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Left ventricular global longitudinal strain adds incremental value for risk prediction in unselected clinical patients
(2025) Backhaus, Sören J; Treiber, Julia M; Wolter, Jan Sebastian; Kriechbaum, Steffen D; Saamann, David; Schuster, Andreas; Sossalla, Samuel; Rolf, Andreas
Aims: Deformation imaging has demonstrated incremental prognostic value compared to left ventricular ejection fraction (LVEF) in specific cardiovascular diseases; however, it remains widely underused. Consequently, we sought to investigate the significance of deformation imaging in an all-comers population to assess its value in a routine in- and outpatient setting. Methods and results: Patients were prospectively recruited to the single-centre cardiac magnetic resonance registry. Volumetric right and left ventricular (RV/LV) analyses and global circumferential strain were assessed on short-axis stacks, RV and LV global longitudinal strain (GLS) on long-axis views respectively. Follow-up was conducted for primary (all-cause mortality and heart failure hospitalization) and secondary (all-cause mortality, hospitalized angina, infarction, and stroke) endpoints. In total, n = 1655 patients met n = 68 primary and n = 107 secondary endpoints during a median follow-up of 399 days. GLS (HR 1.12, 95%CI 1.04–1.21 P = 0.002; HR 1.10, 95%CI 1.03–1.16 P = 0.002) but not LVEF (P = 0.406; 0.209) was an independent predictor for the primary and secondary endpoint. GLS was an independent predictor for the primary endpoint after correction for commonly considered risk factors including, age, NYHA class, tissue characterization native T1, biomarker NT-proBNP, and glomerular filtration rate (HR 1.09, 95%CI 1.03–1.15, P = 0.003). After dichotomization at the median of −16.4%, GLS added incremental value to risk stratification for the primary endpoint on Kaplan-Meier plots in patients with LVEF above (P = 0.045) and below (P = 0.017) the median of 55%. Conclusion: In an all-comers, low-risk patient population, GLS emerged as an independent risk predictor with incremental prognostic value relative to LVEF. This finding may support clinical routine implementation of GLS in cardiac in- and outpatient clinics.
Native T1 adds independent value for cardiovascular risk assessment beyond global longitudinal strain in an all-comers real-world clinical patient population
(2025) Backhaus, Sören J; Treiber, Julia; Wolter, Jan Sebastian; Kriechbaum, Steffen D; Fischer, Ulla; Schuster, Andreas; Puntmann, Valentina O; Nagel, Eike; Sossalla, Samuel; Rolf, Andreas
Aims: Deformation imaging remains underused for cardiovascular risk assessment. As tissue characterization has now been recognized as an additional assessment tool, we sought to investigate the significance of native T1 and extracellular volume (ECV) in an unselected clinical routine population. Methods and results: The single-centre, prospective cardiovascular magnetic resonance (CMR) registry included patients referred for clinical CMR. Left ventricle global longitudinal strain (GLS) was evaluated in long-axis views. Native T1 and ECV were assessed on septal, basal, or midventricular short-axis positions. Follow-up was conducted for primary (all-cause mortality and heart failure hospitalization) and secondary (all-cause mortality, hospitalized angina, and myocardial infarction) endpoints. The final population consisted of n = 1633 patients who met primary (n = 68) and secondary (n = 90) endpoints during the median follow-up of 395 days. A 10-ms T1 increase was associated with a hazard ratio (HR) of 1.11 [95% confidence interval (CI) 1.07–1.15, P < 0.001] for the primary endpoint independent of ECV (P = 0.738). T1 (HR 1.07, 95% CI 1.03–1.11, P = 0.001) but not ECV (P = 0.674) was an independent predictor for the primary endpoint after correction for common risk factors including age, New York Heart Association class, biomarker NT-proBNP/glomerular filtration rate, and GLS. After dichotomization at the median of 1126 ms, T1 added incremental value for primary endpoint prediction on Kaplan–Meier plots in patients with left ventricular ejection fraction above/below (P = 0.019/0.017) the median of 55% and GLS above/below (P = 0.019/0.041) the median of −16.4%. Conclusion: Native T1 was found to be an independent risk predictor beyond GLS as well as common clinical risk factors. This may justify the use of non-contrast CMR protocols in selected patients if contrast application is contraindicated.
