Altered Static and Dynamic Voxel-mirrored Homotopic Connectivity in Patients With Frontal Glioma

Contralateral regions play critical role in functional compensation in glioma patients. Voxel-mirrored homotopic connectivity (VMHC) characterizes the internal functional connectivity of the brain, which is considered to have a regional functional basis. This study aims to investigate the alterations of brain regional function and VMHC in patients with frontal glioma, and further investigate physiological significance of these alterations. We enrolled 22 patients with frontal glioma and 22 demography matched healthy controls (HC). We determined degree centrality (DC), regional homogeneity (ReHo), and VMHC to investigate the alterations of regional function and internal functional connectivity in patients. Furthermore, partial correlation analysis was conducted to explore the relationship between these indicators and cognitive functions.Compared with HC, patients showed decrease in static VMHC, DC, ReHo and dynamic ReHo (dReHo) within right middle frontal gyrus (MFG.R), left middle frontal gyrus (MFG.L), right precuneus(PCUN.R), left precuneus(PCUN.L), left limbic lobe (LIMB.L), right superior frontal gyrus (SFG.R), right postcentral gyrus (POCG.R), right inferior parietal lobule (IPL.R), but increase in dynamic VMHC (dVMHC) within PCUN.R and PCUN.L. Meanwhile, MFG.R with decreased VMHC, LIMB.L with decreased DC, LIMB.L with decreased ReHo, and PCUN.R with increased dVMHC were significantly positively correlated with cognitive function, but the SFG.R with decreased DC was significantly negatively correlated with memory. This study preliminarily confirmed glioma not only cause regional dysfunction, but also disturb long-distance functional connectivity, and the long-distance functional connectivity showed strong instability in patients with frontal glioma. Meanwhile, the altered functional indicators may compensate cognitive function in patients with frontal glioma.

Quantification of Cardiac Kinetic Energy and Its Changes During Transmural Myocardial Infarction Assessed by Multi-Dimensional Seismocardiography

Introduction: Seismocardiography (SCG) records cardiac and blood-induced motions transmitted to the chest surface as vibratory phenomena. Evidences demonstrate that acute myocardial ischemia (AMI) profoundly affects the SCG signals. Multidimensional SCG records cardiac vibrations in linear and rotational dimensions, and scalar parameters of kinetic energy can be computed. We speculate that AMI and revascularization profoundly modify cardiac kinetic energy as recorded by SCG.Methods: Under general anesthesia, 21 swine underwent 90 min of myocardial ischemia induced by percutaneous sub-occlusion of the proximal left anterior descending (LAD) coronary artery and subsequent revascularization. Invasive hemodynamic parameters were continuously recorded. SCG was recorded during baseline, immediately and 80 min after LAD sub-occlusion, and immediately and 60 min after LAD reperfusion. iK was automatically computed for each cardiac cycle (iKCC) in linear (iKLin) and rotational (iKRot) dimensions. iK was calculated as well during systole and diastole (iKSys and iKDia, respectively). Echocardiography was performed at baseline and after revascularization, and the left ventricle ejection fraction (LVEF) along with regional left ventricle (LV) wall abnormalities were evaluated.Results: Upon LAD sub-occlusion, 77% of STEMI and 24% of NSTEMI were observed. Compared to baseline, troponins increased from 13.0 (6.5; 21.3) ng/dl to 170.5 (102.5; 475.0) ng/dl, and LVEF dropped from 65.0 ± 0.0 to 30.6 ± 5.7% at the end of revascularization (both p < 0.0001). Regional LV wall abnormalities were observed as follows: anterior MI, 17.6% (three out of 17); septal MI, 5.8% (one out of 17); antero-septal MI, 47.1% (eight out of 17); and infero-septal MI, 29.4% (five out of 17). In the linear dimension, iKLinCC, iKLinSys, and iKLinDia dropped by 43, 52, and 53%, respectively (p < 0.0001, p < 0.0001, and p = 0.03, respectively) from baseline to the end of reperfusion. In the rotational dimension, iKRotCC and iKRotSys dropped by 30 and 36%, respectively (p = 0.0006 and p < 0.0001, respectively), but iKRotDia did not change (p = 0.41). All the hemodynamic parameters, except the pulmonary artery pulse pressure, were significantly correlated with the parameters of iK, except for the diastolic component.Conclusions: In this very context of experimental AMI with acute LV regional dysfunction and no concomitant AMI-related heart valve disease, linear and rotational iK parameters, in particular, systolic ones, provide reliable information on LV contractile dysfunction and its effects on the downstream circulation. Multidimensional SCG may provide information on the cardiac contractile status expressed in terms of iK during AMI and reperfusion. This automatic system may empower health care providers and patients to remotely monitor cardiovascular status in the near future.

