Development and Validation of a Protein Risk Score for Mortality in Heart Failure : A Community Cohort Study.

BACKGROUND: Heart failure (HF) is a complex clinical syndrome with high mortality. Current risk stratification approaches lack precision. High-throughput proteomics could improve risk prediction. Its use in clinical practice to guide the management of patients with HF depends on validation and evidence of clinical benefit. OBJECTIVE: To develop and validate a protein risk score for mortality in patients with HF. DESIGN: Community-based cohort. SETTING: Southeast Minnesota. PARTICIPANTS: Patients with HF enrolled between 2003 and 2012 and followed through 2021. MEASUREMENTS: A total of 7289 plasma proteins in 1351 patients with HF were measured using the SomaScan Assay (SomaLogic). A protein risk score was derived using least absolute shrinkage and selection operator regression and temporal validation in patients enrolled between 2003 and 2007 (development cohort) and 2008 and 2012 (validation cohort). Multivariable Cox regression was used to examine the association between the protein risk score and mortality. The performance of the protein risk score to predict 5-year mortality risk was assessed using calibration plots, decision curves, and relative utility analyses and compared with a clinical model, including the Meta-Analysis Global Group in Chronic Heart Failure mortality risk score and N-terminal pro-B-type natriuretic peptide. RESULTS: The development (n = 855; median age, 78 years; 50% women; 29% with ejection fraction <40%) and validation cohorts (n = 496; median age, 76 years; 45% women; 33% with ejection fraction <40%) were mostly similar. In the development cohort, 38 unique proteins were selected for the protein risk score. Independent of ejection fraction, the protein risk score demonstrated good calibration, reclassified mortality risk particularly at the extremes of the risk distribution, and showed greater clinical utility compared with the clinical model. LIMITATION: Participants were predominantly of European ancestry, potentially limiting the generalizability of the findings to different patient populations. CONCLUSION: Validation of the protein risk score demonstrated good calibration and evidence of predicted benefits to stratify the risk for death in HF superior to that of clinical methods. Further studies are needed to prospectively evaluate the score's performance in diverse populations and determine risk thresholds for interventions. PRIMARY FUNDING SOURCE: Division of Intramural Research at the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Proteomics for heart failure risk stratification: a systematic review.

BACKGROUND: Heart failure (HF) is a complex clinical syndrome with persistently high mortality. High-throughput proteomic technologies offer new opportunities to improve HF risk stratification, but their contribution remains to be clearly defined. We aimed to systematically review prognostic studies using high-throughput proteomics to identify protein signatures associated with HF mortality. METHODS: We searched four databases and two clinical trial registries for articles published from 2012 to 2023. HF proteomics studies measuring high numbers of proteins using aptamer or antibody-based affinity platforms on human plasma or serum with outcomes of all-cause or cardiovascular death were included. Two reviewers independently screened articles, extracted data, and assessed the risk of bias. A third reviewer resolved conflicts. We assessed the risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposure tool. RESULTS: Out of 5131 unique articles identified, nine articles were included in the review. The nine studies were observational; three used the aptamer platform, and six used the antibody platform. We found considerable heterogeneity across studies in measurement panels, HF definitions, ejection fraction categorization, follow-up duration, and outcome definitions, and a lack of risk estimates for most protein associations. Hence, we proceeded with a systematic review rather than a meta-analysis. In two comparable aptamer studies in patients with HF with reduced ejection fraction, 21 proteins were identified in common for the association with all-cause death. Among these, one protein, WAP four-disulfide core domain protein 2 was also reported in an antibody study on HFrEF and for the association with CV death. We proposed standardized reporting criteria to facilitate the interpretation of future studies. CONCLUSIONS: In this systematic review of nine studies evaluating the association of proteomics with mortality in HF, we identified a limited number of proteins common across several studies. Heterogeneity across studies compromised drawing broad inferences, underscoring the importance of standardized approaches to reporting.

Sphingosine-1-phosphate induces airway smooth muscle hyperresponsiveness and proliferation.

