by illness-related factors, on symptomatic outcomes in patients. Methods In total, 629 probands with non-affective psychosis and their sibling not affected by psychosis were assessed at baseline, 3- and 6-year follow-up. Familial cognitive risk was modeled by three cognitive subtypes (‘normal’, ‘mixed’ and ‘impaired’) in the unaffected siblings. Generalized linear mixed models assessed multi-cross-sectional associations between the sibling cognitive subtype and repeated measures of proband symptoms across all assessments. Between-group differences over time were assessed by adding an interaction effect of time and sibling cognitive subtype. Results Probands affected by psychosis with a sibling of the impaired cognitive subtype were less likely to be in symptomatic remission and showed more disorganization across all time points. When assessing differences over time, probands of siblings with the impaired cognitive subtype showed less remission and less improvement of disorganization after 3 and 6 years relative to the other subtypes. They also showed less reduction of positive, negative and excitement symptoms at 6-year follow-up compared to probands with a sibling of the normal cognitive subtype. Conclusions Cross-sibling pathways from higher levels of familial cognitive vulnerability to worse long-term outcomes may be informative in identifying cognition-related environmental and genetic risks that impact psychotic illness heterogeneity over time.

scholarly journals Influence of Participation in a Quality Improvement Collaborative on Staff Perceptions of Organizational Sustainability

2021 ◽  
Author(s):  
James H Ford II ◽  
Aaron Gilson
Keyword(s):  
Quality Improvement ◽  
Repeated Measures ◽  
Addiction Treatment ◽  
Quality Improvement Collaborative ◽  
Free Standing ◽  
Staff Perceptions ◽  
Participation Level ◽  
Job Function ◽  
The Impact ◽  
Over Time

Abstract Background: Sustainability capacity (SC), which is an organization’s ability to implement and maintain change, is influenced by internal attributes, environmental contextual influencers, and intervention attributes. Temporal changes in staff SC perceptions, as well as the influence of quality improvement collaborative (QIC) participation, has generally not been explored. This project addresses this gap, measuring staff SC perceptions at four time points (baseline and every 9 months) for clinics participating in an intervention – the Network for the Improvement of Addiction Treatment QIC initiative (called NIATx200).Methods: A mixed linear model repeated measures analysis was applied to matched staff members (n=908, representing 2,329 total cases) across the evaluation timeframe. Three separate statistical models assessed potential predictors of SC perceptions: Time (Models I-III); NIATx200 intervention, staff job function, and tenure (Models II &III); and NIATx200 participation hours and four organizational variables (Model III).Results: For Model I, staff perceptions of total SC increased throughout most of the study (t1,4=-6.74, p<.0001; t2,4=-3.100, p<.036; t3,4=-0.23, p=ns). Model II did not change Model I’s overall Time effect, but combined NIATx200 services (t=-2.23, p=.026), staff job function (t=-3.27, p=.001), and organizational administrators (t=-3.50, p=.001) were also significantly associated with greater perceptions of total SC. Inclusion of additional variables in Model III demonstrated the importance of a higher participation level (t=-3.09, p<.002) and being in a free-standing clinic (t=-2.06, p<.04) on staff perceptions of total SC. Conclusion: Although staff exposure to sustainability principals was minimal in NIATx200, staff perceptions about their organization’s SC significantly differed over time. However, an organization’s participation level in a QIC became the principal predictor of staff SC perceptions, regardless of other factors’ influence. Given these findings, it is possible to develop and introduce specific sustainability content within the structure of a QIC to assess the impact on staff SC perceptions over time and the sustainment of organizational change.Trial Registration: ClinicalTrials.gov, NCT00934141 Registered July 6, 2009. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT00934141

Optimizing dosing in navigation interventions across the cancer continuum: A planned secondary data analysis from the Patient Care Connect implementation.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 174-174
Author(s):  
Elizabeth Ann Kvale ◽  
Maria J Pisu ◽  
Courtney Williams ◽  
Kelly Kenzik ◽  
Andres Azuero ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Linear Models ◽  
Secondary Data ◽  
Administrative Claims ◽  
Cost Models ◽  
Total Cost ◽  
Baseline Cost ◽  
Optimal Approach ◽  
The Impact ◽  
Over Time