Assessment of right ventricular segmental volumes and ejection fractions using a 15-segment model: three-dimensional echocardiographic study in healthy volunteers

Funding Acknowledgements Type of funding sources: None. On top of global ventricular function, segmental metrics may bear clinically relevant information. Concerning the left ventricle (LV), standardized segmentation is widely performed in different cardiovascular imaging modalities mainly to correlate regional dysfunction with coronary perfusion territories, or to appreciate and quantify distinct patterns in LV myocardial function. The same applies to the right ventricle (RV); as pulmonary hypertension, or arrhythmogenic cardiomyopathy are just two clinical examples among several others, where established regional dysfunction exists. Nevertheless, only a few options are available for the comprehensive and quantitative assessment of the segmental RV function due to its complex three-dimensional (3D) shape. Therefore, our aim was to develop a 3D echocardiographic software solution for volumetric partitioning of the RV using a 15-segment model and to investigate a large number of healthy volunteers to describe the normal segmental pattern. One hundred and fifty healthy adults with a balanced age range and an equal sex distribution were investigated (15-15 women and men in each age groups: 20-29, 30-39, 40-49, 50-59, 60+). Beyond standard two-dimensional echocardiographic protocol, full volume 3D datasets were acquired. Using commercially available software, we reconstructed the 3D mesh model of the RV and measured end-diastolic (EDV), end-systolic volumes and ejection fraction (EF). The 3D model was post-processed using the ReVISION method to calculate regional and segmental volumes and EFs. Fifteen standard segments were separated and quantified (Figure). Increasing age resulted in significantly lower RV stroke volume (r=-0.17; p < 0.05) and tended towards lower RV EDV (r=-0.15, p = 0.06). EDVs of inflow tract and outflow tract segments decreased during aging (r=-0.21, p < 0.05 and r=-0.26, p < 0.01, respectively). Between the pre-specified age groups, there was no difference concerning global RVEF (ANOVA p = NS). In the 50-59 age group, regional EF of septal segments and also free wall segments were significantly lower compared to subjects in the 30-39 and 40-49 age categories (both p < 0.05). Global RV EDV was significantly lower in women (women vs. men: 95 ± 20 vs. 125 ± 28 ml; p < 0.05) along with a higher RV EF compared to men (62 ± 4 vs. 59 ± 4; p < 0.05). However, segmental EFs of apical, septal mid anterior, free wall mid posterior, free wall mid lateral, septal basal anterior and inflow tract segments were comparable between genders. The ReVISION method allows a volumetric partitioning of the RV 3D models to investigate segmental geometry and function in a 15-segment model. We have explored segmental differences between different ages and genders. Further studies are warranted to justify the importance of segmental assessment of the RV in different cardiac diseases. Abstract Figure. Separation of 15 standard RV segments

CMR fast-SENC segmental intramyocardial LV strain monitors decline in heart function before ejection fraction in patient with mitral valve disease

Background Ejection fraction is the standard metric to analyze cardiac function in the left (LV) or right (RV) ventricles. However, these global metrics are not able to characterize patients in which the heart compensates for regional dysfunction. More sensitive metrics are needed to detect subclinical regional dysfunction before cardiac remodeling results in changes in ejection fraction (EF) and global longitudinal strain (GLS). Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to standard CMR calculations (e.g. LVEF, volumes, mass, etc.) in patients with mitral valve disease. Methods A single center, prospective registry of CMR scans acquired with a 1.5T scanner were evaluated for standard CMR calculations as well as fSENC scans. Intramyocardial LV & RV strain was quantified with MyoStrain software. Three short axis scans (basal, midventricular, & apical) were used to calculate peak strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3-, & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments. Results A total of 493 scans in 424 patients with moderate or severe mitral regurgitation were included in the study. Patients had an average (± stdev) age of 60 (15) yrs and BMI of 27 (4) kg/m2; 63% had arterial hypertension, 19% diabetes mellitus, 10% atrial fibrillation, 15% pulmonary disease, and 32% coronary artery disease. Figure 1 shows the non-linear relationship between segmental fSENC strain (% of normal LV segments ≤−17%) versus LVEF (R=0.81). Conclusion Segmental fSENC detects subclinical LV dysfunction before changes in LVEF. Evaluating segmental longitudinal and circumferential fSENC peak strain provides an alternative metric that shows consistent changes in cardiac function in patients with mitral valve disease irrespective of global calculations that are dependent on loading conditions. Funding Acknowledgement Type of funding source: None