BACKGROUND: The emerging role of sphingosine-1-phosphate (S1P) in regulating smooth muscle functions has led to the exploration of the possibility that this sphingolipid could represent a potential therapeutic target in asthma and other lung diseases. Several studies in animal surrogates have suggested a role for S1P-mediated signaling in the regulation of airway smooth muscle (ASM) contraction, airway hyperresponsiveness, and airway remodeling, but evidence from human studies is lacking. OBJECTIVE: We sought to compare the responsiveness of the airways to S1P in healthy and asthmatic individuals in vivo, in isolated human airways ex vivo, and in murine airways dissected from healthy and house dust mite (HDM)-sensitized animals. METHODS: Airway responsiveness was measured by spirometry during inhalation challenges and by wire myography in airways isolated from human and mouse lungs. Thymidine incorporation and calcium mobilization assays were used to study human ASM cell responses. RESULTS: S1P did not induce contraction of airways isolated from healthy and HDM-exposed mice, nor in human airways. Similarly, there was no airway constriction observed in healthy and asthmatic subjects in response to increasing concentrations of inhaled S1P. However, a 30-minute exposure to S1P induced a significant concentration-dependent enhancement of airway reactivity to methacholine and to histamine in murine and human airways, respectively. HDM-sensitized mice demonstrated a significant increase in methacholine responsiveness, which was not further enhanced by S1P treatment. S1P also concentration-dependently enhanced proliferation of human ASM cells, an effect mediated through S1P receptor type 2, as shown by selective antagonism and S1P receptor type 2 small-interfering RNA knockdown. CONCLUSIONS: Our data suggest that S1P released locally into the airways may be involved in the regulation of ASM hyperresponsiveness and hyperplasia, defining a novel target for future therapies.

Disparities among Black and White patients in plaque burden and composition and long-term impact.

BACKGROUND: Black patients presenting to the catheterization laboratory have more risk factors and worse long-term outcomes. This sub-analysis of the Lipid Rich Plaque (LRP) study quantifies the plaque burden and composition of Black vs White patients and associated outcomes. METHODS: Patients with a singular, self-reported race presenting for cardiac catheterization were enrolled if near-infrared spectroscopy/intravascular ultrasound (NIRS-IVUS) imaging of non-stented, non-culprit (NC) vessels was performed. Lipidic content was quantified at the 4-mm region with maximum Lipid Core Burden Index (maxLCBI4mm). NC major adverse cardiac events (NC-MACE) were defined as: cardiac death, cardiac arrest, non-fatal myocardial infarction, acute coronary syndrome, revascularization, and hospital readmission for angina with >20 % disease progression through 2 years. RESULTS: Among 1346 patients with a singular, self-reported race, 182 were Black. Black vs White patients were more likely to be female, had higher rates of traditional risk factors, and were more likely to present acutely. Both patients and segments were more likely to have maxLCBI4mm > 400 (46.7 % vs 30.6 %, p < 0.001, respectively; 15.5 % vs 8.9 %, p < 0.001, respectively). Vessel size and plaque burden were larger for Black vs White patients. At 2 years, maxLCBI4mm > 400 and Black race were independently predictive of NC-MACE (hazard ratio [HR] maxLCBI4mm > 400: 2.37 [95 % confidence interval (CI) 1.50-3.76, p < 0.001], Black race: 2.8 [95 % CI 1.27-3.42, p = 0.004], pinteraction = 0.137). CONCLUSIONS: Compared to White patients, Black patients had more lipid-rich plaques with greater plaque burden. Both high lipidic burden and Black race were independently predictive of NC-MACE within 2 years. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02033694, NCT02033694.

Characterization of low-density polyethylene (LDPE) films degraded using bacteria strains isolated from oil-contaminated soil.

This study assessed the low-density polyethylene (LDPE) film degradation potential of microorganisms isolated from oil-contaminated soil and also analyzed the morphological and chemical composition of LDPE films after the biodegradation period. The bacteria strains isolated from oil-contaminated soil were standardized and used to degrade the pretreated LDPE films in mineral salt media. Thereafter, they were incubated for 78 days at 37°C in an incubator shaker, and the degraded LDPE films were analyzed quantitatively and qualitatively (using scanning electron microscope (SEM) images and energy dispersal x-ray (EDX)). Isolates A32 and BTT4 amongst other bacteria isolates showed the highest LDPE film degradation activity, with a weight reduction of 71.80% and 89.72% respectively, and were identified using the 16S rRNA sequencing technique. The EDX results showed that LDPE film incubated with A32 has the highest reduction in carbon and nitrogen (23.8% and 44.9% respectively) when compared with the Control. However, LDPE film incubated with BTT4 had an increase in calcium and chlorine (139% and 40% respectively), when compared with the control. Similarly, the SEM images showed the appearance of pinholes, cracks and particles on the surfaces of LDPE films incubated with A32 and BTT4 contrary to the controls. A32 and BTT4 were identified as Proteus mirabilis (Accession number: MN124173.1) and Proteus mirabilis (Accession number: KY027145.1) respectively. Proteus mirabilis showed viable plastic biodegradation potentials and may be useful in the management of plastic waste, leading to a reduction in global plastic waste and a clean environment.

Association of Statins With Nonculprit Coronary Lesions and Adverse Events (from the LRP Study).