174 Background: Patient navigation programs in cancer care have historically focused on assisting persons to overcome barriers to accessing care. Evidence is emerging to support the impact of navigation interventions across the cancer continuum. However, navigation programs have varied designs, resulting in a lack of clarity about the optimal approach to delivering services to patients, and a lack of evidence linking program design to outcomes. Methods: A planned retrospective analysis of Medicare administrative claims for a population of older beneficiaries diagnosed with cancer: The main exposure was the number of contacts in person or over the phone with PCCP navigators in the 6 month period starting from the quarter in which patients enrolled in the PCCP. Repeated measures generalized linear models with normal distribution were used to evaluate trends in total cost over time based on: number of contacts, quarters post-enrollment (TIME), and the interaction between number of contacts and TIME. Intra-correlation was controlled for repeated measures. Results: 4,337 patients were included in this analysis. 17.9% had one contact, 17.7% had two, 22.2% had 3-4, 24.2% had 5-10, and 18.0% had more than 10 contacts. African Americans had a greater number of participants with more than 10 navigator contacts, as stage 4 cancers, and initial or end-of-life phase of care. Patients who received more than 3 contacts had significantly higher levels of baseline cost. Models to evaluate total cost over time demonstrate an effect of navigator contact on cost that is associated with number of contacts. This trend is statistically significant at 3-4 contacts or more, and remains significant at 10 or more contacts. Conclusions: Increased navigator contact is associated with increased slope of decline in utilization and cost indicates that navigation programs should be adequately resourced to deliver care that enables navigators to have contact with patients a minimum of 3-4 contacts over a six month period.

Safety profile of ripretinib, including impact of alopecia, and Palmar-Plantar Erythrodysesthesia Syndrome (PPES) on patient-reported outcomes (PROs), in ≥ fourth-line advanced gastrointestinal stromal tumors (GIST): Analyses from INVICTUS.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11539-11539
Author(s):  
Suzanne George ◽  
Michael C. Heinrich ◽  
John Raymond Zalcberg ◽  
Sebastian Bauer ◽  
Hans Gelderblom ◽  
...  
Keyword(s):  
Safety Profile ◽  
Repeated Measures ◽  
Fixed Effects ◽  
Statistical Significance ◽  
P Value ◽  
Tolerability Profile ◽  
Patient Reported ◽  
The Impact ◽  
Advanced Gist ◽  
Over Time

11539 Background: Ripretinib is a novel switch-control TKI that broadly inhibits KIT and PDGFRA kinase signaling. In INVICTUS (NCT03353753), a randomized, double-blind, placebo (PBO)-controlled trial of ripretinib in ≥4th-line advanced GIST, ripretinib reduced the risk of disease progression or death by 85% vs PBO with a favorable overall safety profile. Common ( > 20%) adverse events (AEs) included, but were not limited to, alopecia and PPES. Exploratory analyses evaluated the impact of alopecia and PPES on quality of life (QoL). Methods: Patients (pts) with advanced GIST previously treated with at least imatinib, sunitinib, and regorafenib were randomized (2:1) to ripretinib 150 mg QD or PBO. AEs were graded using CTCAE v4 and PROs collected using EQ-5D-5L (EQ5D) and EORTC QLQ-C30 (C30). Repeated measures (RM) models assessed the impact of alopecia and PPES on 5 PROs (EQ5D visual analogue scale; and C30 physical functioning, role functioning, and the overall health and overall QoL questions) within the ripretinib arm. Fixed effects were sex, alopecia/PPES, and ECOG scores at baseline. Results: 128/129 randomized pts received treatment (85 ripretinib 150 mg QD; 43 PBO). Alopecia, regardless of causality, occurred in 44 (51.8%) on ripretinib (34 [40.0%] grade 1; 10 [11.8%] grade 2) and 2 (4.7%) on PBO (both grade 1). PPES occurred in 18 (21.2%) on ripretinib (11 [12.9%] grade 1; 7 [8.2%] grade 2); none on PBO. The median times in days to first occurrence and worst severity grade with ripretinib were 57.0 and 62.5 for alopecia; 56.5 and 57.0 for PPES. The RM models showed a slight trend towards improvement in PRO score over time for pts with alopecia; the only association reaching a P-value of < 0.05 was between alopecia and increased overall QoL. None of the associations between PPES and PRO scores reach P < 0.05. All PRO p-values are nominal, and no statistical significance is being claimed. Conclusions: Ripretinib had a favorable overall safety and tolerability profile. When stratified by alopecia and PPES, patient-reported assessments of function, overall health, and overall QoL were maintained over time. For both alopecia and PPES, onset and maximum severity occurred almost simultaneously, indicating that these events generally did not progressively worsen. These results suggest that alopecia and PPES are manageable and do not have a negative effect on function, overall health, and QoL. Clinical trial information: NCT03353753 .

