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Introduction: The early diagnosis of infective endocarditis (IE) is a medical challenge and a multidisciplinary approach is essential to improve its frequently fatal prognosis. Our goal was to evaluate the usefulness of [18F]2-fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET) in the diagnosis of this disease. Materials and Methods: We prospectively assessed 43 patients (five female and 38 male) with clinical suspicion of IE between 2014 and 2017. All patients underwent transesophageal echocardiography (TEE) and an 18F-FDG PET scan, and the results were compared. A positive PET finding was defined as increased FDG uptake on cardiac valves or intracardiac devices. Results: Out of 43 patients with suspected IE, the diagnosis was confirmed in 30 cases (79.7%). 18F-FDG PET was positive in 24 patients, with 19 showing FDG uptake on cardiac valves (two native and 17 prosthetic) and five on cardiac devices, being concordant with echocardiographic findings in 11 cases. 18F-FDG PET sensitivity was 80%, specificity 92%, positive predictive value (PPV) 96% and negative predictive value (NPV) 66%. Echocardiography presented sensitivity, specificity, PPV and NPV of 36%, 84%, 84% and 36%, respectively. Conclusions: 18F-FDG PET proved to be a sensitive technique with a high diagnostic value in patients with prosthetic valves and intracardiac devices and suspected IE. Its utility decreased dramatically in patients with suspected IE on native valves, in which TEE presented higher sensitivity and thus better diagnostic value. Resumo: Introdução: O diagnóstico precoce de endocardite infecciosa (EI) é um desafio médico. Portanto, uma abordagem multidisciplinar é essencial para melhorar o prognóstico desta patologia, muitas vezes fatal. O nosso objetivo foi avaliar a utilidade da tomografia por emissão de pósitrons [18F] 2-fluoro-2-desoxi-D-glicose (18F-FDG-PET) no diagnóstico desta doença. Materiais e métodos: De forma prospetiva, avaliámos 43 doentes (5 do sexo feminino e 38 do masculino) clinicamente suspeitos de EI entre 2014-2017. Todos os doentes foram submetidos a um ecocardiograma transesofágico (ETE) e uma PET 18F-FDG, os resultados foram posteriormente comparados. Um critério PET positivo foi definido como um aumento na captação de FDG nas válvulas cardíacas ou nos dispositivos intracardíacos. Resultados: Dos 43 doentes com suspeita de EI, o diagnóstico foi confirmado em 30 casos (79,7%). O 18F-FDG-PET foi positivo em 24 doentes, dos quais 19 demonstraram captação de FDG nas válvulas cardíacas (2 nativas e 17 protésicas) e cinco nos dispositivos cardíacos, concordando com os achados ecocardiográficos em 11 casos. A sensibilidade de 18F-FDG-PET (S) foi de 80%, especificidade (P) de 92%, valor preditivo positivo (VPP) de 96% e valor preditivo negativo (VPN) de 66%. A ecocardiografia apresentou valores de S, P, PPV e VPN de 36%, 84%, 84% e 36%, respetivamente. Conclusões: O 18F-FDG-PET demonstrou ser uma técnica sensível com alto valor diagnóstico em doentes com suspeita de EI com próteses valvulares e dispositivos intracardíacos. A utilidade desta técnica diminui drasticamente em doentes com suspeita de EI nas válvulas nativas, nas quais a ETE apresentou maior sensibilidade e, portanto, melhor valor diagnóstico. Keywords: Infective endocarditis, Positron emission tomography, 18-Fluoro-2-deoxy-d-glucose, Transesophageal echocardiography, Palavras-chave: Endocardite infecciosa (EI), Tomografia por emissão de pósitrões (18F-FDG-PET), Ecocardiograma transesofágico (ETE)

Abstract The lack of a standardized cut-off value in the quantitative method and an inter-observer disagreement in the evaluation of the semiquantitative score in 99mTc-DPD scintigraphy leaves several patients with cardiac amyloidosis (CA) undiagnosed (grade 1 and H/CL: 1–1.49). This study aims to increase diagnostic productivity of 99mTc-DPD scintigraphy in CA. This is a retrospective study of 170 patients with suspicion of CA. A total of 81 (47.6%) were classified as transthyretin CA (TTR-CA) and 9 (5.3%) as light-chain CA (LC-CA) applying the visual score. An enhanced quantitative method and cut-off point were attempted to reclassify inconclusive patients and reduce inter-observer variability. Applying the proposed quantitative method, of the 19 patients with grade 1 uptake, 2 became grade 0 (none-CA), 2 were reclassified as grade 3 (TTR-CA), and 2 were regrouped as grade 2 (1 TTR-CA and 1 LC-CA). Adjusting the quantitative method’s cut-off value to 1.3, four patients previously inconclusive were reclassified as TTR-CA, the diagnosis was confirmed in 3 and rejected in 1. When a 1.3 threshold is compared to 1.5, the sensitivity increases to 94% without reducing its specificity. The quantitative method improves the visual interpretation, reclassifying doubtful cases. The optimization of the cut-off value from 1.5 to 1.3 reclassifies a higher percentage of patients as TTR-CA with a higher sensitivity without reducing its specificity.

