Lerman, Lilach O.

Abstract Introduction Acoustic analysis of speech has discriminated decompensated acute heart failure (HF). Speech rate (SR) and cepstral peak prominence (CPP) variation are among features previously evaluated. However, the association between SR and CPP and chronic stable HF with and without pulmonary hypertension (PH) as well as PH alone have not been previously studied. Methods Patients evaluated for HF and/or PH in the outpatient setting recorded a standardized text read out loud from which a sentence was extracted and analysed to extract pre-specified acoustic features including SR and CPP calculated for voiced speech (CPP-V) and in all speech (CPP-All). Patients were grouped depending on the presence or absence of disease (HF and/or PH) and symptoms. Linear regression models were fitted to determine the association between each acoustic feature and disease status. Results In total, 2153 patients were included: age 65.32 ± 17.18 years; male n = 1246 (57.9%); 879 had HF (40.8%), 542 had PH (25.2%) and 777 had no disease and no symptoms (36.1%). After adjustment for age and sex, SR was significantly lower in patients with PH only [estimated coefficient, 95% confidence interval (CI): −0.14, −0.21 to −0.06, P = 0.0006], HF only (−0.11, −0.17 to −0.05, P = 0.0002) and HF with PH (−0.17, −0.24 to −0.10, P < 0.0001) compared with no disease. CPP-V differed in patients with PH only (0.37, 0.16–0.57, P = 0.0004) and CPP-All differed significantly compared with patients without disease (0.23, 0.08–0.38, P = 0.0025). Conclusions SR is significantly slower in patients with HF alone, PH alone and HF and PH combined compared with patients without disease. CPP also differs significantly in patients with PH compared with controls. These findings suggest that acoustic analysis may be useful in discriminating chronic stable HF and PH, offering promise for the development of non-invasive screening methods for HF and PH.

Abstract Extracellular vesicles (EVs) are membrane-bound vesicles released by most cells and are found in diverse biological fluids. The release of EVs provides a new mechanism for intercellular communication, allowing cells to transfer their functional cargoes to target cells. Glomerular diseases account for a large proportion of end-stage renal disease (ESRD) worldwide. In recent years, an increasing number of research groups have focused their effort on identifying the functional role of EVs in renal diseases. However, the involvement of EVs in the pathophysiology of glomerular diseases has not been comprehensively described and discussed. In this review, we first briefly introduce the characteristics of EVs. Then, we describe the involvement of EVs in the mechanisms underlying glomerular diseases, including immunological and fibrotic processes. We also discuss what functions EVs derived from different kidney cells have in glomerular diseases and how EVs exert their effects through different signaling pathways. Furthermore, we summarize recent advances in the knowledge of EV involvement in the pathogenesis of various glomerular diseases. Finally, we propose future research directions for identifying better management strategies for glomerular diseases.