Biofilm formation in Acinetobacter baumannii isolates from companion animals and horses: associations with host, clinical origin, antimicrobial resistance, and clonal lineage
(2026) Rühl-Teichner, Johanna; Leidner, Ursula; Semmler, Torsten; Ewers, Christa
Acinetobacter baumannii is a major nosocomial pathogen in both human and veterinary medicine, in which biofilm formation (BF), multidrug resistance (MDR), and specific international clones (ICs) contribute to persistence and spread. In this study, 507 clinical A. baumannii isolates from cats, dogs, and horses, collected between 2008 and 2024, were analyzed for antimicrobial resistance (AMR), BF capacity, and genomic characteristics. Antimicrobial susceptibility was determined using the VITEK® 2 system, BF was quantified after 24 and 48 h by crystal violet assay, and genomic analyses included multilocus sequence typing, assignment to ICs, and detection of AMR and biofilm-associated genes (BAGs). Overall, 79.5% of isolates were classified as MDR, with significantly higher rates in cats and dogs than in horses. BF was widespread and showed host-specific dynamics: canine isolates exhibited progressive biofilm maturation over time, feline isolates remained largely stable, and equine isolates showed delayed but pronounced BF. BF also varied by clinical origin, with isolates from wounds/abscesses, urinary tract infections, and medical devices showing the strongest BF, compared, for example, with isolates from respiratory or genital tract infections. Among all clonal lineages, IC1 and IC2 were characterized by the strongest BF and the highest proportion of MDR isolates. Among the BAGs analyzed, blp1 was positively associated with BF, whereas bap showed an inverse association. These findings indicate that biofilm formation is a central feature of A. baumannii epidemiology in companion animals and is closely linked to clinical origin, MDR phenotype and clonal lineage. Improved understanding of these relationships may support the development of more targeted therapeutic strategies in veterinary medicine.
Transcranial alternating current stimulation over left DLPFC modulates feedback processing : a simultaneous tACS-fMRI study
(2026) Debnath, Ranjan; Lenz, Eva; Tobelander, Johannes; Schweppe, Paula; Renner, Vincent; Mulert, Christoph
Studies have shown that reward-related feedback is processed by distinct brain networks. Neuronal oscillations, particularly theta and beta rhythms, play a key role in facilitating communications within these networks. This study investigated how modulating brain oscillations at theta and beta frequencies using transcranial alternating current stimulation (tACS) influences activation in brain regions involved in feedback processing. In three separate sessions, 28 healthy participants received either theta (5 Hz), beta (25 Hz), or sham tACS over the left dorsolateral prefrontal cortex (DLPFC) while performing a gambling task. fMRI data were recorded simultaneously with tACS to measure BOLD activations associated with gain and loss feedback. Results showed that theta stimulation enhanced activity in brain regions related to sensory processing, error monitoring, cognitive control, and emotion regulation during loss feedback. On the other hand, beta stimulation modulated activation in areas associated with reward sensitivity and emotional processing during gain feedback. These findings demonstrate the distinct roles of theta and beta oscillations in negative and positive feedback processing.
On the implementation of external forcings in a regional climate model : a sensitivity study around the Samalas volcanic eruption in the Eastern Mediterranean\/Middle East
(2025) Hartmann, Eva; Zhang, Mingyue; Wagner, Sebastian; Adakudlu, Muralidhar; Luterbacher, Jürg; Xoplaki, Elena
Natural and human-historical archives document regional climate variations and extremes of the past 2500 years across the Eastern Mediterranean/Middle East. Earth System Models (ESM) can contribute to the interpretation of the variations in the paleoclimate data and the dynamics of the underlying mechanisms. State-of-the-art ESMs have a good temporal resolution but are spatially too coarse to adequately address regional processes. Here, we provide for the first time a regional climate model (RCM) output adjusted to past climates forcings covering the Eastern Mediterranean/Middle East at a 0.44° horizontal and up to hourly temporal resolution. CMIP6 external climate forcings of volcanic, orbital, solar and greenhouse-gas changes are implemented in the RCM COSMO-CLM (CCLM, COSMO 5.0 clm16). The sensitivity of the model to each of the implemented forcing is tested separately and in combination in a case study around the large Samalas volcanic eruption (1255–1264 CE) with strong socio-economic impacts in the study area. We evaluate the impact of the different implemented forcings compared with the standard CCLM model version for the present time. The orbital forcing is found to have the largest effect with cooler winter/spring and warmer autumn during the test period. The volcanic forcing has a strong cooling effect for a couple of years after the large volcanic eruption. Other climate forcings only show a smaller impact in the sensitivity study, while the improvements in simulated precipitation are mainly due to the higher spatial resolution than to a specific forcing. The study is the basis for the new 2500-year-long transient, fully forced RCM simulation. It offers an assessment of the implementation of forcings in the RCM, along with an enhancement of the simulations' skill through the use of the RCM. We aim to enhance our understanding of the role of single and joint forcings on climate variability and extremes, their underlying processes at the regional scale, potential climate-society interactions and address limitations and uncertainties.