Development and validation of an echocardiography score for diagnosis of cardiac masses

Background Echocardiography is the cornerstone in the evaluation of cardiac masses and provides accurate characterization. Despite, its accuracy in diagnosis of cardiac masses (CM) remains challenging and, up to date, no validated diagnostic algorithm is validated. Purpose The aim of our study was to evaluate the diagnostic accuracy of echocardiography, to identify the echocardiographic predictors of malignancy and to develop and then validate a multiparametric echocardiographic score that could be used to estimate the likelihood of the histological nature of a CM. Materials and methods The final sample consisted of 273 consecutive patients who had a 2D-echocardiographic evaluation and a histologic diagnosis. Logistic regression was performed to evaluate the ability of echocardiographic findings to discriminate benign versus malignant masses, then a scoring system was developed and validated in a separate test cohort. Results Of the 322 patients initially included in the Bologna Cardiac Masses Registry, 13 with a poor acoustic window, 27 with no histological examination patients and 9 extra-cardiac masses were excluded. In the remaining 273 patients, classical 2-D echocardiogram identified 249 masses with a diagnostic accuracy of 88%. A weighted score [Diagnostic Echocardiographic Mass (DEM) Score] ranging from 0 to 9 was obtained from 6 variables: infiltration, polylobate mass, moderate-severe pericardial effusion. The AUC for the score was 0.965 (95% CI [0.938-0.993]). In a logistic regression analysis using the DEM score as a predictor, the likelihood of malignant CM increased more than 4 times for a 1-unit increase in the score (OR=4.468; 95% CI 2.733-7.304). A score < 3 denoted a high probability of a benign diagnosis, and a score ≥ 5 points corresponded to a higher risk of malignancy. Conclusion 2D-Echocardiography provides a high diagnostic accuracy in identifying cardiac masses and our multiparametric echocardiographic score could be useful to predict the histological nature of cardiac masses.

Numerical modelling of rock masses interacting with dams: the case of Ridracoli

A three-dimensional Direct Finite Element procedure is here presented which takes into account most of the factors affecting the interaction problem of the dam-water-foundation system, whilst keeping the computational cost at a reasonable level by introducing some simplified hypotheses. A truncated domain is defined, and the dynamic behaviour of the system is treated as a wave-scattering problem where the presence of the dam perturbs an original free-field system. The rock foundation truncated boundaries are enclosed by a set of free-field one-dimensional and two-dimensional systems which transmit the effective forces to the main model and apply adsorbing viscous boundaries to ensure radiation damping. The water domain is treated as an added mass moving with the dam. A strategy is proposed to keep the viscous dampers at the boundaries unloaded during the initial phases of analysis, when the static loads are initialised, and thus avoid spurious displacements. A focus is given to the nonlinear behaviour of the rock foundation, with concentrated plasticity along the natural discontinuities of the rock mass, immersed in an otherwise linear elastic medium with Rayleigh damping. The entire procedure is implemented in the commercial software Abaqus®, whose base code is enriched with specific user subroutines when needed. All the extra coding is attached to the Thesis and tested against analytical results and simple examples. Possible rock wedge instabilities induced by intense ground motion, which are not easily investigated within a comprehensive model of the dam-water-foundation system, are treated separately with a simplified decoupled dynamic approach derived from the classical Newmark method, integrated with FE calculation of dam thrust on the wedges during the earthquake. Both the described approaches are applied to the case study of the Ridracoli arch-gravity dam (Italy) in order to investigate its seismic response to the Maximum Credible Earthquake (MCE) in a full reservoir condition.