Prognostic Value of Pulmonary Vascular Resistance by Magnetic Resonance in Systolic Heart Failure

Abstract Background: Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. Objective: We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). Methods: Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVRwere calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. Results: 105 patients (average LVEF 26.0 ±7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). Conclusions: In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.

maintenance model for systems with phase-type distributed times to failure

Magdeburg, Univ., Fak. für Mathematik, Diss., 2010

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

Abstract Background: More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. Objectives: To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Methods: Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO2). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. Results: After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO2 and 123I-MIBG scintigraphic parameters. Conclusion: Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.

Association between Spirituality and Adherence to Management in Outpatients with Heart Failure

Abstract Background: Spirituality may influence how patients cope with their illness. Objectives: We assessed whether spirituality may influence adherence to management of outpatients with heart failure. Methods: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence. Results: One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments. Conclusion: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

Shapes in vector fields : methods for continuous deformations and surface-based flow visualizations

Magdeburg, Univ., Fak. für Informatik, Diss., 2013

Hilltop terrace sites of Oaxaca, Mexico : intensive surface survey at Guirâun, El Palmillo and the Mitla Fortress / Gary M. Feinman and Linda M. Nicholas.

n.s. no.37(2004)

Distortion of surface groups in Cat (0) free-by-cyclic groups

Given a non-positively curved 2-complex with a circle-valued Morse function satisfying some extra combinatorial conditions, we describe how to locally isometrically embed this in a larger non- positively curved 2-complex with free-by-cyclic fundamental group. This embedding procedure is used to produce examples of CAT(0) free-by-cyclic groups that contain closed hyperbolic surface subgroups with polynomial distortion of arbitrary degree. We also produce examples of CAT(0) hyperbolic free-by-cyclic groups that contain closed hyperbolic surface subgroups that are exponentially distorted.

A topological proof that surface relators are test words

Vegeu el resum a l'inici del document del fitxer adjunt.

A proof that all Seifert 3-manifold groups and all virtual surface groups are conjugacy separable

We prove that the fundamental group of any Seifert 3-manifold is conjugacy separable. That is, conjugates may be distinguished infinite quotients or, equivalently, conjugacy classes are closed in the pro-finite topology.

Observability and overcoming coordination failure in organizations

Many organizations suffer poor performance because its members fail to coordinate on efficient patterns of behavior. In previous research, we have shown that financial incentives can be used to find a way out of such performance traps. Here we examine the sensitivity of this result to the ability of people to observe others' choices. Our experiments are set in a corporate environment where subjects' payoffs depend on coordinating at high effort levels; the underlying game being played repeatedly by the employees of an experimental firm is a weak-link game. Treatments vary along two dimensions. First, subjects either start with low financial incentives for coordination, which typically leads to coordination failure, and then are switched to higher incentives or start with high incentives, which typically yield effective coordination, and are switched to low incentives. Second, as the key treatment variable, subjects either observe the effort levels chosen by all employees in their experimenta

A change would do you good . . . An experimental study on how to overcome coordination failure in organizations

Many organizations suffer poor performance because individuals within the organization fail to coordinate on efficient patterns of behavior. Using controlled laboratory experiments, we study how financial incentives can be used to find a way out of such performance traps. Our experiments are set in a corporate environment where subjects' payoffs depend on coordinating at high effort levels; the underlying game being played repeatedly by employees is a weak-link game. In an initial phase, the benefits of coordination are low relative to the cost of increased effort. Play in this initial phase typically converges to an inefficient outcome with employees failing to coordinate at high effort levels. The experimental design then explores the effects of varying the financial incentives to coordinate at a higher effort level. We find that an increase in the benefits of coordination leads to improved coordination, but, surprisingly, large increases have no more impact than small increases. Once subj

Notas de Ixodologia: II - uma nova espécie do gênero Amblyomma e uma nova espécie do gênero Ixodes (Acari Ixodidae)

A new tick, Amblyomma parkeri, n. sp., is described as a parasite of Coendu sp. from S. Paulo, Brazil. Female holotype, nymph and larva are described (Figs. 2 e 3). The n. sp. differs completly from Koch's species Amblyomma longirostre, the common parasite of the Erethizotidae. Standard data for measures of the female dorsal scutum ixodidae are proposed as follows (fig. 1): PA = Antero-posterior; PB = Postero-basal; PM = Postero-median; TT = Transversal; OO = Inter-ocular; OT= Occulo-transversal; SS = Inter-scapular; CC = Cervical; PT = Postero-transversal; ST = Scapulo-transversal; NPT = Normal to the postero-transversal; NST = Normal to the scapulo-transversal. In the female holotype the standard data are as follows: PA = 2.00 mm; PB = 2.26 mm; PM = 1.10 mm; TT = 2.20 mm; OO = 2.26 mm; SS = 0,84 mm; CC = 0.63 mm; SC = 0.12 mm; NPT = 0.20mm; STN = 0.1 mm. Peritrema 0.80 x 0.42 mm with a narrow postero-internal angle and a large, elongated macula. Coxa I with two short spines and all other coxae with only one shorter spine, shortest in coxa IV. Hypostoma spatulated with formula 3/3. Gnathosoma 1.42 mm long and basis 0.63 mm long by 0.84 greatest wide. Palpi with smoth external surface, 1.00 mm long. Type lot No. 4458 from Cotia, S. Paulo, Brazil; in the acarological collection of the Escola Paulista de Medicina, S. Paulo. Ixodes didelphidis, n. sp., differing from Ixodes loricatus Neumann by the shape of the peritremata (figs. 4 a 5) of the male and female and by the number of the punctations in this organ is described form Didelphidae, Muridae and Cavidae. Twenty eight lots were obtained from Anápolis, Goiás, Brasil, where I. loricatus is subtituded by the n. sp. under description. Comparison with NEUMANN'S types of I. loricatus was possible through the courtesy of Prof. A. BRIZARD from Toulouse, who kindly loaned NEUMANN'S material. Female cotypes N° 40 and male allotype N° 531 in the Collection of Ixodidae of the Oswaldo Cruz Institute.