Intravascular ultrasound and near-infrared spectroscopy can identify vulnerable coronary atherosclerotic plaques. In this LRP (Lipid-Rich Plaque) substudy, we evaluated the association of statins with nonculprit lesion arterial wall lipidic content and subsequent nonculprit major adverse cardiac events. Patients from the LRP study with known statin use were included. We divided the patients into 2 cohorts-"statin therapy" and "statin-naïve"-upon presentation and then described the intravascular ultrasound and near-infrared spectroscopy analysis based on maximum 4-mm lipid core burden index (maxLCBI4mm). At 2-year follow-up, the patients' clinical events were assessed based on their statin regimen change upon discharge. Finally, patients were stratified by statin intensity based on discharge regimen. Among the 1,526 patients, 1,120 were on a statin versus 396 who were statin-naive upon presentation. Patients on a statin at baseline had a statistically higher rate of cardiovascular risk factors, patients who were statin-naive were more likely to present with an acute coronary syndrome, and the maxLCBI4mm did not differ between the 2 groups (315.67 ± 181.36 vs 325.55 ± 192.16; p = 0.359). These findings were consistent in a secondary analysis evaluating statin intensity. Patients who were switched from no statin to a statin had improved outcomes (nonculprit major adverse cardiac events) compared with patients who were on a statin at baseline without change. In conclusion, despite having a higher burden of nonlipid-related cardiac co-morbidities, patients on a statin at baseline had similar maxLCBI4mm with patients who were statin-naive, regardless of intensity. Initiating a statin at discharge provides the most benefit for events related to nonculprit lesions.

Pattern of histologic variants of ameloblastoma in a secondary health care facility in Lagos state a 5-year retrospective study

Ameloblastoma is a benign epithelial odontogenic neoplasm which is common amongst the Yoruba ethinc group. The various histologic types have been elucidated. Aim: This study aimed to assess the prevalent histologic types of ameloblastoma in a Lagos secondary health care facility. Methodology: A 5-year retrospective review of histopathologically diagnosed slides were retrieved. Data extracted include the age, gender, location, ethnicity and histologic variants were analysed by SPSS version 26. Percentages, ratio, mean, standard deviation and crude odd ratio were determined, and p-value ⩽ 0.05 is considered significant. Result: A total of seventy-seven histopathologically diagnosed ameloblastoma slides were retrieved. Males were more affected than females in ratio 1.2:1 with the mean age 33.61±13.3. Ameloblastoma was commonest in the third decade of life and more in the mandible than maxilla. Yoruba ethnic group was most affected. The commonest histologic type was the unicystic type with intraluminal subtype accounting for the largest proportion. There was significant association between histologic types and gender (p= 0.037). Crude odd ratio revealed the odds in the unicystic type between male and female {p=0.041; CI=95%, OR=2.649(1.042-6.733)} and in the follicular between male and female {p=0.013; CI=95%, OR=3.855(1.321-11.288)}. Conclusion: The unicystic histologic type of ameloblastoma was the commonest, occurring more in females and this was followed by the follicular histologic type which occurred more in males in this Lagos State secondary health care facility.

Redesign of a rapid, low-cost HPV typing assay to support risk-based cervical screening and management.

Accelerated cervical cancer control will require widespread human papillomavirus (HPV) vaccination and screening. For screening, sensitive HPV testing with an option of self-collection is increasingly desirable. HPV typing predicts risk of precancer/cancer, which could be useful in management, but most current typing assays are expensive and/or complicated. An existing 15-type isothermal amplification assay (AmpFire, Atila Biosystems, USA) was redesigned as a 13-type assay (ScreenFire) for public health use. The redesigned assay groups HPV types into four channels with differential cervical cancer risk: (a) HPV16, (b) HPV18/45, (c) HPV31/33/35/52/58 and (d) HPV39/51/56/59/68. Since the assay will be most useful in resource-limited settings, we chose a stratified random sample of 453 provider-collected samples from a population-based screening study in rural Nigeria that had been initially tested with MY09-MY11-based PCR with oligonucleotide hybridization genotyping. Frozen residual specimens were masked and retested at Atila Biosystems. Agreement on positivity between ScreenFire and prior PCR testing was very high for each of the channels. When we simulated intended use, that is, a hierarchical result in order of clinical importance of the type groups (HPV16 > 18/45 > 31/33/35/52/58 > 39/51/56/59/68), the weighted kappa for ScreenFire vs PCR was 0.90 (95% CI: 0.86-0.93). The ScreenFire assay is mobile, relatively simple, rapid (results within 20-60 minutes) and agrees well with reference testing particularly for the HPV types of greatest carcinogenic risk. If confirmed, ScreenFire or similar isothermal amplification assays could be useful as part of risk-based screening and management.

