METHODS: The EMBASE, Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to January 2023 for terms related to all CHD, STE, and prognosis. Meta-analysis of association of right ventricle and left ventricle strain (RV Sl and LV Sl, respectively) with major adverse cardiovascular events (MACEs) was performed in atrial switch transposition of the great arteries (asTGA)/congenitally corrected TGA (ccTGA), tetralogy of Fallot (ToF), and congenital aortic stenosis (cAS)/bicuspid aortic valve (BAV). P-value combination analysis was additionally performed for all CHD groups.
RESULTS: A total of 33 studies (30 cohorts, n = 8,619 patients, children, and adults) were included. Meta-analysis showed the following parameters as being associated with MACE: RV Sl in asTGA/ccTGA (hazard ratio [HR] = 1.1/%; CI, [1.03; 1.18]), RV Sl and LV Sl in ToF (HR = 1.14/%; CI, [1.03; 1.26] and HR = 1.14/%; CI, [1.08; 1.2], respectively), and LV Sl in cAS/BAV (HR = 1.19/%; CI, [1.15; 1.23]). The RV Sl and strain rate were associated with outcomes also in single ventricle/hypoplastic left heart syndrome (at all palliation stages except before Norwood stage 1) and LV Sl in Ebstein's anomaly.
CONCLUSIONS: This systematic review and meta-analysis showed that biventricular strain and strain rate were associated with outcomes in a variety of CHD, highlighting the need for updated recommendations on the use of STE in the current guidelines, specific to disease types.
MATERIALS AND METHODS: An in vitro model using synthetic bone blocks mimicking trabecular and cortical bone was used to simulate implant placement. The study involved 40 implants, divided into four groups based on bone type and density: Group A (low-density trabecular bone), Group B (high-density trabecular bone), Group C (low-density cortical bone), and Group D (high-density cortical bone). Primary stability was assessed using insertion torque values and resonance frequency analysis (RFA). Insertion torque was measured using a digital torque meter, and RFA was measured using an Osstell ISQ device.
RESULTS: Group D (high-density cortical bone) exhibited the highest insertion torque values (mean: 45 Ncm) and Implant Stability Quotient (ISQ) values (mean: 75), indicating superior primary stability. Group C (low-density cortical bone) showed moderate stability, with mean insertion torque values of 30 Ncm and ISQ values of 60. Group B (high-density trabecular bone) had lower stability, with mean insertion torque values of 25 Ncm and ISQ values of 55. Group A (low-density trabecular bone) demonstrated the least stability, with mean insertion torque values of 15 Ncm and ISQ values of 45.
CONCLUSION: The study concludes that cortical bone, especially high-density cortical bone, significantly contributes to primary implant stability compared to trabecular bone. The findings suggest that bone quality should be a major consideration during implant placement to ensure optimal primary stability and long-term success.