| 1. |
- Clark, Joseph, et al.
(författare)
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Interchangeability in Left Ventricular Ejection Fraction Measured by Echocardiography and cardiovascular Magnetic Resonance : Not a Perfect Match in the Real World
- 2023
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Ingår i: Current Problems in Cardiology. - : Elsevier BV. - 0146-2806. ; 48:8
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Forskningsöversikt (refereegranskat)abstract
- Comparisons of transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) derived left ventricular ejection fraction (LVEF) have been reported in core-lab settings but are limited in the real-world setting. We retrospectively identified outpatients from 4 hospital sites who had clinically indicated quantitative assessment of LVEFTTE and LVEFCMR and evaluated their concordance. In 767 patients (mean age 47.6 years; 67.9% males) the median inter-modality interval was 35 days. There was significant positive correlation between the 2 modalities (r = 0.75; P < 0.001). Median LVEF was 54% (IQR 47%, 60%) for TTE and 59% (IQR 51%, 64%) for CMR, (P < 0.001). Normal LVEFTTE was confirmed by CMR in 90.6% of cases. Of patients with severely impaired LVEFTTE, 42.3% were upwardly reclassified by CMR as less severely impaired. The overall proportion of patients that had their LVEF category confirmed by both imaging modalities was 64.4%; Cohen's Kappa 0.41, indicating fair-to-moderate agreement. Overall, CMR upwardly reclassified 28% of patients using the British Society of Echocardiography LVEF grading, 18.6% using the European Society of Cardiology heart failure classification, and 29.6% using specific reference ranges for each modality. In a multi-site “real-worldˮ clinical setting, there was significant discrepancy between LVEFTTE and LVEFCMR measurement. Only 64.4% had their LVEF category confirmed by both imaging modalities. LVEFTTE was generally lower than LVEFCMR. LVEFCMR upwardly reclassified almost half of patients with severe LV dysfunction by LVEFTTE. Clinicians should consider the inter-modality variation before making therapeutic recommendations, particularly as clinical trial LVEF thresholds have historically been guided by echocardiography.
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| 2. |
- Galusko, Victor, et al.
(författare)
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Aortic regurgitation management : A systematic review of clinical practice guidelines and recommendations
- 2022
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Ingår i: European Heart Journal - Quality of Care and Clinical Outcomes. - : Oxford University Press (OUP). - 2058-5225 .- 2058-1742. ; 8:2, s. 113-126
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Forskningsöversikt (refereegranskat)abstract
- Guidelines for the diagnosis and management of aortic regurgitation (AR) contain recommendations that do not always match. We systematically reviewed clinical practice guidelines and summarized similarities and differences in the recommendations as well as gaps in evidence on the management of AR. We searched MEDLINE and Embase (1 January 2011 to 1 September 2021), Google Scholar, and websites of relevant organizations for contemporary guidelines that were rigorously developed as assessed by the Appraisal of Guidelines for Research and Evaluation II tool. Three guidelines met our inclusion criteria. There was consensus on the definition of severe AR and use of echocardiography and of multimodality imaging for diagnosis, with emphasis on comprehensive assessment by the heart valve team to assess suitability and choice of intervention. Surgery is indicated in all symptomatic patients and aortic valve replacement is the cornerstone of treatment. There is consistency in the frequency of follow-up of patients, and safety of non-cardiac surgery in patients without indications for surgery. Discrepancies exist in recommendations for 3D imaging and the use of global longitudinal strain and biomarkers. Cut-offs for left ventricular ejection fraction and size for recommending surgery in severe asymptomatic AR also vary. There are no specific AR cut-offs for high-risk surgery and the role of percutaneous intervention is yet undefined. Recommendations on the treatment of mixed valvular disease are sparse and lack robust prospective data.
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| 3. |
- Galusko, Victor, et al.