Primary Hypertension with Target Organ Damage among Apparently Healthy Secondary School Students in Osogbo, South-Western Nigeria.

INTRODUCTION: In recent times, there has been an increase in the frequency of hypertension among young people which is contributing globally to the increase in cardiovascular morbidity and mortality in adults. OBJECTIVE: The aim of this study was therefore to determine the prevalence of primary hypertension and its risk factors among apparently healthy secondary school students in Osogbo, southwestern Nigeria. METHODS: A school-based cross-sectional study of a total of 404 secondary school students in Osogbo city. Following informed parental consents of all the students involved in the study, blood pressure (BP) measurements were taken at 2 different visits by auscultation after a negative urine dip stick test result (thus excluding haematuria or proteinuria) in every subject before each BP was measured. RESULTS: The overall prevalence of hypertension and prehypertension in this study was 3.5% (n = 14) and 6.2% (n = 25), respectively. Obesity, consumption of extra - uncooked salt, high parental education and attendance of privately-owned secondary schools were identified risk factors associated with elevated BP. Seven (29%) of 24 subjects with hypertension had features of left ventricular hypertrophy (an evidence of target organ damage) on echocardiography and electrocardiography. All subjects with elevated BP had normal renal scan. CONCLUSION: Hypertension with features of target organ damage exists among adolescents. No known primary aetiologies were found among the hypertensive adolescents in the study and thus they were all deemed to have essential hypertension.

INTRODUCTION: Ces derniers temps, on a constaté une augmentation de la fréquence de l'hypertension chez les jeunes, ce qui contribue globalement à l'augmentation de la morbidité et de la mortalité cardiovasculaires chez les adultes. OBJECTIF: Le but de cette étude était donc de déterminer la prévalence de l'hypertension primaire et de ses facteurs de risque parmi des élèves du secondaire apparemment en bonne santé à Osogbo, sud-ouest du Nigeria. MÉTHODES: Étude transversale en milieu scolaire portant sur un total de 404 élèves du secondaire dans la ville d'Osogbo. Après avoir obtenu le parents informés de tous les élèves participant à l'étude, des mesures de l'étude, la pression artérielle a été mesurée par auscultation lors de 2 visites après un résultat négatif à la bandelette urinaire (excluant ainsi l'hématurie ou la protéinurie) chez chaque sujet avant que la TA ne soit mesurée. RÉSULTATS: La prévalence globale de l'hypertension et de la préhypertension dans cette étude était de 3,5% (n = 14) et de 6,2% (n = 25), respectivement. L'obésité, la consommation de sel extra-cuit, le haut niveau d'éducation des parents et la fréquentation d'écoles secondaires privées ont été identifiés comme des facteurs de risque associés à une tension artérielle élevée. Sept (29%) des 24 sujets hypertendus présentaient des caractéristiques d'hypertrophie du ventriculaire gauche (preuve d'une atteinte des organes cibles) à l'échocardiographie et à l'électrocardiographie. Tous les sujets présentant une PA élevée avaient une scintigraphie rénale normale. CONCLUSION: L'hypertension avec des caractéristiques d'atteinte des organes cibles existe chez les adolescents. Aucune étiologie primaire connue n'a été trouvée chez les adolescents hypertendus de l'étude et donc tous considérés comme souffrant d'hypertension essentielle. Mots clés: Hypertension primaire, dommages aux organes cibles, adolescents sains.

Optical coherence tomography assessment of acute thrombogenicity at bifurcation sites using different stenting techniques: A porcine arteriovenous shunt study.

OBJECTIVES: We aimed to compare bare-metal stents (BMS), durable-polymer everolimus-eluting stents (DP-EES), and abluminal biodegradable-polymer sirolimus-eluting stents (ABP-SES) in the bifurcation model setup. BACKGROUND: The mechanism of thrombogenicity, which differs among second-generation stents implanted using double-kissing (DK) crush or culotte stenting techniques, remains unclear. We have shown previously that setting up a porcine arteriovenous shunt model is feasible and useful to assess thrombogenicity at vessel bifurcation points. METHODS: Six porcine shunt models were prepared for the comparison between DK crush and culotte stenting techniques using BMS, DP-EES, and ABP-SES. Intracoronary imaging with high-resolution optical coherence tomography (OCT) was performed to evaluate the thrombogenicity in different stent types in the bifurcation stenting model and was evaluated by a core lab. RESULTS: Culotte stenting demonstrated more thrombogenicity at the proximal main branch (MB) with DP-EES, side branch (SB) with BMS, and the bifurcation site irrespective of the stent type, while DK crush technique exhibited thrombogenicity only at SB with BMS and ABP-SES. OCT analysis revealed malapposition of DP-EES in the proximal MB with culotte stenting. Stent expansion was generally larger in ABP-SES than BMS and DP-EES. CONCLUSIONS: The study provides hypothesis-generating findings in distinct thrombogenicity of bifurcation stenting with DP- or ABP-coated drug-eluting stents.

