Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association

Heart failure (HF) is a complex clinical syndrome with multiple interactions between the failing myocardium and cerebral (dys‐)functions. Bi‐directional feedback interactions between the heart and the brain are inherent in the pathophysiology of HF: (i) the impaired cardiac function affects cerebral structure and functional capacity, and (ii) neuronal signals impact on the cardiovascular continuum. These interactions contribute to the symptomatic presentation of HF patients and affect many co‐morbidities of HF. Moreover, neuro‐cardiac feedback signals significantly promote aggravation and further progression of HF and are causal in the poor prognosis of HF. The diversity and complexity of heart and brain interactions make it difficult to develop a comprehensive overview. In this paper a systematic approach is proposed to develop a comprehensive atlas of related conditions, signals and disease mechanisms of the interactions between the heart and the brain in HF. The proposed taxonomy is based on pathophysiological principles. Impaired perfusion of the brain may represent one major category, with acute (cardio‐embolic) or chronic (haemodynamic failure) low perfusion being sub‐categories with mostly different consequences (i.e. ischaemic stroke or cognitive impairment, respectively). Further categories include impairment of higher cortical function (mood, cognition), of brain stem function (sympathetic over‐activation, neuro‐cardiac reflexes). Treatment‐related interactions could be categorized as medical, interventional and device‐related interactions. Also interactions due to specific diseases are categorized. A methodical approach to categorize the interdependency of heart and brain may help to integrate individual research areas into an overall picture.     

Prospective assessment of VI-RADS score in multiparametric MRI in bladder cancer: accuracy and the factors affecting the results

PURPOSEWe aimed to investigate the accuracy of Vesical Imaging - Reporting and Data System (VI-RADS) in the detection of muscle-invasive bladder cancer (MIBC) and to determine which factors affect the results of this scoring system.METHODSA prospective data analysis of 80 patients who were detected to have bladder tumor was performed between March 2019 and October 2020. VI-RADS scoring was used to determine the probability of muscle invasion. The scores were compared with pathological results to evaluate the accuracy of the VI-RADS scoring system. Interobserver agreement was assessed by VI-RADS scoring of 20 randomly chosen patients by a different experienced radiologist.RESULTSUsing the VI-RADS scoring system, the sensitivity, specificity, positive predictive value, and negative predictive value of multiparametric magnetic resonance imaging (mpMRI) were 87.5%, 87.5%, 63.6%, and 96.6%, respectively. The interobserver agreement expressed as the interclass correlation coefficient (ICC) was 0.72 (95% CI: 0.44-0.84, P < .001). In addition, the flat appearance of the tumor was an important factor affecting the accuracy of the VI-RADS score (odds ratio: 5.3 [95% CI: 1.1-27.0] and relative risk: 1.87 [95% CI: 1.24-2.82]).CONCLUSIONThe mpMRI, used in conjunction with VI-RADS, has proven to be an effective imaging method for detecting muscle invasion in cases of bladder cancer. VI-RADS scoring system can distinguish whether there is a muscle-invasive and non-muscle invasive bladder cancer with acceptable accuracy. In addition, the flat appearance of the tumor is an important entity that can affect the accuracy of the VI-RADS scoring system.

Main points

• The mpMRI, used in conjunction with VI-RADS, has shown to be an effective imaging method for detecting muscle invasion in cases of bladder cancer with acceptable accuracy.
• The sensitivity, specificity, positive predictive value, and negative predictive value of mpMRI were 87.5%, 87.5%, 63.6%, and 96.6%, respectively.
• The flat appearance of the tumor is an important factor affecting the accuracy of the VI-RADS scoring system.

Bladder cancer (BCa) is one of the most common cancers worldwide which predominantly affects men.¹ The treatment approach for BCa depends on the radiologic and pathologic stage of the tumor because muscle invasion of the tumor is one of the important parameters to decide treatment options. Preoperative radiologic staging of the muscle invasion in patients with BCa has become an important topic because the pathologic diagnosis after transurethral resection of bladder tumor (TURB) also has the potential of understaging. That is why the urologists have been performing re-TURB on patients with T1 tumors.²With the use of Prostate Imaging Reporting and Data System (PI-RADS),^3,4 multiparametric magnetic resonance imaging (mpMRI) became an important tool to detect and stage solid renal masses and prostate cancer in the daily practices of urooncologists and uroradiologists. mpMRI with functional sequences (diffusion-weighted imaging and dynamic contrast-enhanced MRI) and anatomic sequences (T1 and T2) is currently the best imaging modality used in the detection of the local regional staging of bladder cancer thanks to its superior soft tissue contrast.⁴ Vesical Imaging Reporting and Data System (VI-RADS) score was defined to provide preoperative BCa staging by using mpMRI and it was standardized in a number of studies.^4-10The purpose of VI-RADS is to differentiate Ta-T1 non-muscle invasive bladder cancer (NMIBC) from T2-T4 muscle-invasive bladder cancer (MIBC)⁵ and in accordance with this purpose, there have been few prospective studies in the literature that investigate the applicability and accuracy of the VI-RADS.The present study aimed to investigate the impact of VI-RADS on detecting MIBC and to determine the factors that affect the results of this scoring system, prospectively.     

Thrombolysis in Myocardial Infarction Risk Index Predicts 1-Year Mortality in Patients with Heart Failure: An Analysis of the SELFIE-TR Study

ObjectivePredicting outcomes is an essential part of evaluation of patients with heart failure (HF). While there are multiple individual laboratory and imaging variables as well as risk scores available for this purpose, they are seldom useful during the initial evaluation. In this analysis, we aimed to elucidate the predictive usefulness of Thrombolysis in Myocardial Infarction Risk Index (TIMI-RI), a simple index calculated at the bedside with three commonly available variables, using data from a multicenter HF registry.Subjects and MethodsA total of 728 patients from 23 centers were included in this analysis. Data on hospitalizations and mortality were collected by direct interviews, phone calls, and electronic databases. TIMI-RI was calculated as heart rate × (age/10)²/systolic pressure. Patients were divided into three equal tertiles to perform analyses.ResultsRehospitalization for HF was significantly higher in patients within the 3rd tertile, and 33.5% of patients within the 3rd tertile had died within 1-year follow-up as compared to 14.5% of patients within the 1st tertile and 15.6% of patients within the 2nd tertile (p < 0.001, log-rank p < 0.001 for pairwise comparisons). The association between TIMI-RI and mortality remained significant (OR: 1.74, 95% CI: 1.05–2.86, p = 0.036) after adjustment for other variables. A TIMI-RI higher than 33 had a negative predictive value of 84.8% and a positive predictive value of 33.8% for prediction of 1-year mortality.ConclusionTIMI-RI is a simple index that predicts 1-year mortality in patients with HF; it could be useful for rapid evaluation and triage of HF patients at the time of initial contact.