(författare)
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Management of mitral stenosis : a systematic review of clinical practice guidelines and recommendations
- 2022
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Ingår i: European heart journal. Quality of care & clinical outcomes. - : Oxford University Press (OUP). - 2058-1742 .- 2058-5225. ; 8:6, s. 602-618
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Tidskriftsartikel (refereegranskat)abstract
- A number of guidelines exist with recommendations for diagnosis and management of mitral stenosis (MS). We systematically reviewed existing guidelines for diagnosis and management of MS, highlighting their similarities and differences, in order to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (5/4/2011-5/9/2021), the Guidelines International Network, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two independent reviewers screened titles and abstracts, and the full text of potentially relevant articles where needed. Selected guidelines were assessed for rigor of development; only guidelines with Appraisal of Guidelines for Research and Evaluation II instrument score >50% were included in the final analysis. Four guidelines were retained for analysis. There was consensus for percutaneous mitral balloon commissurotomy as first-line treatment of symptomatic severe rheumatic MS with suitable anatomy. In patients with unfavourable anatomy, surgical intervention should be considered. Exercise testing is indicated if discrepancy exists between symptoms and echocardiographic measurements. There was no clear divide between rheumatic MS and degenerative MS for their respective diagnoses and management. Pregnancy in severe MS is discouraged and the stenosis should be treated before conception. Long-term antibiotic prophylaxis is recommended for patients with rheumatic MS. Recommendations for the management of patients with mixed valvular diseases are lacking.
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| 4. |
- Galusko, Victor, et al.
(författare)
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Mitral regurgitation management : a systematic review of clinical practice guidelines and recommendations
- 2022
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Ingår i: European heart journal. Quality of care & clinical outcomes. - : Oxford University Press (OUP). - 2058-1742 .- 2058-5225. ; 8:5, s. 481-495
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Tidskriftsartikel (refereegranskat)abstract
- Multiple guidelines exist for the diagnosis and management of mitral regurgitation (MR), the second most common valvular heart disease in high-income countries, with recommendations that do not always match. We systematically reviewed guidelines on diagnosis and management of MR, highlighting similarities and differences to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (1 June 2010 to 1 September 2021), the Guidelines International Network, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two reviewers independently screened the abstracts and identified articles of interest. Guidelines that were rigorously developed (as assessed with the Appraisal of Guidelines for Research and Evaluation II instrument) were retained for analysis. Five guidelines were retained. There was consensus on a multidisciplinary approach from the heart team and for the definition and grading of severe primary MR. There was general agreement on the thresholds for intervention in symptomatic and asymptomatic primary MR; however, discrepancies were present. There was agreement on optimization of medical therapy in severe secondary MR and intervention in patients symptomatic despite optimal medical therapy, but no consensus on the choice of intervention (surgical repair/replacement vs. transcatheter approach). Cut-offs for high-risk intervention in MR, risk stratification of progressive MR, and guidance on mixed valvular disease were sparse.
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| 5. |
- Khanji, Mohammed Y., et al.
(författare)
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Management of aortic stenosis : A systematic review of clinical practice guidelines and recommendations
- 2021
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Ingår i: European Heart Journal - Quality of Care and Clinical Outcomes. - : Oxford University Press (OUP). - 2058-5225 .- 2058-1742. ; 7:4, s. 340-353
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Forskningsöversikt (refereegranskat)abstract
- Multiple guidelines exist for the management of aortic stenosis (AS). We systematically reviewed current guidelines and recommendations, developed by national or international medical organizations, on management of AS to aid clinical decision-making. Publications in MEDLINE and EMBASE between 1 June 2010 and 15 January 2021 were identified. Additionally, the International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations were searched. Two reviewers independently screened titles and abstracts. Two reviewers assessed rigour of guideline development and extracted the recommendations. Of the seven guidelines and recommendations retrieved, five showed considerable rigour of development. Those rigourously developed, agreed on the definition of severe AS and diverse haemodynamic phenotypes, indications and contraindications for intervention in symptomatic severe AS, surveillance intervals in asymptomatic severe AS, and the importance of multidisciplinary teams (MDTs) and shared decision-making. Discrepancies exist in age and surgical risk cut-offs for recommending surgical aortic valve replacement (SAVR) vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers and complementary multimodality imaging for decision-making in asymptomatic patients and surveillance intervals for non-severe AS. Contemporary guidelines for AS management agree on the importance of MDT involvement and shared decision-making for individualized treatment and unanimously indicate valve replacement in severe, symptomatic AS. Discrepancies exist in thresholds for age and procedural risk used in choosing between SAVR and TAVI, role of biomarkers and complementary imaging modalities to define AS severity and risk of progression in asymptomatic patients.