Physiologic and compositional coronary artery disease extension in patients with takotsubo syndrome assessed using artificial intelligence: an optical coherence tomography study.

BACKGROUND: Takotsubo syndrome (TTS) is an acute and reversible ventricular motion abnormality without epicardial coronary obstruction. Optical flow ratio (OFR) is an approach to evaluate the coronary stenosis significance based on three-dimensional optical coherence tomography (3D-OCT). The aim of this study is to utilize OCT and an artificial intelligence plaque characterization model to show the prevalence and composition of atherosclerotic disease in coronary vessels of patients with TTS. METHODS: This is a retrospective and observational study which enrolled patients with TTS who underwent coronary angiography and OCT examination. OCT images were analyzed for tissue characterization and OFR computation using a novel artificial intelligence algorithm. RESULTS: A total of 37 patients and 49 vessels were studied. All patients were imaged in the left anterior descending coronary artery (LAD) and about two-thirds were also imaged in the left circumflex coronary artery (LCX). Most patients were women ( n = 35), and apical was the most common takotsubo type. Tissue composition analysis yielded the following overall plaque types: fibrous (67.1%), lipid (15.5%), and calcium (3.77%). The mean OFR for LAD and LCX was 0.97 ± 0.04 and 0.98 ± 0.02, respectively. CONCLUSION: Utilizing automatic plaque characterization on OCT images by artificial intelligence, we found that TTS patients have coronary artery disease (i.e. presence of lipid, calcified, or fibrous tissue). The advent of artificial intelligence methods may allow for large-scale studies of patients with TTS.

Geophysical and contamination assessment of soil spatial variability for sustainable precision agriculture in Omu-Aran farm, Northcentral Nigeria.

The spatial and temporal variability of soil properties (fluid composition, structure, and water content) and hydrogeological properties employed for sustainable precision agriculture can be obtained from geoelectrical resistivity methods. For sustainable precision agricultural practices, site-specific information is paramount, especially during the planting season. An integrated one-dimensional (1D) and two-dimensional (2D) electrical resistivity survey have been adopted to characterize the subsoil parameters and delineate the aquifer unit of large farm areas, especially in precision agricultural practices. Also, contamination assessment reveals the soil quality status of farmlands. This study aims to determine the site-specific soil parameters of a commercial farm in Omu-Aran, Northcentral, Nigeria. The subsoil features from the geoelectrical resistivity surveys indicate 3 to 4 distinctive lithology to a depth of 43.4 m into the subsurface of the farm. The ID (Vertical Electrical Sounding) and 2D resistivity inversion models results have revealed the heterogeneity nature of the topsoil, also known as the stone zone comprising of reworked clayey soil and sandy gravelly soil, the weathered/saprolite zone (gravelly sandy/sandy soil), the fractured basement and the fresh basement rock. Contamination factor (Cf), pollution load index (PLI) and Nemerow integrated pollution index (NIPI) were used to assess the contamination index on the farmland. Toxic elements such as arsenic, cadmium, chromium, cobalt, lead, manganese, nickel, and zinc have low to moderate contamination in the farm. The depth of investigation (≤3m) covers the upper root zone of significant crops grown in the area. The findings can assess soil contamination, delineate basement features, subsoil variability, soil profiling, and determine the subsoil hydrological properties.

Impact of Baseline Imaging of Non-Culprit Coronary Lesions on Adverse Events: Insight From LRP Study.