The optic nerve lamina region is a neural progenitor cell niche

Retinal ganglion cell axons forming the optic nerve (ON) emerge unmyelinated from the eye and become myelinated after passage through the optic nerve lamina region (ONLR), a transitional area containing a vascular plexus. The ONLR has a number of unusual characteristics: it inhibits intraocular myelination, enables postnatal ON myelination of growing axons, modulates the fluid pressure differences between eye and brain, and is the primary lesion site in the age-related disease open angle glaucoma (OAG). We demonstrate that the human and rodent ONLR possesses a mitotically active, age-depletable neural progenitor cell (NPC) niche, with unique characteristics and culture requirements. These NPCs generate both forms of macroglia: astrocytes and oligodendrocytes, and can form neurospheres in culture. Using reporter mice with SOX2-driven, inducible gene expression, we show that ONLR-NPCs generate macroglial cells for the anterior ON. Early ONLR-NPC loss results in regional dysfunction and hypomyelination. In adulthood, ONLR-NPCs may enable glial replacement and remyelination. ONLR-NPC depletion may help explain why ON diseases such as OAG progress in severity during aging.

Comparative study between ischemic compression and dry needling in myofascial pain syndrome: possibilities in health

Introduction: Myofascial Pain Syndrome (MPS) is a neuromuscular regional dysfunction characterized by the presence of sensitive regions in strained muscle bands (trigger points), able to cause local and referred pain, functional losses and change the quality of life (QOL) of affected people. It can be triggered by musculoskeletal injuries, postural imbalances, endocrinal factors and psych emotional disorders. The diagnostic is clinical, the intervention is multidisciplinary and the treatment may involve the use of drugs and several invasive and non-invasive techniques. Objective: Compare the effects of ischemic compression associated to physiotherapy and dry needling associated to pain control and the QOL of people with MPS. Methods: 40 subjects took part of the study. They were of both genders, aged from 20 to 60 years old, with MPS, divided into 2 groups with 20 participants each. The first group receives ischemic compression and physiotherapy and the second, dry needling and physiotherapy. The statistical analysis involves proportions for categorical variables, significance and standard deviation for continuous variables. In order to evaluate the change in the pain and QOL perception of subjects, the Student’s t-test (p<0.05). Results: The best results were verified in the dry needling and physiotherapy group. Conclusion: Both ischemic compression and physiotherapy as dry needling and physiotherapy can promote pain relief and better QOL in subjects suffering from MPS.

P1740 Normal values for TAPSE in the HUNT study of subjects without evidence of heart disease

Background TAPSE is a simple and robust measure of RV function, but only in the absence of regional dysfunction and translational effects from the LV. Normal values from large normal studies are scarce, however. The aim of this study was to present normal values from the HUNT 3 study. Methods The HUNT study examined 1266 subjects without evidence of heart disease, from a mixed urban / rural population of North Tøndelag county in Norway. TAPSE was measured by reconstructed M-mode through the lateral tricuspid ring of the RV, in apical four-chamber view as shown in figure 1. Results Age and gender related values are given in table 1. TAPSE was normally distributes with a skewness of 0.42. Mean TAPSE was 2.8 cm (SD = 0.5), TAPSE declined with increasing age (p &lt; 0.001), but the correlation with age was moderate (R=-0.15, p &lt; 0.001). There was only a small gender difference (p &lt; 0.001), and a moderate correlation with BSA (R = 0.24, p &lt; 0.005). In linear regression with BSA and gender, only BSA was significant. Conclusions As all long axis measures, it declines with age, but this is moderate, so the relevance of age-specific measures can be discussed. TAPSE is near gender independent, and gender differences are only due to body size. Age and gender related values for TAPSE Age (years): &lt;40 40-60 &gt;60 All Women TAPSE(cm) 2.9 (0.5) 2.7 (0.5) 2.5 (0.5) 2.8 (0.5) Men TAPSE(cm) 3.0 (0.6) 2.9 (0.6) 2.8 (0.6) 2.9 (0.6) All TAPSE(cm) 2.9 (0.5) 2.8 (0.5) 2.7 (0.5) 2.8 (0.5) Abstract P1740 Figure. Fig. 1

Anthropomorphic left ventricular mesh phantom: a framework to investigate the accuracy of SQUEEZ using Coherent Point Drift for the detection of regional wall motion abnormalities

We present an anthropomorphically accurate left ventricular (LV) phantom derived from human CT data to serve as the ground truth for the optimization and the spatial resolution quantification of a CT-derived regional strain metric (SQUEEZ) for the detection of regional wall motion abnormalities. Displacements were applied to the mesh points of a clinically derived end-diastolic LV mesh to create analytical end-systolic poses with physiologically accurate endocardial strains. Normal function as well as regional dysfunction of four sizes (1, 2/3, 1/2, and 1/3 AHA (American Heart Association) segments as core diameter), each exhibiting hypokinesia (70% reduction in strain) and subtle hypokinesia (40% reduction in strain), were simulated. Regional shortening (RSCT) estimates were obtained by registering the end-diastolic mesh to each simulated end-systolic mesh condition using a non-rigid registration algorithm. Ground-truth models of normal function and of hypokinesia were used to identify the optimal parameters in the registration algorithm, and to measure the accuracy of detecting regional dysfunction of varying sizes and severities. For normal LV function, RSCT values in all 16 AHA segments were accurate to within ±5%. For cases with regional dysfunction, the errors in RSCT around the dysfunctional region increased with decreasing size of dysfunctional tissue.