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| 6. |
- Khanji, Mohammed Y., et al.
(författare)
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The role of hand-held ultrasound for cardiopulmonary assessment during a pandemic
- 2020
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Ingår i: Progress in cardiovascular diseases. - : Elsevier BV. - 0033-0620. ; 63:5, s. 690-695
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Forskningsöversikt (refereegranskat)abstract
- During the COVID-19 pandemic, we are likely to see a significant increase in the requests for rapid assessment of cardiac function, due to the frequent pre-existence of cardiac pathologies in patients admitted to hospital, and to the emergence of specific cardiac manifestations of this infection, such as myocarditis, sepsis related cardiomyopathy, stress induced cardiomyopathy and acute coronary syndromes. Hand-held, point-of-care ultrasound (HH-POCUS) is particularly suited for the provision of rapid, focused, integrated assessments of the heart and lungs. We present a review of the indications and protocols for focused HH-POCUS use in an acute setting and formulate proposals for streamlining their application in the COVID-19 context towards guiding optimum management of these patients while at the same time allowing adherence to robust infection control measures to provide safety to both the patient and our clinical staff.
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| 7. |
- Mantini, Cesare, et al.
(författare)
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Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity : A Prospective Pilot Study
- 2021
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Ingår i: Frontiers in Cardiovascular Medicine. - : Frontiers Media SA. - 2297-055X. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOAcmr ), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age-and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOAcmr; (ii) geometric orifice area (GOAcmr ) by direct CMR planimetry; (iii) EOAecho by TTE-continuity equation; and (iv) the “gold standard” multimodality EOA (EOAhybrid ) obtained by substituting CMR LVOT area into Doppler continuity equation. Results: There was excellent pairwise positive linear correlation among AOAcmr, EOAhybrid, GOAcmr, and EOAecho (p < 0.001); AOAcmr had the highest correlation with EOAhybrid (R2 = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOAcmr and EOAhybrid . AOAcmr yielded excellent intra-and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively). Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate “one-stop shop” CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.
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| 8. |
- Ornbjerg, Lykke Midtboll, et al.
(författare)
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One-Third of European Patients With Axial Spondyloarthritis Reach Pain Remission With Routine Care Tumor Necrosis Factor Inhibitor Treatment
- 2023
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Ingår i: JOURNAL OF RHEUMATOLOGY. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 50:8, s. 1009-1019
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the distribution of patient-reported outcomes (PROs) in patients with axial spondyloarthritis (axSpA) initiating a tumor necrosis factor inhibitor ( TNFi), to assess the proportion reaching PRO "remission" across registries and treatment series, and to compare patients registered to fulfill the modified New York (mNY) criteria for ankylosing spondylitis (AS) vs patients with nonradiographic axSpA (nr-axSpA). Methods. Fifteen European registries contributed PRO scores for pain, fatigue, patient global assessment (PtGA), Bath Ankylosing Spondylitis (AS) Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and Health Assessment Questionnaire (HAQ) from 19,498 patients with axSpA. Changes in PROs and PRO remission rates (definitions: <= 20 mm for pain, fatigue, PtGA, BASDAI, and BASFI; <= 0.5 for HAQ) were calculated at 6, 12, and 24 months of treatment. Results. Heterogeneity in baseline characteristics and outcomes between registries were observed. In pooled data, 6 months after the start of a first TNFi, pain score was reduced by approximately 60% (median at baseline/6/12/24 months: 65/25/20/20 mm) in patients on treatment. Similar patterns were observed for fatigue (68/32/30/25 mm), PtGA (66/29/21/20 mm), BASDAI (58/26/21/19 mm), BASFI (46/20/16/16 mm), and HAQ (0.8/0.4/0.2/0.2). Patients with AS (n = 3281) had a slightly better response than patients with nr-axSpA (n = 993). The Lund Efficacy Index (LUNDEX)-adjusted remission rates at 6 months for pain/fatigue/PtGA/BASDAI/BASFI/HAQ were 39%/30%/38%/34%/35%/48% for the AS cohort and 30%/21%/26%/24%/33%/47% for the nr-axSpA cohort. Better PRO responses were seen with a first TNFi compared to a second and third TNFi. Conclusion. Patients with axSpA starting a TNFi achieved high PRO remission rates, most pronounced in those fulfilling the mNY criteria and for the first TNFi.
