1026 Prognostic implications of global and regional RV strain in patients with heart failure and conduction delays

Abstract Background Right ventricular (RV) dysfunction is present in a substantial proportion of candidates for cardiac resynchronization therapy (CRT) but its prognostic implication has not been fully determined. We investigated the association of different echocardiographic indices of RV function and survival in patients with heart failure (HF) and conduction delays. Methods A total of 122 HF patients with bundle branch blocks (BBB), not treated with device therapy, were included in this retrospective observational study. RV function was assessed by measuring the tricuspid annular plane systolic excursion (TAPSE) and RV free wall longitudinal strain (RVFWSL). Patients were followed for cardiac mortality during a median period of 33 months. Results Both TAPSE ≤ 18 mm and RVFWSL≥-25% were associated with unfavorable long-term survival (log rank p &amp;lt; 0.05 for both, Figure A and B). Importantly, in patients with normal TAPSE, RVFWSL remained predictive of long-term outcome (HR 1.15, 95% CI 1.003-1.327; p = 0.045). In the multivariate regression analysis, only NYHA class (HR 2.21, 95%CI (1.122 – 4.357; p = 0.022) and RVFWSL (HR 1.11, 95%CI 1.029 – 1.204; p = 0.008) were independently associated with cardiac mortality. Significant differences among segmental RVFWLS values were observed, including a basal-to-apical gradient with the highest strain values in the base and the lowest in the apex (Figure C). Conclusions RV dysfunction is associated with unfavorable survival in HF patients with BBB. RVFWSL appears to be stronger predictor of mortality than TAPSE. Different segments of the RV may contribute differently to RV dysfunction in patients with conduction delays. Abstract 1026 Figure. </jats:sec

Effect of heat treatment on structural changes in metastable AlSi10mg alloy

This paper presents a study on structural changes occurring in a rapidly quenched metastable AlSi10Mg alloy during heating cycles within the temperature range from room temperature to 800 K. Measurement of electrical resistivity of a ribbon showed that structural stabilization takes place at temperatures ranging from 450 K to 650 K. The isotherms of the electrical resistivity measured at temperatures 473 K, 483 K and 498 K revealed two stages of structural stabilization i.e. a kinetic process and diffusion process. Measurement of the thermoelectromotive force of the thermocouple made from the investigated alloy and a copper conductor by a mechanical joining was used to determine relative changes in the electron density of states of the quenched sample after successive heat treatments. The same alloy sample was subjected to successive heat treatments at temperatures up to 503 K, 643 K, 683 K and 763 K. The change in the thermopower suggested that each heating was followed by an increase in free electron density in the alloy. Therefore, the abrupt decline in electrical resistivity was induced by an increase in both the mean free electron path and free electron density during the thermal stabilization of the structure.</jats:p

Effect of heat treatment on structural changes in metastable AlSi10Mg alloy

This paper presents a study on structural changes occurring in a rapidly quenched metastable AlSi10Mg alloy during heating cycles within the temperature range from room temperature to 800 K. Measurement of electrical resistivity of a ribbon showed that structural stabilization takes place at temperatures ranging from 450 K to 650 K. The isotherms of the electrical resistivity measured at temperatures 473 K, 483 K and 498 K revealed two stages of structural stabilization i.e. a kinetic process and diffusion process. Measurement of the thermoelectromotive force of the thermocouple made from the investigated alloy and a copper conductor by a mechanical joining was used to determine relative changes in the electron density of states of the quenched sample after successive heat treatments. The same alloy sample was subjected to successive heat treatments at temperatures up to 503 K, 643 K, 683 K and 763 K. The change in the thermopower suggested that each heating was followed by an increase in free electron density in the alloy. Therefore, the abrupt decline in electrical resistivity was induced by an increase in both the mean free electron path and free electron density during the thermal stabilization of the structure

CT or Invasive Coronary Angiography in Stable Chest Pain.

Background: In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain. Methods: We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedure-related complications and angina pectoris. Results: Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48). Conclusions: Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.)