Abstract Background Most serious complications of infective endocarditis (IE) appear in the so-called “critical phase” of the disease, which represents the first days after diagnosis. The majority of patients overcoming the acute phase has a favorable outcome, yet they remain hospitalized for a long period of time mainly to complete antibiotic therapy. The major hypothesis of this trial is that in patients with clinically stable IE and adequate response to antibiotic treatment, without signs of persistent infection, periannular complications or metastatic foci, a shorter antibiotic time period would be as efficient and safe as the classic 4 to 6 weeks antibiotic regimen. Methods Multicenter, prospective, randomized, controlled open-label, phase IV clinical trial with a non-inferiority design to evaluate the efficacy of a short course (2 weeks) of parenteral antibiotic therapy compared with conventional antibiotic therapy (4–6 weeks). Sample: patients with IE caused by gram-positive cocci, having received at least 10 days of conventional antibiotic treatment, and at least 7 days after surgery when indicated, without clinical, analytical, microbiological or echocardiographic signs of persistent infection. Estimated sample size: 298 patients. Intervention: Control group: standard duration antibiotic therapy, (4 to 6 weeks) according to ESC guidelines recommendations. Experimental group: short-course antibiotic therapy for 2 weeks. The incidence of the primary composite endpoint of all-cause mortality, unplanned cardiac surgery, symptomatic embolisms and relapses within 6 months after the inclusion in the study will be prospectively registered and compared. Conclusions SATIE will investigate whether a two weeks short-course of intravenous antibiotics in patients with IE caused by gram-positive cocci, without signs of persistent infection, is not inferior in safety and efficacy to conventional antibiotic treatment (4–6 weeks). Trial registration ClinicalTrials.gov Identifier: NCT04222257 (January 7, 2020). EudraCT 2019–003358-10.

Atrial fibrillation is the most prevalent tachyarrhythmia in clinical practice, with very high cardiovascular morbidity and mortality with a high-cost impact in health systems. Currently, it is one of the main causes of stroke and subsequent heart failure and sudden death. miRNAs mediate in several processes involved in cardiovascular disease, including fibrosis and electrical and structural remodeling. Several studies suggest a key role of miRNAs in the course and maintenance of atrial fibrillation. In our study, we aimed to identify the differential expression of circulating miRNAs and their predictive value as biomarkers of recurrence in atrial fibrillation patients undergoing catheter pulmonary vein ablation. To this effect, 42 atrial fibrillation patients were recruited for catheter ablation. We measured the expression of 84 miRNAs in non-recurrent and recurrent groups (45.2%), both in plasma from peripheral and left atrium blood. Expression analysis showed that miRNA-451a is downregulated in recurrent patients. Receiver operating characteristic curve analysis showed that miR-451a in left atrium plasma could predict atrial fibrillation recurrence after pulmonary vein isolation. In addition, atrial fibrillation recurrence is positively associated with the increment of scar percentage. Our data suggest that miRNA-451a expression plays an important role in AF recurrence by controlling fibrosis and progression.

Cardiac resynchronization therapy represents a therapeutic option for heart failure drug-refractory patients. However, due to the lack of success in 30% of the cases, there is a demand for an in-depth analysis of individual heterogeneity. In this study, we aimed to evaluate the prognostic value of circulating miRNA differences. Responder patients were defined by a composite endpoint of the presence of left ventricular reverse remodelling (a reduction ≥15% in telesystolic volume and an increment ≥10% in left ventricular ejection fraction). Circulating miRNAs signature was analysed at the time of the procedure and at a 6-month follow-up. An expression analysis showed, both at baseline and at follow-up, differences between responders and non-responders. Responders presented lower baseline expressions of miR-499, and at follow-up, downregulation of miR-125b-5p, both associated with a significant improvement in left ventricular ejection fraction. The miRNA profile differences showed a marked sensitivity to distinguish between responders and non-responders. Our data suggest that miRNA differences might contribute to prognostic stratification of patients undergoing cardiac resynchronization therapy and suggest that preimplant cardiac context as well as remodelling response are key to therapeutic success.

Irrigation is essential for maintaining food production in water-scarce regions. The irrigation need depends on the water content of the soil, which we measured with the novel technique of cosmic-ray neutron sensing (CRNS). The potential of the CRNS technique for drip irrigation scheduling was explored in this study for the Picassent site near Valencia, Spain. To support the experimental evidence, the neutron transport simulation URANOS was used to simulate the effect of drip irrigation on the neutron counts. The overall soil water content (SWC) in the CRNS footprint was characterized with a root mean square error

In this study, hybrid pepper rootstock NIBER® is tested for its ability to overcome water stress situations under soil conditions. The impact of deficit irrigation (DI) on yield and fruit quality, irrigation water use efficiency is evaluated, and consequently, the agronomic impact of employing water-stress tolerant rootstock is compared to ungrafted pepper plants. For this purpose, plants of the California-type sweet pepper ‘Maestral F1’ grafted onto NIBER® underwent a sustained DI regime during seasons 2018 and 2019 and were compared to their respective controls. Plants were drip-fertirrigated, and volumetric soil water content was continuously monitored by capacitance sensors. Gas exchange and leaf water potential measurements were taken early in the morning and midday 58, 79, and 114 days after transplanting. Plant and fruit dry biomass, marketable quality, blossom-end rot incidence and harvest index were also determined. For consecutive years, our results confirmed that grafting a pepper cultivar onto an appropriate rootstock (NIBER® in this case) as part of a DI strategy can overcome the negative effects of sustained water stress conditions. The plant biomass production and fruit yields of grafted plants were less affected by DI due to less sensitivity to water stress. This can be attributed to a less marked reduction in shoot dry weight in the grafted plants, which allowed greater whole photosynthesis by maintaining sink activity compared to ungrafted plants.