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| 9. |
- Ricci, Fabrizio, et al.
(författare)
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Tricuspid regurgitation management : a systematic review of clinical practice guidelines and recommendations
- 2022
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Ingår i: European heart journal. Quality of care & clinical outcomes. - : Oxford University Press (OUP). - 2058-1742 .- 2058-5225. ; 8:3, s. 238-248
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Tidskriftsartikel (refereegranskat)abstract
- Tricuspid regurgitation (TR) is a highly prevalent condition and an independent risk factor for adverse outcomes. Multiple clinical guidelines exist for the diagnosis and management of TR, but the recommendations may sometimes vary. We systematically reviewed high-quality guidelines with a specific focus on areas of agreement, disagreement, and gaps in evidence. We searched MEDLINE and EMBASE (1 January 2011 to 30 August 2021), the Guidelines International Network International, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, Google Scholar, and websites of relevant organizations for contemporary guidelines that were rigorously developed (as assessed by the Appraisal of Guidelines for Research and Evaluation II tool). Three guidelines were finally retained. There was consensus on a TR grading system, recognition of isolated functional TR associated with atrial fibrillation, and indications for valve surgery in symptomatic vs. asymptomatic patients, primary vs. secondary TR, and isolated TR forms. Discrepancies exist in the role of biomarkers, complementary multimodality imaging, exercise echocardiography, and cardiopulmonary exercise testing for risk stratification and clinical decision-making of progressive TR and asymptomatic severe TR, management of atrial functional TR, and choice of transcatheter tricuspid valve intervention (TTVI). Risk-based thresholds for quantitative TR grading, robust risk score models for TR surgery, surveillance intervals, population-based screening programmes, TTVI indications, and consensus on endpoint definitions are lacking.
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| 10. |
- Saeidi, Ali, et al.
(författare)
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Nanowire Tunnel FET with Simultaneously Reduced Subthermionic Subthreshold Swing and Off-Current due to Negative Capacitance and Voltage Pinning Effects
- 2020
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Ingår i: Nano Letters. - : American Chemical Society (ACS). - 1530-6992 .- 1530-6984. ; 20:5, s. 3255-3262
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Tidskriftsartikel (refereegranskat)abstract
- Nanowire tunnel field-effect transistors (TFETs) have been proposed as the most advanced one-dimensional (1D) devices that break the thermionic 60 mV/decade of the subthreshold swing (SS) of metal oxide semiconductor field-effect transistors (MOSFETs) by using quantum mechanical band-to-band tunneling and excellent electrostatic control. Meanwhile, negative capacitance (NC) of ferroelectrics has been proposed as a promising performance booster of MOSFETs to bypass the aforementioned fundamental limit by exploiting the differential amplification of the gate voltage under certain conditions. We combine these two principles into a single structure, a negative capacitance heterostructure TFET, and experimentally demonstrate a double beneficial effect: (i) a super-steep SS value down to 10 mV/decade and an extended low slope region that is due to the NC effect and, (ii) a remarkable off-current reduction that is experimentally observed and explained for the first time by the effect of the ferroelectric dipoles, which set the surface potential in a slightly negative value and further blocks the source tunneling current in the off-state. State-of-the-art InAs/InGaAsSb/GaSb nanowire TFETs are employed as the baseline transistor and PZT and silicon-doped HfO2 as ferroelectric materials.
