Optimal threshold score of aortic valve calcification for identification of significant aortic stenosis on non-electrocardiographic-gated computed tomography.

OBJECTIVES: This study evaluated the association between aortic valve calcification (AVC) and aortic stenosis (AS) by scoring the AVC to determine the threshold scores for significant AS on non-electrocardiographic (ECG)-gated computed tomography (CT). METHODS: We retrospectively analyzed the AVC scores of 5385 patients on non-contrast non-ECG-gated CT, who underwent transthoracic echocardiography (TTE) from March 1, 2013, to December 26, 2019, at our institution. Multivariable logistic regression models were used to identify potential risk factors for significant AS. The thresholds for significant AS were computed using receiver operator characteristic (ROC) curves, based on the AVC scores after propensity score matching. RESULTS: A significant association was found between AS and age (p < 0.001; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06), female sex (p < 0.001; OR, 4.5; 95% CI, 2.75-7.36), bicuspid aortic valve (p < 0.001; OR, 23.2; 95% CI, 7.35-72.9), and AVC score (AVC score/100) (p < 0.001; OR, 1.82; 95% CI, 1.71-1.95). All sex-specific AVC thresholds for significant AS (moderate and over AS severity, moderate and over AS severity without discordance, discordant severe AS, and concordant severe AS) showed high sensitivity and specificity (AUC, 0.939-0.968; sensitivity, 84.6-96%; specificity, 84.2-97.1%). CONCLUSIONS: We determined the optimal AVC threshold scores for significant AS, which may aid in diagnosing significant asymptomatic AS on incidental detection of AVC through non-ECG-gated CT for non-cardiac indications. KEY POINTS: • Increased frequency of non-electrocardiographic (ECG)-gated computed tomography (CT) for non-cardiac indications has led to the increased incidental identification of aortic valve calcification (AVC). • It is important to identify patients with significant aortic stenosis (AS) who require additional echocardiographic assessment on incidental detection of AVC via non-ECG-gated CT. • We determined the AVC thresholds with high sensitivity and specificity to identify significant AS on non-ECG-gated CT, which could lead to early diagnosis of asymptomatic significant AS and improved prognosis.

Effect of Neutral, Internal, and External Focus on Drop Jump Performance: Is Drop Jump Performance Affected by Plyometric Training Experience?

ABSTRACT: Furuhashi, Y, Hioki, Y, Yoshimoto, S, and Hayashi, R. The effect of neutral, internal, and external focus on drop jump performance: is drop jump performance affected by plyometric training experience? J Strength Cond XX(X): 000-000, 2021-Providing an external focus of attention through verbal instructions can improve the drop jump (DJ) performance, which differs based on the skill level of athletes. The purpose of this study was to assess the effect of change of focus of attention on the performance of DJs in experienced and inexperienced athletes. Thirty-eight male collegiate athletes divided into the experienced group (E group: age, 21.5 ± 1.4 years; height, 173.4 ± 5.7 cm; and body mass, 65.7 ± 6.2 kg) and the inexperienced group (I group: age, 21.9 ± 1.5 years; height, 172.8 ± 5.1 cm; and body mass, 68.7 ± 5.5 kg) performed 2 trials of DJs after listening to instructions designed to evoke a neutral, internal, or external focus of attention. Contact time (CT), jump height (JH), reactive strength index (RSI), and leg-spring stiffness (k vert ) were recorded during DJ and compared between the 2 groups using a repeated-measures analysis of variance. In the E group, the neutral condition was associated with a significantly higher RSI, JH, and k vert than the internal and external conditions ( p < 0.05). In the I group, the external condition was associated with significantly higher RSI and k vert and shorter CT than other conditions ( p < 0.05). Therefore, this suggests that attentional focus strategies need to be selected depending on DJ experience: A neutral focus may be preferable for athletes experienced in DJs, whereas an external focus may be more suitable for athletes with lesser DJ experience.