Progression of left atrial volume index in a population at risk for heart failure:a substudy of the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) trial

AIMS: Limited data are available concerning the evolution of the left atrial volume index (LAVI) in pre-heart failure (HF) patients. The aim of this study was to investigate clinical characteristics and serological biomarkers in a cohort with risk factors for HF and evidence of serial atrial dilatation.

METHODS AND RESULTS: This was a prospective substudy within the framework of the STOP-HF cohort (NCT00921960) involving 518 patients with risk factors for HF electively undergoing serial clinical, echocardiographic, and natriuretic peptide assessment. Mean follow-up time between assessments was 15 ± 6 months. 'Progressors' (n = 39) were defined as those with serial LAVI change ≥3.5 mL/m(2) (and baseline LAVI between 20 and 34 mL/m(2)). This cut-off was derived from a calculated reference change value above the biological, analytical, and observer variability of serial LAVI measurement. Multivariate analysis identified significant baseline clinical associates of LAVI progression as increased age, beta-blocker usage, and left ventricular mass index (all P < 0.05). Serological biomarkers were measured in a randomly selected subcohort of 30 'Progressors' matched to 30 'Non-progressors'. For 'Progressors', relative changes in matrix metalloproteinase 9 (MMP9), tissue inhibitor of metalloproteinase 1 (TIMP1), and the TIMP1/MMP9 ratio, markers of interstitial remodelling, tracked with changes in LAVI over time (all P < 0.05).

CONCLUSION: Accelerated LAVI increase was found to occur in up to 14% of all pre-HF patients undergoing serial echocardiograms over a relatively short follow-up period. In a randomly selected subcohort of 'Progressors', changes in LAVI were closely linked with alterations in MMP9, TIMP1, and the ratio of these enzymes, a potential aid in highlighting this at-risk group.

Achievable sum-rate of multiuser massive MIMO downlink in ricean fading channels

We investigate the achievable ergodic sum-rate of multi-user multiple-input multiple-output systems in Ricean fading channels. We first derive a lower bound on the average signal-to-leakage-and-noise ratio by utilizing the Mullen's inequality, which is then used to analyze the effect of channel mean information on the achievable sum-rate. With these results, a novel statistical-eigenmode space-division multipleaccess downlink transmission scheme is proposed. For this scheme, we derive an exact closed-form expression for the achievable ergodic sum-rate. Our results show that the achievable ergodic sum-rate converges to a saturation value in the high signal-to-noise ratio (SNR) region and reaches to a lower limit value in the lower Ricean K-factor range. In addition, we present tractable upper and lower bounds, which are shown to be tight for any SNR and Ricean K-factor value. Finally, the theoretical analysis is validated via numerical simulations.