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| 11. |
- Smith, Anderson, 1985-
(författare)
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Graphene-based Devices for More than Moore Applications
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Moore's law has defined the semiconductor industry for the past 50 years. Devices continue to become smaller and increasingly integrated into the world around us. Beginning with personal computers, devices have become integrated into watches, phones, cars, clothing and tablets among other things. These devices have expanded in their functionality as well as their ability to communicate with each other through the internet. Further, devices have increasingly been required to have diverse of functionality. This combination of smaller devices coupled with diversification of device functionality has become known as more than Moore. In this thesis, more than Moore applications of graphene are explored in-depth.Graphene was discovered experimentally in 2004 and since then has fueled tremendous research into its various potential applications. Graphene is a desirable candidate for many applications because of its impressive electronic and mechanical properties. It is stronger than steel, the thinnest known material, and has high electrical conductivity and mobility. In this thesis, the potentials of graphene are examined for pressure sensors, humidity sensors and transistors.Through the course of this work, high sensitivity graphene pressure sensors are developed. These sensors are orders of magnitude more sensitive than competing technologies such as silicon nanowires and carbon nanotubes. Further, these devices are small and can be scaled aggressively.Research into these pressure sensors is then expanded to an exploration of graphene's gas sensing properties -- culminating in a comprehensive investigation of graphene-based humidity sensors. These sensors have rapid response and recovery times over a wide humidity range. Further, these devices can be integrated into CMOS processes back end of the line.In addition to CMOS Integration of these devices, a wafer scale fabrication process flow is established. Both humidity sensors and graphene-based transistors are successfully fabricated on wafer scale in a CMOS compatible process. This is an important step toward both industrialization of graphene as well as heterogeneous integration of graphene devices with diverse functionality. Furthermore, fabrication of graphene transistors on wafer scale provides a framework for the development of statistical analysis software tailored to graphene devices.In summary, graphene-based pressure sensors, humidity sensors, and transistors are developed for potential more than Moore applications. Further, a wafer scale fabrication process flow is established which can incorporate graphene devices into CMOS compatible process flows back end of the line.
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| 12. |
- Yu, Yingtao, 1996-
(författare)
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Silicon Nanowire Based Sensors for Bacterial Tests
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rapid and reliable antibiotic susceptibility testing (AST) is urgently required to diagnose bacterial infectious diseases and avoid antibiotic misuse, providing valuable information on the efficacy of antibiotic agents and their dosages for treatment. However, the currently employed phenotypic ASTs normally demand the growth of bacteria into colonies, which usually takes more than two days. In this thesis, silicon nanowire field-effect transistors (SiNWFETs) are emploied to realize rapid ASTs, and a novel suspended SiNW-net sensor is also developed as a potential device platform for bacterial motility detection.The thesis first introduces SiNWFET sensors for rapid ASTs. The extracellular pH change generated by bacterial metabolism is an efficient indicator of bacterial activity, which is monitored by our SiNWFET sensors. Rapid ASTs are achieved by using SiNWFET sensors array with a total assay time of less than 30 minutes for different bacterial strains. As a follow-up, the metabolic response of E. coli under ampicillin treatment is systematically studied. When exposed to bactericidal antibiotics, the bacterial respiration rate will be accelerated, thereby enhancing the lethality of the antibiotics. This work demonstrates the capabilities of SiNWFETs for rapid ASTs and bacterial metabolism investigations.To further improve the detection limit of SiNWFET, Schottky junction gated SiNWFET (SJGFET) is developed, in which the noisy Si channel/gate oxide interface is replaced by a PtSi/Si junction. Ultra-low low-frequency noise is demonstrated in SJGFETs fabricated on high-quality bonded silicon-on-insulator (SOI) substrate. The best achieved Svg are 1.2 × 10−10 and 1.1 × 10−11 V2μm2/Hz at 1 Hz and 10 Hz, respectively. Then, a thorough investigation of low-frequency noise (LFN) is performed using the CNF + CMF model specifically modified for SJGFET structure on SOI substrate. The observed LFN dependence on substrate voltage and channel width is mainly ascribed to the nonuniform energy distribution of interface traps.For the purposes of bacterial mobility detection, we propose a novel SiNW-net-based nanoelectromechanical sensor, with a 30-μm suspended SiNW-net and a metal Lorentz loop stacked on top. The lock-in amplifier measurement setup is optimized to significantly reduce the system noise. During rapid thermal processing in the device fabrication, lateral boron autodoping is discovered, which happens via ambient diffusion limited by the redeposition step at the interface. This technique enables shallow junction formation and will be integrated into SiNW-net fabrication to form well-controlled piezoresistors.
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