High-sensitivity C reactive protein (hs-CRP) has been associated with outcomes in adult congenital heart disease (ACHD). However, its prognostic value beyond N-terminal pro B type natriuretic peptide (NT-proBNP) or troponin T remains unknown. We studied the temporal evolution of hs-CRP, as well as the relation between hs-CRP and adverse clinical outcomes independent of NT-proBNP and troponin T in patients with ACHD.
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Advances in medical imaging allow non-invasive visualisation and quantification of structural changes related to OA progression. Quantitative morphometric analysis (QMA) using micro-computed tomography (microCT) was shown to be sensitive to bone, cartilage, and whole-joint changes in preclinical animal models of knee OA [1]. As elastic links, each distal/proximal component of the joint can move relative to one another - changing the joint pose and affecting whole-joint QMA metrics. Control of joint pose and alignment is vital to maintaining the reproducibility and sensitivity of these measurements. Develop a novel micro-computed tomography (microCT) imaging protocol that allows reproducible and longitudinal whole-joint QMA measurements of the mouse knee. A mouse positioning device compatible with the in vivo microCT animal bed (vivaCT80, Scanco Medical AG, Switzerland) was designed in-house and 3D printed. Seven healthy excess C57Bl/10 male mice (n = 14 knees) were sacrificed and placed in the positioning device, then scanned with microCT at 10.4 μm voxel size. Each mouse was scanned five times, with repositioning between scans. Fully automated joint alignment was done by representing the tibia's rough shape and relative position using lower-order spherical harmonics descriptors (SPHARM), which describe objects of spherical topology as a weighted sum of spherical harmonic basis functions [2]. The joint centre of mass was measured from the aligned images, defined as a vector with length, λ (mm), and orientations, α (°); β (°); and γ (°), connecting the centres of mass of the femur and tibia [1]. Reproducibility was calculated as precision error, expressed in both absolute value (PESD) and coefficients of variation (PE%CV), as well as intraclass correlation coefficient (ICC). The protocol was applied to a longitudinal study using four healthy C57Bl/10 mice (n = 8 knees). Each mouse was scanned in vivo weekly for 9 weeks and processed. Joint centre of mass was calculated and its precision expressed as relative standard deviation (RSD). Exemplar joint centre of mass measurements using the protocol are shown in Figure 1. For repeated measurements, high ICC were obtained for all parameters (ICC λ: 0.832, α: 0.912, β: 0.892, γ: 0.903), indicating excellent reproducibility (ICC > 0.75). Low precision errors (PE(SD) λ: 0.08, α: 4.08, β: 2.87, γ: 4.19; PE(%CV) λ: 2.69%, α: 6.81%, β: 3.03%, γ: 2.79%) were also obtained. The novel protocol, consisting of a positioning device and a SPHARM image processing workflow, enables highly reproducible QMA of the mouse knee. The protocol has been applied to an in vivo longitudinal study of an OA mouse model to reveal changes associated with disease progression. Next steps involve validation with histopathological analysis. Discovery Projects scheme from the Australian Research Council (DP180101838). None CORRESPONDENCE ADDRESS: [email protected]
Ischemic mitral regurgitation can be treated with a restrictive mitral annuloplasty, with or without coronary revascularization. In this study, the extent of reverse remodeling of the left ventricle following this strategy is assessed, as well as the factors that influence it.Eighty-seven consecutive patients with ischemic mitral regurgitation and a mean ejection fraction of 32+/-10% underwent restrictive mitral annuloplasty (downsizing by two ring sizes, median ring size 26), with additional coronary revascularization in 75 patients. All underwent transthoracic echocardiography 18 months after surgery to assess residual mitral regurgitation, mitral valve gradient and left ventricular end-systolic and end-diastolic dimensions. Univariate and multivariate analysis was performed to identify predictors for reverse remodeling, defined as a 10% reduction in left ventricular dimension. Receiver-operating characteristic analysis was used to identify cut-off values for preoperative left ventricular dimensions in predicting reverse remodeling.Early mortality was 8.0% (seven patients, three non-cardiac), late mortality was 7.5% (six patients, four non-cardiac). There were two reoperations (redo annuloplasty), and four readmissions for heart failure. At 29 months follow-up, NYHA class improved from 3.0+/-0.9 to 1.3+/-0.5 (P<0.01). Mitral regurgitation grade decreased from 3.1+/-0.5 to 0.6+/-0.6 at 18 months, left ventricular end-systolic dimension decreased from 52+/-8 to 44+/-11 mm (P<0.01), and end-diastolic dimension from 64+/-8 to 58+/-10mm (P<0.01). Multivariate analysis identified preoperative left ventricular end-diastolic dimension as the single best factor in predicting occurrence of reverse remodeling. For end-systolic dimension, 51mm was the optimal cut-off value to predict reverse remodeling (specificity and sensitivity 81%, area under curve 0.85); for end-diastolic dimension, the cut-off value was 65mm (specificity and sensitivity 89%, area under curve 0.92).Stringent restrictive mitral annuloplasty with or without revascularization provides excellent clinical results with acceptable mortality. At 18 months follow-up, there is no significant residual mitral regurgitation. Reverse remodeling occurs in the majority of patients, but is limited by preoperative left ventricular dimensions. In patients with a left ventricular end-diastolic dimension exceeding 65mm, additional surgical procedures are necessary to try and obtain reverse remodeling in this subgroup.