Abstract 2487: Torsional and Reverse Rotational Mechanics of the Left Ventricular Apex Is Abnormal in Patients with Type 2 Diabetes Mellitus Independent of Presence of Hypertension, Left Ventricular Hypertrophy, Elevated Filling Pressures and Left Atrial Volume

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Wei Zhao ◽  
Peng Li ◽  
Geu-Ru Hong ◽  
Shizhen Liu ◽  
Helene Houle ◽  
...  
Keyword(s):  
Ventricular Hypertrophy ◽  
Left Atrial Volume ◽  
Rotation Velocity ◽  
Left Ventricular ◽  
List Type ◽  
Type 2 Dm ◽  
Apical Rotation ◽  
Rotational Mechanics ◽  
Normal Lvef

Background : Diastolic dysfunction (DD) is common in patients with Type 2 DM even in the absence of HTN and LVH. We tested whether apical rotational mechanics offered any additional insights into DD in DM over conventional echo-Doppler measures. Methods: We studied 4 groups : 12 normals (wall thickness-WT 0.9±0.1cm); 17 patients with DM (WT 1.0±0.1cm, HbA1c 7±1%, BP 128±4/68±5 mmHg); 16 patients with DM +HTN (WT 0.9±0.1cm, HbA1c 7±1%, BP 134±23/72±18 mmHg); and 20 patients with DM+HTN+LVH (WT 1.4±0.2cm, HbA1c 7±4%, BP 135±13/76±9mmHg). All patients had normal LVEF and mitral E/A ratio. SAX of the LV apex and base were obtained. Velocity Vector Imaging (Siemens, CA) was used to measure: Longitudinal myocardial velocity (LMV, cm/sec) and strain (LS,%); Apical rotation velocity (ARV, cm/sec)and reverse rotation velocity(ARRV, cm/sec); Apical rotation (AR, degree) and LV torsion-LVTOR (degree/cm, and Circumferential (CS,%) and Radial strains (RS,%). Results: Figure shows LVTOR and % reduction in ARRV data. All other data will be presented. Thus, LV torsion is increased in DM alone or DM+HTN (-LVH) groups. But ARRV is reduced by ~ 20% in these groups even with relatively normal E/E’ ratio and LAVI. In the DM+HTN+LVH group, E/E’ and LAVI are increased and apical rotational mechanics resemble the same spectrum as the above groups but are more severe (~25% reduction in ARRV). Thus, reduction in ARRV is a marker of early DD in DM even in the absence of LVH . Conclusions: Apical rotational mechanics is more sensitive than conventional echo-Doppler measures to identify myocardial DD in type 2 DM even in the presence of normal E/A ratio, LAVI and LVEF, and in the absence of HTN and/or LVH.

Brain Type Natriuretic Peptide

2008 ◽  
Vol 27 (5) ◽  
pp. 343-346 ◽  
Author(s):  
Patricia Nash
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Transplant Rejection ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Preterm Neonates ◽  
Term Infants ◽  
End Diastolic Volume ◽  
Ventricular Diastolic Dysfunction ◽  
Near Term

BRAIN TYPE NATRIURETIC PEPTIDE, also called B-type natriuretic peptide (BNP), has emerged as a valuable diagnostic and prognostic marker in the assessment of heart failure in adults.1–7 Serum BNP levels have also been shown to differentiate pulmonary from cardiac causes of dyspnea and to be useful as a screening tool for ventricular hypertrophy, ventricular diastolic dysfunction, transplant rejection, and risk for sudden death in adult patients with congestive heart failure (CHF).3,7,8 In pediatric patients, BNP levels have been found to increase with a hemodynamically significant ventricular septal defect and to correlate with the volume of the shunt and the left ventricular end diastolic volume.7 Recently, BNP levels have been investigated for use in determining the hemodynamic significance of a patent ductus arteriosus (PDA) in preterm neonates.3,7,9–11 They have also been studied for use in the diagnosis and management of persistent pulmonary hypertension in term and near-term infants.6 This article reviews BNP terminology, structure, physiology, measurement, and potential utility in the NICU.

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