BACKGROUND/PURPOSE: Intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) can identify vulnerable coronary atherosclerotic plaques. We aimed to compare the presence or absence of baseline intravascular imaging of non-culprit lesions and their subsequent adverse events. METHODS/MATERIALS: We identified patients from the Lipid Rich Plaque (LRP) study who had a non-culprit-lesion adverse event and divided them into 2 cohorts: those with lesions detected with NIRS-IVUS imaging at baseline and those with lesions not imaged at baseline. RESULTS: Overall, 73 patients had an adverse event (99 coronary segments) during the 24-month follow-up period. Among them, 41 patients (56.2%) had a non-culprit-lesion adverse event related to a coronary segment imaged at baseline, and 32 patients (43.8%) had a non-culprit-lesion adverse event adjudicated to a segment that was not scanned at baseline. Angiographic core laboratory analysis suggested that unscanned lesions were more often in the right coronary artery (~50%); branches of the left coronary artery, i.e., diagonal or left obtuse marginal arteries (~20%); smaller vessels; or more tortuous vessels; and less often in the left anterior descending or distal locations. There was a weak trend for acute severe events (adjudicated myocardial infarction and acute coronary syndrome) in patients with lesions not scanned at baseline (50.0% versus 36.6%, p = 0.250). CONCLUSIONS: In patients with follow-up non-culprit-lesion adverse events, nearly half were not imaged with NIRS-IVUS at baseline. Because events related to non-imaged lesions were at least as severe as events related to imaged lesions, future clinical trials and clinical protocols should be designed to minimize this issue. CLINICAL TRIAL REGISTRATION: The Lipid-Rich Plaque Study (LRP), https://clinicaltrials.gov/ct2/show/NCT02033694, NCT02033694.

Predicting future left anterior descending artery events from non-culprit lesions: insights from the Lipid-Rich Plaque study.

AIMS: The left anterior descending (LAD) artery is the most frequently affected site by coronary artery disease. The prospective Lipid Rich Plaque (LRP) study, which enrolled patients undergoing imaging of non-culprits followed over 2 years, reported the successful identification of coronary segments at risk of future events based on near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) lipid signals. We aimed to characterize the plaque events involving the LAD vs. non-LAD segments. METHODS AND RESULTS: LRP enrolled 1563 patients from 2014 to 2016. All adjudicated plaque events defined by the composite of cardiac death, cardiac arrest, non-fatal myocardial infarction, acute coronary syndrome, revascularization by coronary bypass or percutaneous coronary intervention, and rehospitalization for angina with >20% stenosis progression and reported as non-culprit lesion-related major adverse cardiac events (NC-MACE) were classified by NIRS-IVUS maxLCBI4 mm (maximum 4-mm Lipid Core Burden Index) ≤400 or >400 and association with high-risk-plaque characteristics, plaque burden ≥70%, and minimum lumen area (MLA) ≤4 mm2. Fifty-seven events were recorded with more lipid-rich plaques in the LAD vs. left circumflex and right coronary artery; 12.5% vs. 10.4% vs. 11.3%, P = 0.097. Unequivocally, a maxLCBI4 mm >400 in the LAD was more predictive of NC-MACE [hazard ratio (HR) 4.32, 95% confidence interval (CI) (1.93-9.69); P = 0.0004] vs. [HR 2.56, 95% CI (1.06-6.17); P = 0.0354] in non-LAD segments. MLA ≤4 mm2 within the maxLCBI4 mm was significantly higher in the LAD (34.1% vs. 25.9% vs. 13.7%, P < 0.001). CONCLUSION: Non-culprit lipid-rich segments in the LAD were more frequently associated with plaque-level events. LAD NIRS-IVUS screening may help identify patients requiring intensive surveillance and medical treatment.

Comparison of Angiographic and Intravascular Ultrasound Vessel Measurements in Infra-Popliteal Endovascular Interventions: The Below-the-Knee Calibration Study.

BACKGROUND: Endovascular revascularization (ER) via percutaneous transluminal angioplasty (PTA) and stenting are viable options for revascularization in below-the-knee (BTK) peripheral arterial disease. Two-dimensional angiography has been the standard of practice for estimating vessel size and selecting treatment devices during ER. However, in other vascular territories, intravascular ultrasound (IVUS) offers better visualization of the lumen dimensions. PURPOSE: To compare angiographic and intravascular ultrasound reference vessel (lumen) measurements in below-the-knee peripheral artery interventions. METHODS: Twenty consecutive patients were enrolled in the BTK Calibration study from 2 sites in the United States and Australia. Patients with at least one diseased segment in a native infra-popliteal artery (below-the-knee) and a clinical indication for endovascular therapy (EVT) were included with no limitations with regard to vessel diameter or lesion length. Digital subtraction angiography and IVUS imaging were collected pre- and post-PTA and images were sent to an independent core lab for standardized quantitative analysis of the normal-looking reference vessel dimensions when available. The results were presented as least square means with 95% confidence intervals and a p-value of <0.05 was considered significant. RESULTS: The overall (N = 19) mean reference vessel diameter for QVA was 2.98 ± 1.24 mm vs. 3.47 ± 0.72 mm for IVUS (mean difference was -0.50 mm, (95% CI: -0.80, -0.20; p = 0.14). As expected, in the proximal segments (N = 12), the mean reference vessel diameters were larger: for QVA, it was 3.17 ± 1.34 mm vs. 3.55 ± 0.76 mm in IVUS, (mean difference was -0.38 mm, (95% CI: -0.79, 0.03; p = 0.40); while in the distal segments (N = 7), mean reference vessel diameters were smaller: for QVA, it was 2.64 ± 1.06 mm vs. 3.33 ± 0.67 mm in IVUS, (mean difference was -0.69 mm, (95% CI: -1.04, 0.34; p = 0.17). We observed a greater degree of acute gain in cases where the treatment balloon size correlated with the IVUS measured reference size. CONCLUSION: Angiography underestimates infrapopliteal reference vessel lumen size even when quantitatively assessed. Adjunctive IVUS imaging use in guiding BTK procedures could help ensure adequate sizing and possibly impact immediate post-procedure indices.

