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Τρίτη 14 Φεβρουαρίου 2023

MRI Investigation of the Differential Impact of Left Ventricular Ejection Fraction After Myocardial Infarction in Elderly vs. Nonelderly Patients to Predict Readmission for Heart Failure

AlexandrosSfakianakis shared this article with you from Inoreader

Background

Patients with ST-segment elevation myocardial infarction (STEMI), especially elderly individuals, have an increased risk of readmission for acute heart failure (AHF).

Purpose

To study the impact of left ventricular ejection fraction (LVEF) by MRI to predict AHF in elderly (>70 years) and nonelderly patients after STEMI.

Study Type

Prospective.

Population

Multicenter registry of 759 reperfused STEMI patients (23.3% elderly).

Field Strength/Sequence

1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences.

Assessment

One-week MRI-derived LVEF (%) was quantified. Sequential MRI data were recorded in 579 patients. Patients were categorized according to their MRI-derived LVEF as preserved (p-LVEF, ≥50%), mildly reduced (mr-LVEF, 41%–49%), or reduced (r-LVEF, ≤40%). Median follow-up was 5 [2.33–7.54] years.

Statistical Tests

Univariable (Student's t, Mann–Whitney U, chi-square, and Fisher's exact tests) and multivariable (Cox proportional hazard regression) comparisons and continuous-time multistate Markov model to analyze transitions between LVEF categories and to AHF. Hazard ratios (HR) with 95% confidence intervals (CIs) were computed. P < 0.05 was considered statistically significant.

Results

Over the follow-up period, 79 (10.4%) patients presented AHF. MRI-LVEF was the most robust predictor in nonelderly (HR 0.94 [0.91–0.98]) and elderly patients (HR 0.94 [0.91–0.97]). Elderly patients had an increased AHF risk across the LVEF spectrum. An excess of risk (compared to p-LVEF) was noted in patients with r-LVEF both in nonelderly (HR 11.25 [5.67–22.32]) and elderly patients (HR 7.55 [3.29–17.34]). However, the mr-LVEF category was associated with increased AHF risk only in elderly patients (HR 3.66 [1.54–8.68]). Less transitions to higher LVEF states (n = 19, 30.2% vs. n = 98, 53%) and more transitions to AHF state (n = 34, 53.9% vs. n = 45, 24.3%) were observed in elderly than nonelderly patients.

Data Conclusion

MRI-derived p-LVEF confers a favorable prognosis and r-LVEF identifies individuals at the highest risk of AHF in both elderly and nonelderly patients. Nevertheless, an excess of risk was also found in the mr-LVEF category in the elderly group.

Evidence Level

2.

Technical Efficacy

Stage 2.
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QSM Throughout the Body

AlexandrosSfakianakis shared this article with you from Inoreader

Magnetic materials in tissue, such as iron, calcium, or collagen, can be studied using quantitative susceptibility mapping (QSM). To date, QSM has been overwhelmingly applied in the brain, but is increasingly utilized outside the brain. QSM relies on the effect of tissue magnetic susceptibility sources on the MR signal phase obtained with gradient echo sequence. However, in the body, the chemical shift of fat present within the region of interest contributes to the MR signal phase as well. Therefore, correcting for the chemical shift effect by means of water-fat separation is essential for body QSM. By employing techniques to compensate for cardiac and respiratory motion artifacts, body QSM has been applied to study liver iron and fibrosis, heart chamber blood and placenta oxygenation, myocardial hemorrhage, atherosclerotic plaque, cartilage, bone, prostate, breast calcification, and kidney stone.
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Use of a novel body mandibular plane (mental foramen–protuberance menti) in analyzing mandibular asymmetry compared with conventional border mandibular plane

AlexandrosSfakianakis shared this article with you from Inoreader

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ABSTRACT
Objectives
To compare a novel body mandibular horizontal plane (mental foramen–protuberance menti; Body-MHP) with the conventional border mandibular horizontal plane (gonion–menton [Me]; Border-MHP) to assess mandibular body inclination and dental compensation of skeletal Class III patients with and without facial asymmetry.
Materials and Methods
Retrospective data obtained from diagnostic cone-beam computed tomography of 90 skeletal Class III patients (mean age, 21.67 ± 2.93 years; range, 15.0–30.6 years) were divided into symmetry (n = 30) and asymmetry groups (n = 60). The asymmetry group was subdivided into roll (n = 30) and non-roll types (n = 30). The differences in body inclination and dental measurements (distance and angle) according to two mandibular planes (Body-MHP and Border-MHP) were assessed in the groups and subgroups.
Results
Mandibular body inclinations relative to the Body-MHP were not different in the roll-type asymmetric mandibl e between the sides, while those relative to the Border-MHP were different (P < .001). For the mandibular first molar positions relative to the Border-MHP, the differences in vertical distance between the sides were undermeasured and the inclination differences were overmeasured when compared relative to the Body-MHP.
Conclusions
The Body-MHP demonstrated better bilateral similarity in body inclination compared with the Border-MHP in patients with roll-type facial asymmetry. The novel body mandibular plane ensures an accurate diagnosis for tooth movement and jaw surgery, particularly in the roll-type asymmetric mandible.
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