P3556Segmental intramyocardial CMR Fast-SENC objectively quantifies cardiac dysfunction that causes symptoms based on NYHA classification before global longitudinal strain or ejection fraction

Background Global longitudinal strain (GLS) has become an alternative to ejection fraction (EF) in identifying reduced cardiac function. However, these global metrics are not able to characterize patients in which symptoms occur even while the heart compensates for regional dysfunction. More sensitive metrics are needed to detect subclinical regional dysfunction and determine the relationship to symptoms that may or may not be associated with cardiac causes. Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to global metrics GLS and LVEF based on NYHA classification. Methods A single center, prospective registry of MRI scans acquired with a 1.5T scanner were evaluated for conventional CMR diagnostics including biventricular EF, volumes and mass. In addition, fSENC scans were acquired and processed with the MyoStrain software to quantify intramyocardial LV & RV strain. Three short axis scans (basal, midventricular, & apical) were used to calculate strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3- & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments. All metrics were compared based on NYHA classification. Results A total of 977 scans in 779 patients were included in the study; this population included 210 myocarditis, 46 dilated cardiomyopathy, and 30 ischemic cardiomyopathy cases. Patients had an average (± stdev) age of 55 (17) yrs and BMI of 26 (5) kg/m2; 48% had arterial hypertension, 12% diabetes mellitus, 33% valve disease, 24% cancer, 7% atrial fibrillation, 13% pulmonary disease, 5% left bundle branch block, 35% hypercholesterolemia, and 24% coronary artery disease. Figure 1 shows the relationship between segmental strain, calculated as the percent of normal LV segments (longitudinal & circumferential) based on intramyocardial fSENC <−17%, versus GLS and LVEF. All metrics were compared based on NYHA classification. Figure 1 Conclusion Segmental fSENC identified changes in NYHA classification well before changes in EF or GLS. Measuring segmental fSENC provides an objective view of symptomatic heart failure progression and can serve as surrogate endpoints for trials instead of purely relying on quality of life and subjective symptom perception.

P600CMR Fast-SENC segmental intramyocardial LV strain detects heart disease progression based on ACC/AHA Heart Failure stage before global longitudinal strain or ejection fraction

Background Global longitudinal strain has become an alternative to ejection fraction in identifying reduced cardiac function in the left (LV) or right (RV) ventricles. However, these global metrics are not able to characterize patients in which the heart compensates for regional dysfunction. More sensitive metrics are needed to detect subclinical regional dysfunction before cardiac remodeling results in changes in ejection fraction (EF) and global longitudinal strain (GLS). Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to global metrics GLS and LVEF based on modified ACC/AHA Heart Failure Stage that categorized differing levels of structural heart disease for Stage B and C. Methods A single center, prospective registry of MRI scans acquired with a 1.5T scanner were evaluated for conventional CMR diagnostics including biventricular EF, volumes and mass. In addition, fSENC scans were acquired and processed with the MyoStrain software to quantify intramyocardial LV & RV strain. Three short axis scans (basal, midventricular, & apical) were used to calculate strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3- & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments. All metrics were compared based on ACC/AHA Heart Failure Stage determined by full CMR exam. Results A total of 977 scans in 779 patients were included in the study; this population included 210 myocarditis, 46 dilated cardiomyopathy, and 30 ischemic cardiomyopathy cases. Patients had an average (± stdev) age of 55 (17) yrs and BMI of 26 (5) kg/m2; 48% had arterial hypertension, 12% diabetes mellitus, 33% valve disease, 24% cancer, 7% atrial fibrillation, 13% pulmonary disease, 5% left bundle branch block, 35% hypercholesterolemia, and 24% coronary artery disease. Figure 1 shows the relationship between segmental strain, calculated as the percent of normal LV segments (longitudinal & circumferential) based on intramyocardial fSENC <−17%, versus LVEF based on ACC/AHA Heart Failure stage. Figure 1 Conclusion Segmental fSENC detects subclinical LV dysfunction well before changes in EF or GLS. Incorporating both longitudinal and circumferential components into segmental fSENC metrics provides an alternative metric that shows consistent changes in heart failure progression irrespective of risk factors or underlying cardiac disease.