First in-human evaluation of a novel intravascular ultrasound and optical coherence tomography system for intracoronary imaging.

AIMS: We evaluated the first in-human performance of a novel hybrid imaging catheter that permits simultaneous and co-registered acquisition of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) images. METHODS AND RESULTS: A total of 17 patients undergoing planned percutaneous coronary intervention (PCI) were imaged between August 2018 and August 2019. Eleven patients with both pre- and post-PCI IVUS and OCT images were included in the offline image analysis. IVUS and OCT images were analyzed separately then together with co-registered images for pre-stent findings, and only separately for post-stent findings. A total of 926 frames were analyzed (218 pre-PCI, 708 post-PCI). There was substantial agreement to detect calcific plaque between co-registered IVUS-OCT and standalone IVUS (Kappa 0.72 [0.65-0.79]) and standalone OCT (Kappa 0.75 [0.68-0.81]) while standalone imaging modalities showed lower agreement to detect lipidic and fibrotic plaques compared with co-registered IVUS-OCT. There were more frames with stent underexpansion on IVUS than OCT [72 (28.7%) vs. 58 (23.1%), respectively, p = 0.039]. Detection rates of incomplete stent apposition (present on 20 OCT frames vs. 2 IVUS frames, p < 0.001) and tissue protrusion (40 vs. 27 frames, p < 0.001) were higher on OCT than IVUS. One stent edge dissection was detected in the image analysis and was seen on OCT but not IVUS. All 177 frames with image artifacts contained at least one co-registered imaging modality with interpretable diagnostic content. There were no study device-related adverse events. CONCLUSIONS: Hybrid image acquisition was safe. The availability of both IVUS and OCT changed image interpretation compared to either modality alone, suggesting a complementary role of these two techniques.

Ultra-Short Term Evaluation of Coronary Vessel Wall Changes in Reference Segments Adjacent to Culprit Lesions in ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Culprit lesions of ST-segment elevation myocardial infarction (STEMI) patients are friable, soft, and prone to disruption during primary percutaneous coronary intervention (pPCI). The presence of dissections in reference vessel segments (RVSs), adjacent to stented culprit lesions, and dynamic luminal changes in proximal or distal RVSs have not yet been investigated. We therefore sought to assess the healing patterns of edge dissections and the changes of lumen area at RVSs within 1 week post stent implantation in patients with STEMI. METHODS: In the MATRIX trial (ClinicalTrials.gov NCT01433627), optical coherence tomography (OCT) was performed at the end of pPCI and within 1 week during staged PCI. The RVS dissection was defined as: type 1 = flap; type 2 = cavity; type 3 = double barrel; and type 4 = fissure. We compared separately the fate of residual dissection and luminal area/dimension by OCT in the target vessel between pPCI and staged PCI, including 1-year clinical outcomes. RESULTS: Out of 151 patients, 46 patients had dissections in 50 RVSs and did not experience worse clinical outcome. Dissections were 44% type 1, 28% type 2, 12% type 3, and 16% type 4. Overall, 18% of the dissections healed. The mean lumen area of the RVS enlarged in 82 patients (59%) from pPCI to staged PCI. Compared with the proximal RVS, there was a significant increase in the lumen diameter at the distal RVS (0.06 ± 0.25 mm vs -0.01 ± 0.21 mm; P=.01). CONCLUSION: Dissections occur frequently after pPCI. One-fifth of them heal within 1 week and do not seem to negatively impact clinical outcomes. Distal RVS lumen area increased compared with proximal RVS, likely reflecting a different vasoconstriction pattern over time.

Effects of Curculigo pilosa supplementation on antioxidant and antidiabetic activities of yam flour.

