Prediction of cardiac events using fully automated GLS and BNP titers in patients with known or suspected heart failure.
- 作者列表："Otani K","Higa Y","Kitano T","Nabeshima Y","Takeuchi M
BACKGROUND:Although global longitudinal strain (GLS) measurements provide useful predictive information, measurement variability is still a major concern. We sought to determine whether fully automated GLS measurements could predict future cardiac events in patients with known or suspected heart failure (HF). METHODS:GLS was measured using fully automated 2D speckle tracking analysis software (AutoStrain, TomTec) in 3,150 subjects who had undergone clinically indicated brain natriuretic peptide (BNP) assays and echocardiographic examinations. Among 1,514 patients in the derivation cohort, optimal cut-off values of BNP and GLS for cardiac death (CD) and major adverse cardiovascular events (MACEs) were determined using survival classification and regression tree (CART) analysis. The remaining 1,636 patients, comprising the validation cohort, were stratified into subgroups according to predefined cut-off values, and survival curves were compared. RESULTS:Survival CART analysis selected GLS with cut-off values of 6.2% and 14.0% for predicting CD. GLS of 6.9% and 13.9% and BNP of 83.2 pg/mL and 206.3 pg/mL were selected for predicting MACEs. For simplicity, we defined GLS of 7% and 14% and BNP of 100 pg/mL and 200 pg/mL as cut-off values. These cut-off values stratify high-risk patients in the validation cohort with known or suspected HF for both CD and MACEs. CONCLUSIONS:In addition to BNP, fully automated GLS measurements provide prognostic information for patients with known or suspected HF, and this approach facilitates clinical work flow.
背景: 尽管全球纵向应变 (GLS) 测量提供了有用的预测信息，但测量变异性仍然是一个主要问题。我们试图确定全自动GLS测量是否可以预测已知或疑似心力衰竭 (HF) 患者的未来心脏事件。 方法: 使用全自动二维斑点追踪分析软件 (autostrainse，TomTec) 对3,150名接受过临床指征脑钠肽 (BNP) 测定和超声心动图检查的受试者进行GLS测量。在推导队列的1,514例患者中，使用生存分类和回归树 (CART) 分析确定了BNP和GLS对于心脏死亡 (CD) 和主要不良心血管事件 (MACEs) 的最佳截止值。其余1,636例患者，包括验证队列，根据预定义的截止值分为亚组，并比较生存曲线。 结果: 生存CART分析选择具有6.2% 和14.0% 的截止值的GLS用于预测CD。选择6.9% 和13.9% 的GLS和83.2 pg/mL和206.3 pg/mL的BNP用于预测MACEs。为简单起见，我们将7% 和14% 的GLS和100 μ g/mL和200 μ g/mL的BNP定义为截止值。这些截止值对验证队列中CD和MACEs的已知或疑似HF的高风险患者进行分层。 结论: 除了BNP之外，全自动GLS测量为已知或疑似HF患者提供预后信息，并且这种方法促进了临床工作流程。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.