The practice of using nutritional knowledge to enhance the general health of the populace forms the basis of food fortification. In this study, an antioxidant-rich Curculigo pilosa is substituted (1, 3, 5 and 10%) into yam tuber flour with the aim of improving the antidiabetic and antioxidant properties of the yam tuber flour. Antioxidant property was evaluated by polyphenol contents, ascorbic acid content, reducing effects, scavenging activity and inhibition of linoleic acid peroxidation. Antidiabetic activity was assessed by inhibition of α- amylase and α- glucosidase enzymes. The antioxidant property was significantly (p < 0.05) enhanced; also, the ability of the sample to inhibit the activity of α- amylase and α- glucosidase enzymes were significantly (p < 0.05) enhanced by supplementation with Curculigo pilosa. The profiling of the samples by High Performance Liquid Chromatography revealed some proven antioxidant and antidiabetic agents which were enhanced in supplemented yam flour. It can be concluded from the results obtained in this study that Curculigo pilosa powder could be a promising functional ingredient for yam flour in the management of diabetes and other oxidant-related diseases.

Impact of endothelial shear stress on absorption process of resorbable magnesium scaffold: A BIOSOLVE-II substudy

BACKGROUND/PURPOSE: Local hemodynamic forces such as endothelial shear stress (ESS) may have an influence on appropriate neointimal healing, vessel remodeling, and struts absorption process following second-generation drug-eluting resorbable magnesium scaffold (RMS, Magmaris, Biotronik AG, Buelach, Switzerland) placement. The aim of this study was to investigate the impact of ESS assessed by optical coherence tomography (OCT)- based computational fluid dynamic (CFD) simulations on absorption process and coronary lumen dimension after Magmaris implantation. METHODS AND RESULTS: A total of 22 patients who were enrolled in the BIOSOLVE-II trial and underwent serial OCT assessment immediately after Magmaris implantation and at 6- and 12-month follow-up were included. We evaluated qualitative OCT findings frame by frame, and CFD simulations were performed to calculate the ESS at 3-dimensional (3D) reconstructed arteries. For quantitative calculation, the average ESS within each 1-mm section was classified into three groups: low (2.5 Pa). A significant difference of percentage remnants of scaffold was observed among the 3 groups at 12-month follow-up (P = 0.001) but not at 6-month follow-up. Low-ESS segment at baseline resulted in a greater lumen change of −1.857 ± 1.902 mm2 at 1 year compared to −1.277 ± 1.562 mm2 in the intermediate-ESS segment (P = 0.017) and − 0.709 ± 1.213 mm2 in the high-ESS segment (P = 0.001). CONCLUSION: After Magmaris implantation, the presence of higher ESS might be associated with slower strut absorption process but less luminal loss. SUMMARY FOR TABLE OF CONTENTS: The authors analyzed 22 patients from the BIOSOLVE-II trial who underwent optical coherence tomography assessment immediately after receiving a Magmaris second-generation drug-eluting resorbable magnesium scaffold. The analysis found that after Magmaris implantation, the presence of higher endothelial shear stress (ESS) might be associated with slower strut absorption process but less luminal loss. This study is the first demonstrating the impact of ESS assessed by OCT on absorption process and coronary lumen dimension after Magmaris implantation.

Comparison of Quantitative Flow Ratio and Invasive Physiology Indices in a Diverse Population at a Tertiary United States Hospital.

BACKGROUND: Quantitative flow ratio (QFR) is a technology to evaluate the coronary stenosis significance on 3-dimensional quantitative coronary angiography. The aim of this study is to evaluate and compare the QFR versus fractional flow reserve (FFR) and/or instantaneous free-wave ratio (iFR) in a US population with a fair African American population representation. METHODS AND RESULTS: This was a retrospective, observational and single-center study that enrolled 100 patients who underwent coronary angiography. The diagnostic performance of QFR in terms of sensitivity was 0.80 (95%CI 0.64-0.97) and specificity was 0.95 (95% CI 0.90-1.00), the positive predictive value (PPV) was 0.83 (0.68-0.98), while the negative predictive value (NPV) was 0.94 (0.88-0.99). The overall accuracy was 0.91 and area under the curve (AUC) was 0.92 (95% CI 0.87-0.97). The R-squared was 0.54 and the Bland-Altman plot showed a bias of 0.0016 (SD 0.063) and limits of agreement (LOA): Upper LOA 0.13 and Lower LOA -0.12. In African Americans (n = 33), accuracy, AUC, sensitivity, specificity (94%; 0.90 [0.80-1.00]; 0.90 [0.71-1.00]; 0.96 [0.87-1.00], respectively) were better than those for the overall population. CONCLUSIONS: In a US-based representative population, vessel QFR accuracy and agreement with FFR as reference is high. Diagnostic performance of QFR in African Americans is also excellent.